Calling women of all ages, and especially if you are over the age of 20 years old and have not prepared to protect your bones from menopausal bone loss, I wrote this blog for you.
Bone loss notably affects more women than men and as you age, your risk of fracture from bone loss increases. We form new bone and remove old bone all our life, a process called bone remodeling. By your late twenties you have reached your peak bone mass (PBM), the time in life when you have your greatest bone density. The importance of building a high PBM is similar to a bank account, but you can only deposit money until you are about 25 years old. After that, your ability to deposit money (or bone, in this metaphor) stops. You can only withdraw money from that account and that money must last you the rest of your life. Thus, the more bone you have deposited by the age of 25, the more bone you have available to withdraw, and the stronger your bones will be as you age.
Fortunately, there are many ways to build strong bones, and starting sooner rather than later is critically important. Exercise, such as weight-bearing activities, and a diet rich in calcium, vitamin D, and protein are necessary to ensure optimal growth and development and strong bones for your future. In this blog, we focus on the role of calcium and how it can help prevent bone loss and fracture and maintain good bone before, during, and after menopause.
Bone Stressors
Before we delve into how menopause affects your bone, it’s important to understand the four major stressors that influence your bones. They are:
- Mechanical stress – lack of exercise, particularly weight-bearing exercises, and being immobile.
- Hormonal stress – loss of estrogen and testosterone or an imbalance of other hormones.
- Nutritional stress – not consuming or absorbing enough calcium, vitamin D, and protein.
- Aging – more bone is removed than formed, leading to a decline in bone strength.
When bones cannot adapt to these stresses, they can become fragile and at increased risk of fracture.
What is Menopause?
Around your mid-40s, you may begin to experience irregular periods, and eventually menopause, where you will not menstruate for 12 consecutive months. In North America, the average age is 51 years old. Common symptoms of menopause include hot flashes, night sweats, frequent urination, irritability, vaginal dryness, breast tenderness, depression, and changes in sexual desire, that eventually result in no menstruation within 9-12 months. Since menopause is not the only reason why your menstrual cycle may stop (i.e., extreme athletics, pregnancy, radiation, or surgical removal of ovaries), talk with your healthcare provider if you experience changes in your cycle.
During menopause, your ovaries stop producing estrogen and progesterone. Estrogen is the main sex hormone in women and helps block the bone-dissolving action of the parathyroid hormone. Progesterone helps balance the effects of estrogen. With your body no longer producing these hormones, it is less able to maintain the balance between bone formation and removal. The loss of estrogen can result in a 1.5-3% decrease in bone density each year. This can continue for five to six years around menopause, thus increasing your risk of osteoporosis, a bone disease characterized by thin, weak, fragile, bones that increase your risk of fracture from a fall from a standing height, lifting a package or even movements that stress your spine.
Calcium
You can take steps to slow bone loss through adequate calcium intake. There are many foods that are rich in calcium, and supplements are available. Receiving calcium from the food you eat is best. For example, an 8oz/250ml glass of milk contains about 320mg of calcium. It is also fortified in vitamin D. For a non-dairy alternative, an 8oz/250ml glass of fortified almond, rice and soymilk beverage also contains about 320mg of calcium. Therefore, drinking two glasses of milk, or fortified beverage, a day is a good start toward meeting your daily calcium requirements.
It’s important that you follow the recommended daily intake of calcium for your age. People who have diets high in calcium, particularly dairy products, may encounter problems that include lactose intolerance, constipation and too many calories from high fat intake. If you avoid dairy, be sure to incorporate the appropriate amount of other calcium-rich foods such as canned sardines, beans, collard greens or kale and veggies like cooked broccoli, Chinese cabbage, and edamame.
If you have a condition(s) that may prevent your body from absorbing calcium, place certain restrictions with your diet or just do not like milk or dairy, talk with your physician or a registered dietitian.
Below are recommendations for calcium intake by age.[i],[ii] The total per day includes both dietary and supplemental calcium.
| Age | Recommended calcium intake (milligrams a day) |
| Infants 0-6 months | 200* |
| Infants 7-12 months | 260* |
| 1-3 years | 700 |
| 4-8 years | 1,000 |
| 9-18 years | 1,300 |
| 19-50 years | 1,000 |
| Males 51-70 years | 1,000 |
| Females 51-70 years | 1,200 |
| 71+ years | 1,200 |
A calcium supplement may be necessary. There are many types of calcium supplements and the body will only absorb about 500mg of a calcium supplement at any one time. If you are at risk of kidney stones, be sure to talk with your doctor and pharmacists to find the best way to supplement your dietary calcium. So, make sure you keep track of how much calcium you’re consuming!
Menopause and bone loss are normal processes within your body. As you age, your bones are continuously being formed and removed.
With education and proper understanding of how your body works, knowing when and how to build and maintain strong bone is crucial to preventing avoidable fractures, and most importantly, help you reach your optimal quality of life in your older years.
Additional Resources
Calcium is not enough by itself to restore bone health. There are several lifestyle and dietary approaches, exercise, and medications you can take to slow bone loss, and build bone, while reducing your risk of a future fracture. There is so much to understanding bone health, such as bone growth and development, nutrition, exercise needs, how to identify and manage risk factors for prevention, which supplements to take and what foods to eat. The list goes on.
To provide accurate and easy to follow information about osteoporosis, fracture prevention, disease management and medications, I co-wrote Bone Health Basics: Tips for Preventing and Managing Osteoporosis with leading Canadian rheumatologist Dr. John Wade. If you are a healthcare professional and would like more detail, we also have The Osteoporosis Book: Bone Health, 4th Edition, which I wrote with pharmacist Dr. Alan Low and John. You can find these books here.
[i] Health Canada (2010). Vitamin D and calcium: Updated dietary reference intakes. Available online: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/vitamins-minerals/vitamin-calcium-updated-dietary-reference-intakes-nutrition.html. [ii] Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press, 2010.