Dem’ Bones
Women aged over 45 years spend more days in hospital due to osteoporosis than diabetes, heart attack or breast cancer
International Longevity Centre
Your bones need love
There’s no nice way of saying this, if you’re a woman over 45 you’re losing bone density and muscle. You should be scared and you need to do something about it right now.
Older women are pretty likely to have either low bone mass (51% of American women over 50) or brittle bone disease, osteoporosis (15%). You should be concerned about it because it can lead to fractures. If you fracture your hip when you’re 65+ (not actually that long off, 15 years for me, shit) you have a 50% chance of never living independently again, 40% cannot walk on their own again and 30% die within the first 12 months. Fuckadoodledoo.
But hip fractures aren’t the only things to worry about - you can have vertebral fractures, kyphosis (dowager’s hump), chronic pain, incontinence/mobility issues, lung problems and depression all stemming from bone fractures. And don’t think it’s not that common - a hip fracture is more likely than getting breast cancer and just as common as suffering a stroke or heart attack.
Your bones are not fixed things, they are living tissue. They get built and rebuilt all the time. Osteoblasts create bone tissue and osteoclasts break them down. As you age the breaking down starts to outweigh the building.
When you were 30 you had the strongest bones you're ever going to have.
Menopause = plummeting bone density
Since then you've been losing bone, but slowly, at a rate of <0.4% a year. But then, one year before your final period and about two years after your bone density accelerates and drops off a cliff - on average 6% over those three years. Some women lose even more, 3 to 5% a YEAR. It then levels off a bit but it's still higher than before menopause (0.5-1% a year).
What can we do to avoid this clusterfuck?
If you see bone as living tissue you can see maintaining healthy bones isn't just about calcium but improving your general health to help out your old bones.
Smoking affects your bones.
Drinking more than 3 units of alcohol a day increases your risk. A 175ml glass of wine is 2 units.
Insulin resistance (pervasive in menopausal women) affects your bones. Assess your diet - how much sugar and simple carbs are you eating? Are you doing any anaerobic cardio? (Not slow ploddy stuff, intense bouts of max heart rate intervals.)
HRT helps. Oestrogen slows bone resorption, supports collagen and tensile bone strength and significantly reduces the risk of fracture. Progesterone has unique bone-building properties.
Calcium. Proper food gives you calcium from seeds, bony fish, green veg and dairy. (But dairy consumption has never been shown to prevent hip fracture in menopausal women.)
Prioritise quality rest/sleep because "adequate sleep timed appropriately during the circadian night" has been found to improve bone health. Go to bed at 10-10.30. Tart cherry juice just before bed can help raise your melatonin naturally. This helps with deeper sleep as well as improves bone turnover in perimenopausal women (promotes osteoblasts, the cells that build bone).
Get your vitamin D (with sun exposure, eating egg yolks, salmon, fatty fish or supplementing in the winter months*) and pair it with vitamin K2 (cheddar, gouda, fermented foods like kimchi) to help absorb calcium into the bones.
Resistance training, resistance training, resistance training!!
Start lifting weights! Lifting weights makes the muscles pull on the bones. The body senses this and two things happen. One, it starts to synthesise protein to build more muscle fibres and two, it lays down more bone mineral which means denser bones. The resistance needs to be hard to set this reaction off. A cardio class with a set of pink dumbbells is doing nothing for a menopausal woman except tiring her out! Even women who already have osteoporosis can do managed resistance training.
Having muscle also means you’re much less likely to fall over. My mother is typical. She walks a lot and thinks she’s fairly fit but that’s it. She has zero muscle (she has to push herself out of a chair) and falls over often. And when she does fall over she cannot get up off the floor for several minutes - hanging on to furniture to haul herself up.
Plyometrics (jumping) or multi-directional sports (like tennis) are really good for balance and bone strength in a different way - they work on the tensile strength (twisting force on bone). Running does not class as resistance training nor plyometrics.
References
* Before necking any supplements get the advice of a registered dietician as they make affect any medication or individual circumstances. Inside Out Health staff are ALL registered dieticians and can help you.
Menopause for Athletes, Dr Stacy Sims
The Menopause Manifesto, Dr Jen Gunter
Hormone Repair Manual, Lara Briden ND
Royal College of Nursing https://www.rcn.org.uk/clinical-topics/womens-health/osteoporosis
Oestrogen regulates the secretion of cytokines involved in bone homeostasis, elevates calcium absorption and decreases renal excretion. Without IGF-1 (insulin growth factor) and oestrogen we lose a lot of stimulus for bone density and bone turnover.
Swanson CM, Kohrt WM, Buxton OM, Everson CA, Wright KP Jr, Orwoll ES, Shea SA. The importance of the circadian system & sleep for bone health. Metabolism. 2018 Jul;84:28-43. doi: 10.1016/j.metabol.2017.12.002. Epub 2017 Dec 9. PMID: 29229227; PMCID: PMC5994176.
https://asbmr.onlinelibrary.wiley.com/doi/full/10.1002/jbmr.3284
The LIFTMOR study followed women (average age 65) over 8 weeks given a resistance training programme compared with another group who were doing low intensity. They gained bone mass and not one of them suffered fractures or serious complications. They were closely monitored.
Running happens in one plane of motion and is not a strong enough stimulus to replace the loss of oestrogen for bone mineral density. You need jumping and multi-directional work.