DEAR MAYO CLINIC: What are the latest medications or exercise recommendations for women who want to avoid osteoporosis? I am 55 and went through menopause a few years ago.
ANSWER: Although some bone loss is inevitable after menopause, developing a regular exercise routine can be useful in limiting that loss. Medications can be used to limit bone loss, too, but they are not necessarily for everyone.
Your body regularly makes new bone and breaks down old bone. The hormone estrogen plays a key role in that process. When you’re young, your body makes new bone faster than it breaks down old bone, and bone mass increases. Most people reach peak bone mass in their mid-20s to mid-30s. The higher your peak bone mass, the more bone your body has to sustain bone health throughout the rest of your life.
Osteoporosis occurs when the body’s creation of new bone no longer can keep up with the breakdown of old bone. Bones then become weak, brittle, and more easily broken. Menopause substantially raises the risk of osteoporosis because bone loss is rapid within the first six to eight years after menopause due to a rapid decline in estrogen.
No natural approach can stop postmenopausal bone loss, but regular exercise may help slow it. A combination of strength training and weight-bearing exercises usually is best. Strength training helps strengthen muscles and bones in your arms and upper spine. Weight-bearing exercises, such as walking, jogging, running, dancing, stair climbing, skipping rope, or skiing, have benefits for the entire skeleton, particularly the bones in your legs, hips, and lower spine.
The overall strength of bones relies on their size and density. Bone density depends in part on the amount of calcium, phosphorus, and other minerals bones contain. When bones contain fewer minerals than normal, they become weak and eventually begin to break down and lose their internal support structure. Medications for osteoporosis are geared toward slowing bone breakdown.
The most common medications prescribed for osteoporosis are bisphosphonates. They work by decreasing the rate that bones break down, allowing the body to maintain bone density and structure. These medications generally are not prescribed before osteoporosis develops. But they may be appropriate in some cases when the risk for breaking a bone is high.
Getting enough calcium and vitamin D in your diet is also important to help keep your bones healthy. People between 18 and 50 need 1,000 milligrams of calcium per day. That increases to 1,200 milligrams when women turn 50 and men turn 70.
Good sources of calcium include low-fat dairy products, dark green leafy vegetables, canned sardines with bones, canned salmon, and soy products. Many cereals and juices are calcium-fortified. If you can’t get enough calcium in your diet, your healthcare provider may recommend a supplement.
Vitamin D is necessary for your body to absorb calcium. While some people get all the vitamin D they need from sunlight, others do not, due to factors such as time spent indoors or the use of sunscreen. Your healthcare provider can do a blood test to check your vitamin D level. If it’s low, you may need a vitamin D supplement.
A bone density test is one way to assess the health of your bones. It measures how many grams of calcium and other minerals are in a segment of bone. The higher the bone mineral content, the denser the bone. In general, the denser the bones are, the stronger they are and the less likely to break.
In women who have never broken a bone and who don’t have other osteoporosis risk factors, a bone density test to screen for osteoporosis is recommended at age 65. But the specific age when you’ll need a bone density test depends on your osteoporosis risk. Talk to your healthcare provider to find out what’s best for you. — Matthew Drake, MD, PhD, Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, Minnesota