Top Tips for Bone health in Menopause

As we get older, it can feel like a rite of passage that we become a bit stiffer and our joints less flexible. Maybe there’s more stiffness getting out of bed in the morning, or a few more general aches and pains. However, aside from talk of general “wear & tear” there’s not much thought as to why this happens, or discussion around what we can do to support our bone health.

The connection between bone health & menopause

Did you know that throughout our lifetime, our bones are continuously going through a process of turnover and remodelling? Osteoblasts are cells responsible for new bone formation, working together with osteoclasts to break down and resorb “old” bone. The equilibrium between these two types of cells maintains bone tissue and bone density. If this is working well, it ensures we have strong bones…however, bone density naturally reduces from our late 30s bringing with it an increased risk of breaks as our bones become more fragile.

The menopause can also speed up bone loss by up 20% and continued loss of bone density can lead to osteoporosis affecting an estimated 1 in 10 women over 60 worldwide {1}. Why is this? Oestrogen promotes osteoblast activity, so when levels fluctuate across perimenopause and then eventually drop in menopause, this directly reduces new bone turnover and thus bone strength.

Taking steps to support our bone health is key. Establishing and maintaining good habits as early as possible can pay dividends in preparation for, and during, the menopause years. This is where nutrition and lifestyle measures can be particularly effective. Here are my top tips on things you can incorporate this into your daily routine.

1) Follow an Anti-inflammatory diet

There is increasing research to indicate that a good quality diet can have a direct effect on supporting bone health. A large-scale study of menopausal women found that those following a less inflammatory diet lost less bone mineral density than those eating more “inflammatory” foods [2].

What I mean by an “anti-inflammatory diet" is one which focuses on boosting nutrients known to reduce inflammation including:

• Omega 3-rich foods e.g. oily fish, olive oil, flaxseeds, walnuts

• A rainbow of vegetables and fruit- e.g. green leafy vegetables (e.g. spinach, kale), and berries.

• Wholegrains e.g. oats, brown rice, quinoa

• Beans & legumes

• Herbs & spices e.g. garlic, turmeric

At the same time limiting foods which may increase inflammation, such as:

• Sugar - not just sweet treats, but check the labels on everyday items such as cereals to check for sugar content.

• Processed foods including meats-often high in preservatives, salt and omega-6 fatty acids which can worsen inflammation.

• Refined carbohydrates- try swapping white rice, pasta etc for wholegrain options

• Alcohol- excess can trigger inflammation and impair vitamin D and calcium absorption (key for bone strength).Also worth pointing out that Smoking is linked to loss of bone mineral density. [3]

2) Embrace the weights!

Physical activity increases bone turnover and bone strength, so it becomes even

more important as we get older. The NHS recommends at least 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity per week [4]. Whilst any aerobic movement- from walking to dancing and bootcamps- is of benefit to our overall health, our bones particularly love strength & weight-bearing exercises.

• Weight-bearing- e.g. brisk walking with a rucksack, lunges, jumping, jogging, yoga.

• Strength training- e.g. resistance bands, free weights, kettlebells, dumbbells (or any weights close to hand such as baked bean cans!)

Whether choosing low or high impact options, the fact that our bones are living tissues means the more they are used, the stronger they get.

For anyone who may have osteoporosis, it’s essential to first talk to your doctor before starting an exercise routine.

3) Boost bone health “Heroes”

Within our diet there are specific vitamins & minerals which play a key role in bone health, so it’s important we are getting sufficient.

• Calcium- the major component of bone, providing our skeleton’s strength and structure. Also important for muscle contraction, so one to consider if you're suffering from restless legs or cramps. Food first is always my motto versus supplements where possible. Rich sources of calcium include: dairy, fortified plant based milks, broccoli, almonds, small fish with bones (e.g. tinned sardines), tofu, tahini, greens (e.g. kale, spring greens, watercress), edamame.

Vitamin D- key for absorbing the calcium we eat. The sun is our best source of calcium, so during summer months 15-20 minutes a day in the sun helps achieve this. During winter months in the UK (October to April) the Department of Health recommends supplementing 10 micrograms/ 400 IU. I often find clients can be low in vitamin D and would benefit from a higher supplement level so often recommend having a private test done to identify what level supplement would be beneficial.

• Vitamin K- specifically K1 and K2- may be lesser discussed, but equally important for bone health by aiding calcium absorption and bone mineralisation. We can gain sufficient from our diet by including leafy greens and foods such as kale, spinach, Brussel sprouts. The only watch out here being for anyone on blood thinners, where caution is required.

Additionally we shouldn’t forget the importance of magnesium and iron, whilst adequate protein is also key for maintaining bone mass and strength.

We wear our skeleton 24/7 so it’s important that we give it the support it deserves. Just a few small changes now can really make significant changes to optimising long term bone health.

If you're interested in boosting your bone health or discussing any of the above, then book a free 15-minute nutrition consultation with me to see if my services can help you.

References:

[1] Endocrine Society."Menopause and Bone Loss | Endocrine Society." Endocrine.org, Endocrine Society, 18 March 2023, https://www.endocrine.org/patient-engagement/endocrine-library/menopause-and-bone-loss

[2] Orchard, T. Yildiz, V. Steck, S. et al. (2017). 'Dietary Inflammatory Index, Bone Mineral Density, and Risk of Fracture in Postmenopausal Women: Results From the Women's Health Initiative', JBMR, 32(5), 1136-1146.

[3] Trevisan C, Alessi A, Girotti G, et al. (2020) 'The Impact of Smoking on Bone Metabolism, Bone Mineral Density and Vertebral Fractures in Postmenopausal Women,' J Clin Densitom. 23(3):381-389.

[4] https://www.nhs.uk/live-well/exercise/exercise-guidelines/physical-activity-guidelines-for-adults-aged-19-to-64/