Bone Health is one important aspect of aging well and maintaining health. 

What is osteoporosis?

Osteoporosis is defined as an impairment in bone strength due to abnormal quantity and/or quality of bone. This deterioration of bone tissue increases the risk of fracture. The most common fractures associated with osteoporosis are the hip, spine, wrist, and shoulder. At least 1 in 3 women will suffer from an osteoporotic fracture during their lifetime. Nutrition and exercise both play important roles in keeping bones healthy.

What are the risk factors for osteoporosis?

The following factors put women at some risk of osteoporosis:

• Older age (>65 years)

• Fragility fracture after age 40

• Prolonged use of glucocorticoids

• Use of other high-risk medications (e.g., anti-epileptic drugs, high dose thyroid medication)

• Parental hip fracture

• Vertebral fracture or osteopenia

• Current smoking

• Alcohol (consistently more than three drinks a day)

• Low body weight (<60 kg)

• Major weight loss (>10% of body weight at age 25)

• Rheumatoid arthritis

• History of irregular periods, no periods or an eating disorder

• Malabsorption syndrome

• Primary hyperparathyroidism

• Infrequent exercise

• Life-long low calcium intake

• Low vitamin D intake

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Is hormone therapy an option if I have a medical history that suggests that osteoporosis could be in my future?

Even short-term hormone therapy (HT) can improve a women’s bone structure, and then other medications can be used to sustain bone health over the longer-term. The Women’s Health Initiative in the United States, a randomized clinical trial involving menopausal women, found that HT was clearly effective in the prevention of hip fractures, vertebral breaks and other injuries. The response is dose-related and persists after stopping estrogen-alone therapy. The SOGC Consensus Report, however, does not recommend HT as a first line therapy for osteoporosis, but HT may be recommended for certain individuals with the disease.

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What are some of the early signs of osteoporosis?

Usually osteoporosis does not cause any symptoms until a break occurs. One sign may be loss of height. By the time a bone fracture occurs, even after a small fall, osteoporosis may have already done its damage. Understanding the risk factors previously mentioned, is the best way to determine if you are at risk for osteoporosis.

Osteoporosis Canada recommends that all postmenopausal women, men over 50, and all individuals over the age of 65, be assessed to see if they are at risk for osteoporosis. Assessment involves measuring your height annually and assessing bone mineral density (BMD) which is safe and painless, much like an X-ray. A BMD test can tell you whether or not you have osteoporosis and how likely you are to develop it in the future, and can help you to make decisions now that may prevent fractures or further bone loss. You may also have a blood test to measure your calcium levels and other markers of bone health.

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Heart Health 

Menopause is a time when a woman stops having menstrual cycles. Your risk of heart disease and stroke increases after menopause. Before and after menopause, you may experience:

• An increase in total blood cholesterol, low density lipoprotein cholesterol (LDL or ‘bad’ cholesterol) and triglyceride levels

• A decrease in high density lipoprotein cholesterol (HDL or ‘good’ cholesterol)

• A tendency toward higher blood pressure

• An increase in central body fat, which can be harmful to your body because you may be more prone to  blood clots and blood sugar problems.

• Symptoms such as severe sweating or sleep disturbances

Hormone Replacement Therapy:

Women who are taking estrogen as part of Hormone Replacement Therapy (HRT) have an increased risk of stroke and heart attack. If you are on HRT, discuss with a healthcare professional what this means for you and what your options are.

Cholesterol

You may have heard or read that natural estrogen helps to keep cholesterol levels in a healthy range. After menopause, as natural estrogen levels drop, more and more women tend to develop high cholesterol. Talk with your doctor about how often you should have your cholesterol checked. Read How to Manage Your Cholesterol.

Triglycerides

Triglycerides are the most common type of fat in the body. A high triglyceride level often goes with higher levels of total cholesterol and LDL, lower levels of HDL and an increased risk of diabetes. Research suggests that having high triglycerides may increase the risk of heart disease and stroke for women. Talk to your doctor about your risk.

Making Heart-Healthy Changes in your life

A woman’s overall risk of heart disease or stroke is determined by all of her risk factors. You can control some of these risk factors, but not all of them. 

Risk factors that you can control include smoking, high blood pressure, high blood cholesterol, diabetes, physical inactivity and obesity. 

Risk factors that you cannot control include age, gender, family history and ethnicity. 

Women can prevent and reduce their risk of heart disease by:

• Becoming and remaining smoke free.

• Achieving and maintaining a healthy body weight.

• Being physically active for at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more.

• Maintaining a healthy blood pressure through lifestyle changes (such as increased physical activity) and when needed through medication.

• Eating a healthy diet that is lower in fat, higher in fibre and includes foods from each of the four food groups.

• Using medications to reduce the risk of heart disease and stroke as prescribed by your healthcare provider, for example medications for high blood pressure, high blood cholesterol and diabetes.