An ounce of prevention is worth a pound of cure. It’s a cliché for a reason, but unfortunately, in the realm of women’s healthcare, it still hasn’t quite sunk in. Dr. Mary Claire Haver, author of The New Menopause, emphasized the importance of osteoporosis prevention on Instagram following her 87-year-old mother’s total hip replacement in the wake of a dementia-induced fall.
“I 100% guarantee you, she never once thought of ‘How can I prevent osteoporosis or how can I not fracture?’” said Haver. “I am absolutely shocked by the lack of information around prevention for diseases specific to women.”
“Many people think that if they aren’t experiencing pain or fractures, their bones are fine. In reality, osteoporosis often progresses without any signs, so by the time a fracture happens, bone loss can be quite advanced.”
Dr. Navya Mysore, Medical Director of Women’s Health at Nurx
Prevention is all the more important when it comes to osteoporosis specifically, according to Dr. Navya Mysore, Medical Director of Women’s Health at Nurx, a leading women’s healthcare company. By the time people realize they have the disease, it’s often too late.
“One of the biggest misconceptions about osteoporosis is that you can rely on symptoms to tell you if your bones are weak,” she says. “Many people think that if they aren’t experiencing pain or fractures, their bones are fine. In reality, osteoporosis often progresses without any signs, so by the time a fracture happens, bone loss can be quite advanced.”
Can Osteoporosis Be Reversed?
Catching it early is all the more essential seeing as, while the disease can be managed and even slowed, there is no cure. “Osteoporosis is not fully reversible,” says Mysore, “meaning you can’t completely restore the bone density to what it was before.”
Dr. Holly Ingraham, PhD, a professor of cellular molecular pharmacology at UCSF, agrees. While she recently led a promising research project on mice that seemed to indicate the potential for capitalizing on the bone building ability of a maternal hormone present in breastfeeding women, “new therapies are needed to improve bone formation after you’ve had bone loss,1” she said.
In her Instagram post, Haver called above all for her mother’s journey to serve as an example. “It’s not too late for us,” she wrote in her caption. “This lack of education is costing us far too much, and it’s my fight to change that.”
In the spirit of Dr. Haver’s call for awareness, here are a few things to know about preventing osteoporosis.
What Is Osteoporosis?
Over the course of our lives, bone breaks down and rebuilds itself constantly. Osteoporosis is a condition in which bone matter is not replaced at the same rate at which it is broken down.
This causes the bones to become weak and brittle, to the point where something as mild as a cough can lead to breakage, often in the hips, wrists, or spine2. According to Ingraham, studies have shown that sufferers usually break bones in their hands and feet first, followed by long bones, followed by the hips.
The Osteoporosis Downward Spiral
“When you break your hip, that’s when you’re really going to be in trouble,” says Ingraham.
“Once you start breaking bones, your morbidity goes up, and your quality of life goes down.”
Dr. Holly Ingraham, PhD, professor of cellular molecular pharmacology at UCSF
Osteoporosis can also affect quality of life in other ways, according to Mysore. “For example, vertebral fractures (in the spine) are common in osteoporosis and can lead to height loss, spine deformities, and chronic pain,” she says. “These fractures may not always be obvious, but they can impact posture and mobility.”
Breaks and fractures also impact the risk of early death, according to Ingraham. “Once you start breaking bones, your morbidity goes up, and your quality of life goes down,” she says. An increased risk of breakage may challenge one’s ability or willingness to engage in activities like hiking or biking. This, she says, leads to “a decline in quality of life that then becomes a little bit like a downward spiral.”
“If you’re afraid to go out and do things because you’re afraid to break your bones,” she says, “then you’re not using your bones, and your skeletal system.” And this lack of use may increase the risk of breaks, turning it into a bit of a vicious cycle.
What Are the Risk Factors for Osteoporosis?
More than 200 million people around the world have osteoporosis3. While the disease can affect anyone, the risk of developing osteoporosis increases with age, something Ingraham notes means more people are living with the disease than ever before.
“Bone loss is something that we are confronting as our population ages, because we’re living longer,” she says. Those who have a family history of osteoporosis are more likely to develop it themselves, according to Mysore, and unfortunately, there’s nothing one can do about genetics. But there are some lifestyle choices that can reduce the likelihood.
“Small, thin individuals, those with poor diets (low in calcium and vitamin D), those who lack exercise and those who smoke or drink excessively are at increased risk,” explains Mysore, who also cites certain medications, like corticosteroids, anticonvulsants, or certain cancer treatments, as potential risk factors.
Indeed, a 2022 research review in the International Journal of Molecular Sciences noted that glucocorticoids, which the researchers categorized as “the most widely used anti-inflammatory drug around the world,” contribute “substantial” risk of osteoporosis, especially within the first six months of use4. But perhaps the biggest risk factor? Being a woman.
The Link Between Hormones and Osteoporosis
Osteoporosis affects far more women than men, especially in the leadup to menopause. According to the Endocrine Society, approximately one in ten women over the age of 60 are affected by osteoporosis worldwide, and one in two postmenopausal women will suffer from osteoporosis.
This is due to the role of estrogen in bone formation and density. The link between osteoporosis and estrogen, Ingraham explains, stems from the fact that estrogen is an anabolic hormone for bone5. “In other words,” she says, “it’s basically going to help bone formation occur. Losing that is going to lead to bone loss.”
“Menopausal and perimenopausal women need to be especially aware of osteoporosis and bone density.”
Dr. Navya Mysore, Medical Director of Women’s Health at Nurx
The same International Journal of Molecular Sciences research review illustrated this link, noting that the risk of osteoporosis for women began at 3.3% in the latter half of the 40s, with risks doubling approximately every five years and reaching 50% in women 85 and older4.
“Estrogen plays a crucial role in maintaining bone density,” explains Mysore, “so as its levels drop, bone loss accelerates, leading to weaker bones that are more susceptible to fractures. Hormonal changes also affect the bone remodeling process, where old bone is broken down faster than new bone can be formed, further weakening bones.” As a result, she says, “menopausal and perimenopausal women need to be especially aware of osteoporosis and bone density.”
This, Ingraham notes, is particularly true for breast cancer survivors or those who, due to BRCA1 or BRCA2 mutations, choose to have their ovaries removed. For these women, she says, “everything is going to be accelerated.”
“There’s a substantial number of women who have breast cancer, who have had to go on anti-estrogens, especially those women who were not pre-menopausal, but right around the time where they could be considered peri-menopausal,” she says. “They’re put on anti-hormone therapy for five to ten years. And so that has a dramatic effect on your bones.”
How Can I Decrease My Risk of Developing Osteoporosis?
Some risk factors, like gender and genetics, are insurmountable. “There’s many women who, no matter what they do, they are gonna have bone loss,” says Ingraham. “Some women preserve their bone quite well, like my mother did, and then there are others that really lose it quickly.”
That said, there are some lifestyle choices that can mitigate the risks.
Choose the Right Kind of Activity
Exercise can have beneficial effects on the musculoskeletal system, and specific exercises for osteoporosis may help reduce the risk of osteoporosis-induced breaks later in life. The experts at Harvard Medical School recommend focusing on a combination of weight-bearing exercises like walking and climbing stairs, muscle-strengthening exercises like free weights or lifting, balance exercises like tai chi and yoga, and flexibility exercises like stretching5.
Mysore agrees. “Weight-bearing exercises, such as walking or jogging, stimulate bone formation by putting pressure on the bones,” she says. “Strength training, or resistance exercises like lifting weights, also helps build bone mass and increase muscle strength. Balance and flexibility exercises, such as yoga or tai chi, improve coordination and reduce the likelihood of falls, which are a common cause of fractures in people with osteoporosis.”
Dave Asprey, Author of Heavily Meditated, Health Science and Biotech Entrepreneur, echoes these recommendations. “Resistance training promotes bone density as well as regular movement like walking,” he says.
He also recommends targeted programs, such as OsteoStrong, which relies on “osteogenic loading” to improve bone strength. “The machine applies brief, intense force to different parts of your body,” he explains. “Under the guidance of a trainer, you push or pull as hard as you can for a few seconds on each machine, aiming to reach a force of 4.2 times your body weight to stimulate bone growth and increase strength.”
Whole body vibration like Power Plate may also help increase bone strength, he says. “It involves standing on a plate that vibrates 30 times per second,” he says. “Studies confirm that whole body vibration improves bone density in postmenopausal women.”
Eat a Diet That’s Good for Your Bones
Anyone who grew up in the “Got Milk” campaign era knows that calcium is essential for good bone health. But preventing osteoporosis is way more complicated than drinking a glass of milk and calling it a day.
“One of the biggest misconceptions is that it’s all about calcium deficiency,” says Asprey. “The truth is it’s a lot more complex than that — you need the right minerals and fat-soluble vitamins in the right forms and amounts.”
Calcium is still a good place to start — according to Mysore, it’s “essential” for bone strength. To ensure you’re getting enough, she recommends consuming not just dairy, but also leafy greens and tofu.
Pairing calcium with vitamins like vitamin D and vitamin K help aid the mineral’s absorption, explains Asprey. “Vitamin D3 helps you absorb calcium and vitamin K2 directs the calcium where it needs to go — in your bones and teeth instead of in your tissues or arteries,” he explains. You can find vitamin D in fatty fish, egg yolks, or through sunlight exposure, and vitamin K is present in leafy greens like kale, spinach, and broccoli. Magnesium is another mineral that aids in calcium absorption that’s present in nuts, seeds, whole grains, and leafy greens.
That said, diet may not be enough — especially for those consuming a mainly plant-based diet.
“Nutrients from plant foods are much less bioavailable than those from animal foods,” explains Asprey. “Also, our soil isn’t the same as it used to be. It contains a lot less minerals than it used to.” Soil depletion has led to lowered mineral content in many plants6, leading some experts to recommend supplementation to ensure you’re getting the essential vitamins and minerals you need7.
In addition to adding healthful foods to your diet, Mysore adds that it’s essential to reduce the intake of foods or drinks, like excessive caffeine and alcohol, that can interfere with calcium absorption.
Make Lifestyle Changes that Support Bone Strength
According to Mysore, there are other lifestyle choices that may help impact hormone health and thus bone health. These include managing stress through relaxation techniques and getting enough sleep — and the latter is even more essential if you’re a woman.
The well-known recommendation of seven to eight hours of sleep per night stem from research done on men — women need more. Research published in the American Sociological Review in 2013 indicated that women need an average of 11 minutes more sleep than men7, while more recent research on women’s longer circadian rhythms8 has led experts like Dr. Patrick Flynn to recommend women get up to ten hours of sleep a night9.
It’s also essential to stay informed about the state of your bone density. “Regular bone density testing is crucial for monitoring bone health and catching osteoporosis early, allowing for timely intervention,” says Mysore.
The Contentious Question of HRT
Some experts also recommend hormone replacement therapy, or supplementation with bioidentical artificial hormones, as a preventative measure for osteoporosis. This practice is somewhat controversial, due to the increased risk of blood clotting disorders, cardiovascular disease, breast cancer, or stroke associated with HRT. The Cleveland Clinic also notes that some hormones, particularly compounded bioidentical hormones, lack FDA oversight regarding their purity and safety10.
Despite these concerns, HRT can mitigate the effects of osteoporosis or even prevent the disease, according to Mysore. “Hormone Replacement Therapy (HRT) can help manage the decline in estrogen levels during menopause, which plays a key role in maintaining bone density,” she says. And Ingraham adds that in addition to exercise, maintaining estrogen levels as long as possible is “the only thing that I would say that probably does make a difference” in mitigating osteoporosis risk.
Mysore recommends that women speak with a healthcare provider about whether HRT for osteoporosis is a good option for them, and Asprey adds that regular advanced hormone labs should become a habit for women as they approach menopause. “This way, you can identify and fix potential issues long before they become a problem,” he says.
Sources:
- https://www.nia.nih.gov/news/maternal-brain-hormone-key-strengthening-bones-could-help-treat-osteoporosis-bone-fractures
- https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968
- https://www.nia.nih.gov/news/maternal-brain-hormone-key-strengthening-bones-could-help-treat-osteoporosis-bone-fractures
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8836058/
- https://www.health.harvard.edu/newsletter_article/effective-exercises-for-osteoporosis
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7917752/
- https://www.mayoclinic.org/drugs-supplements/magnesium-supplement-oral-route/description/drg-20070730
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4868418/
- https://www.instagram.com/p/CptD9-BJvHN/?hl=en&img_index=2
- https://my.clevelandclinic.org/health/treatments/15660-bioidentical-hormones
