Osteoporosis and Osteopenia are a major concern for women over 50. Bone loss accelerates during the menopause transition, leaving women at a much higher risk after menopause. This is partially because estrogen regulates bone metabolism, and when estrogen levels drop a woman may lose bone density.
When it comes to osteo prevention vs. management of osteoporosis and osteopenia, the outcomes we are looking at are slightly different. When it comes to prevention, we want to focus on nutritional adequacy and hormonal balance (good healthy cycles = estrogen = bone health). BUT, once a woman passes 50/menopause, or has been diagnosed with osteoporosis or osteopenia, we change our goals. Although we are of course still interested in bone mineral density, the main goal here becomes preventing fractures.
I advocate for my patients to follow testing guidelines and get their DEXA scans, and ask for early screening if they fall into one of the high risk factor categories (premature menopause, malabsorption syndrome such as celiac disease, use of any of the 'high risk' medications including glucocorticosteroids, smoker, high alcohol intake, any of the other disorders with an association with rapid bone loss, and a fragility fracture after age 40).
One of the most common questions I get in clinic in regards to Osteoporosis is 'Should I be taking a calcium supplement?'
Calcium for osteoporosis is a common recommendation. While the answer to this is dependent on the person, we do know that women over 50 should be getting 1200 mg a day of calcium. This can be from diet and/or supplement form. There are lots of great dietary sources, a good exercise to see if you are meeting your needs, is to track your diet for a week and see what your calcium comes in at. If you diet is fairly consistent, you can use that baseline and add a supplement to make up for the rest.
What about the other nutrients?
Vitamin D: Most studies looked at calcium (1200 mg) along with 800 IU Vitamin D. But I always test and treat vitamin D deficiency, so your dose is customized for you.
Vitamin K:Â There is biological plausibility that Vit K would be important to bone health, which is where the recommendations came in. But if you actually comb through the research there is really only one study showing benefit. And only ever, if combined with the above two.
Magnesium: This is a nutrient we see depleted often in patients, and we are not always hitting our goals with diet alone. Dosages studied range from 250-1800 mg. And the forms usually studied are not well absorbed (citrate or oxide).
Now, again remember, especially once someone already has osteoporosis, we are really most interested in preventing fractures. Especially as age increases, fractures have a HUGE impact on mortality. So, given that, this is the most important thing to be trying to prevent.
There are some really important things to consider for this:
Fracture-proof your environment (remove obstacles you could trip on, make sure it is well-lit etc.)
Work on your balance! Yoga is fantastic for this
Work on strength-training - this helps with balance, and fracture prevention, bone density and fracture recovery - aka. very important 🙂
I have a much more detailed list of recommendations I give patients, but that is the basics! Hope you learned something - let me know if there are any questions !!
Cheers,
Dr. C