How can you overcome the risks of Osteoporosis during Menopause?

menopause and osteoporosis

What is osteoporosis?

Osteoporosis is the condition of losing bone mass and strength, which eventually leads to bone loss. Although it’s tragic, it’s common among the elderly. Osteoporosis leads to weakened bones in the body, making you vulnerable to bone fractures with small bumps or sudden falls. Women are more susceptible to osteoporosis because of the critical phase of menopause in their lives. However, men are not exempted from this risk.

Menopause represents a primary risk factor for osteoporosis among older women. Around 21% of women and 7% of men in Europe are diagnosed with osteoporosis. Viewing corresponding percentages for both men and women show that a combined 27 million people have osteoporosis and are at risk of bone loss. It is also worth mentioning that around 30% of women have osteoporosis in the aftermath of their menopause.

Menopause and estradiol: an alarm for osteoporosis?

menopause and osteoporosis

Menopause begins when there hasn’t been any period in a single year. Since menopause is a critical phase in older women’s lives, the transition to it is not easy. If not managed properly, it could lead to osteoporosis and other health complications. Some common symptoms of menopause are hot flashes, difficulty digesting food, and abdominal fat gain.

Estradiol decline is a common characteristic of the menopause transition among women. Estradiol is a hormone whose primary function is supporting the female reproductive system, and with menopause, the production of estradiol declines.

The decline in estradiol production also has a link with sluggish metabolism and high insulin resistance. Not many people know this fact, but reduced estradiol production also reduces the ability to regulate appetite. Irregular appetite poses high risks of developing abdominal fat and unhealthy weight gains over time.

The risk of GERD

gastric reflux

The postmenopausal phase is critical as most women tend to suffer from gastroesophageal reflux disease (GERD). GERD appears with heartburn symptoms and can also emerge as an unwanted consequence of estradiol production decline.

In response to their digestive problems, many postmenopausal women take medications that contain omeprazole. However, prolonged use of this medication may have some adverse effects on health, including a higher risk for osteoporosis.

Omeprazole inhibits the production of hydrochloric acid in the stomach. Since this acid plays a role in the absorption of calcium, iron, and vitamin B12, prolonged omeprazole use can increase the risk of vitamin deficiency and loss of minerals essential for bone health, such as calcium. This mechanism explains the higher risk of osteoporosis associated with the prolonged use of such medications. Dietary and lifestyle changes are more recommended.

At what age should you start preventing osteoporosis?

Since menopause is a critical phase for women aged between 45 and 55, it is essential to consider healthy food choices and consider maintaining healthy bones during this phase to overcome the risk of osteoporosis.

Unfortunately, it’s not entirely true. It would help if you worked on your bone health way before menopause. Your diet during your adolescence and adulthood, particularly your calcium and vitamin D intakes, is crucial to sustaining good bone health before you usher into the menopause phase.

The earlier you begin, the better the results

menopause and osteoporosis

Bone development starts in concurrence with fetus development. Bones mature and are fully grown by the age of 20. However, the amount of bone mass at the peak may vary based on different genetic factors. Nevertheless, proper nutrition during adolescence can help overcome the risk of osteoporosis during adulthood.

What can you do to reduce your risk of bone loss?

  • First, make sure you have a sufficient protein intake -, calcium-, phosphorus-, and potassium-rich foods. Eggs and fish contain loads of protein, with an egg containing up to 6 g. Fruits and vegetables such as bananas, beans, soybeans, grapes, and apples contain phosphorus, essential for bone health. Try including foods rich in these nutrients in your diet (see the two tables below). You may also want to focus on exposure to the sun for vitamin D or supplement it during wintertime.
  • Second, ensure that you perform some physical activity. Of particular importance is that you do some strength training exercise, for instance, weight lifting or push-ups, at least 2-3 times a week. Remember to build a routine for exercise.
  • Third, keep away from smoking and other poor habits that can intoxicate your body. Curbing on alcohol may be challenging. But, it’s better if you keep your intakes low.

The above advice should be followed from a younger age, even though adopting these habits provides several benefits when applied during menopause.

Here are the tables I mentioned above; the article continues below.

Potassium (mg)Calcium (mg)Phosphorus (mg)Protein (g)
Dairy products (100 g)
Hard cheese (average)7770748725
White cheese (average)8254440824
Goat milk170100903
Cow milk (semi-skimmed)156120944
Cow milk (skimmed)162125964
Cow milk (full-fat)157120963
Greek yogurt, plain1841261386
Low-fat yogurt2281621435
Yogurt (full-fat), plain2802001706
Eggs
Egg (one piece)7323906
Yolk (of one egg)31371504
Canned fish (100 g)
Canned anchovies23030030025
Canned salmon30516429124
Canned sardines in oil41050052023
Shrimps (boiled)40032027024

Table 1: Potassium, calcium, phosphorus, and protein content of selected foods of animal origin.

Potassium (mg)Calcium (mg)Phosphorus (mg)Protein (g)
Nuts & Seeds (10 g)
Brazil nuts6617591
Chestnuts50570
Hazelnuts7314301
Pecan nuts526311
Pistachio nuts10411422
Walnuts459381
Anise seeds14465442
Coriander seeds12771411
Cumin seeds17993502
Dill seeds119152282
Fennel seeds166120512
Sesame seeds5767722
Sunflower seeds7111642
Tahini paste5868732
Dried fruit (10 g)
Dried apricots1889120
Dried figs972590
Grains (100 g)
Porridge oats (unfortified)375391
Quinoa788231
Herbs (10 g)
Basil (fresh)302540
Dill (fresh)753490
Mint (fresh)262180
Parsley (fresh)762060
Sage (fresh)396030
Legumes (100 g)
Canned beans (cannellini)309131
Canned chickpeas285141
Dried soya beans17324664
Tempeh3712202
Seaweeds (10 g)
Dried kombu45.0090.0021.000.71
Dried nori284.0043.0035.003.07
Dried wakame22.0066.0031.001.24
Vegetables (100g )
Broccoli, green, raw39748814.3
Spinach, baby, raw682119442.6
Spinach, mature, raw500170452.8
Spring greens, raw370210913.0
Watercress, raw300138612
Dairy product replacements
Soy milk74120482
Soy yogurt94120723

Table 2: Potassium, calcium, phosphorus, and protein content of selected foods of vegetable origin.

Say ‘Yes’ to nuts and dried fruit

nuts and dried fruit

You may want to feed-on something easy and delicious in the evening. I recommend increasing your intake of nuts such as cashews, pistachios, and others. These foods are high in healthy fats and contain the minerals that strengthen your bones (see the tables above).

Dried apricots and figs are also included in the recommended food list and work perfectly for your snack-time. These foods will give you energy and a healthy amount of calcium, phosphorus, iron, and potassium.

Say ‘No’ to Alcohol and Sodas

Alcohol and soda drinks are not recommended, particularly during menopause. Alcohol will worsen menopause symptoms. According to this study conducted by the North American Menopause Society, menopausal women consuming alcohol excessively were at higher risk of developing cancer, heart disease, liver problems, and osteoporosis. Since we talk about overcoming the risk of osteoporosis with a nutritious diet and healthy lifestyle, you may want to keep alcohol out of the picture.

Avoid processed foods

avoid processed food

Processed foods may be tempting, but they are not healthy at all. They contain loads of refined sugar, salt, and unhealthy fats. Alternatively, you can try including more fruit in your diet since this food contains natural sugar.

I also recommend eating slowly, which helps achieve satiety with less food and prevent excessive weight gain. I also recommend a healthy breakfast enriched with foods rich in essential minerals and protein (see the tables above).

Why could you need melatonin?

Melatonin is an essential hormone, known primarily for its imminent function of regulating the circadian rhythm. It helps to maintain a healthy metabolism by contributing to the regulation of both appetite and metabolism. A reduced melatonin production, as it happens during menopause, means more hunger and more digestive problems. Lower melatonin levels are not a direct cause of osteoporosis, but they can increase GERD’s risk, which is (indirectly) linked to osteoporosis, as discussed above.

Melatonin may not be a cure-all solution for all the complexities that women develop during menopause. Physical exercise and adequate sun exposure, which are also suitable for osteoporosis prevention, promote melatonin’s natural production.

Although melatonin content varies widely even within the same type of food, the most concentrated sources of melatonin are:

  • Eggs and fish;
    • Grains (black rice, wheat, barley, rolled oats);
    • Fruits and vegetables (tart cherries, grapes, tomatoes, peppers);
    • Germinated legumes and seeds (e.g., soybean sprouts);
    • Porcini mushrooms;
    • Various nuts, although pistachios contain very high amounts;
    • Coffee;

Limit caffeine consumption

limit coffee consumption

Caffeinated beverages pose an increased risk of hot flashes and night sweats. Caffeine can also enhance acid production in the stomach, something you want to be mindful of during menopause. Be careful with energy drinks, in particular, which often contain high doses of caffeine.

What about supplements?

Supplements are also a good source of calcium and essential vitamins. Most menopausal women remedy their symptoms with supplements. However, you may want to be a little careful here, as prolonged use of calcium supplements associated with vitamin D can enhance the risk of myocardial infarction. Eat calcium-rich foods and try to expose yourself to the sun, supplementing vitamin D only during wintertime.

Exercise Regularly and Expose Yourself to Morning Sunlight

exercise regularly and expose yourself to sunlight

You may want to start with exercise. Little to mild exercise outside is excellent for good bone health. Training is also essential given the body’s reduced ability to absorb calcium and crucial vitamins during menopause and later ages. With physical exercise, you can induce a more efficient calcium absorption. Also, exposing yourself to the sun help boost the production of vitamin D.

Exercise will regulate the production of essential hormones like melatonin and contribute to better sleep management. Natural melatonin production induced with exercise will also provide you a healthy appetite and limit the risk of unwanted weight increase during the postmenopausal period.

Important to raise awareness on menopause and osteoporosis

menopause and osteoporosis

It’s vital to raise awareness for building a healthy lifestyle for women in their menopause and the importance of a healthy diet during childhood and adolescence. Surveys on women and young girls have shown that they both have an insufficient intake of both calcium and essential vitamins, contributing to a higher risk of osteoporosis in the future.

Most people don’t know that adequate protein intake is also necessary for bone health. Protein requirements are higher among older adults: 1.2 g of protein per kg of bodyweight instead of the usual 0.8-1 g/kg recommended to adults in general.

Menopause and osteoporosis: conclusions

In conclusion, it is crucial to raise awareness of the importance of a healthy diet at an early age to prevent the risk of osteoporosis later in life. However, it is never too late to switch to a healthier lifestyle. Women in their menopause phase should be physically active, perform strength training exercise regularly, and follow a healthy diet. The latter should be rich in melatonin, calcium, phosphorus, potassium, and protein but low in caffeinated and alcoholic beverages and processed food.

Picture of Gianluca Tognon

Gianluca Tognon

Gianluca Tognon is an Italian nutrition coach, speaker, entrepreneur and associate professor at the University of Gothenburg. He started his career as a biologist and spent 15 years working both in Italy and then in Sweden. He has been involved in several EU research projects and has extensively worked and published on the association between diet, longevity and cardiovascular risk across the lifespan, also studying potential interactions between diet and genes. His work about the Mediterranean diet in Sweden has been cited by many newspapers worldwide including the Washington Post and The Telegraph among others. As a speaker, he has been invited by Harvard University and the Italian multi-national food company Barilla.

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About Me

I’m an Italian nutrition coach, speaker, entrepreneur and associate professor at the University of Gothenburg. I started MY career as a biologist and spent 15 years working both in Italy and then in Sweden.

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