Women’s Voices for Change
Bone Health Begins at 40
By Dr. Sonal Parr
The median age for menopause is 51. At this time the loss of estrogen accelerates bone loss. The greatest bone loss occurs is in the first 5 years after menopause. This is what every woman in her 40s should do to optimize lifelong bone health.
1. Know your risk for osteoporosis.
- Family history of osteoporosis, osteopenia, hip or wrist fractures, or other metabolic bone disease.
- Personal history of past fractures.
- Autoimmune or inflammatory diseases, like ulcerative colitis, Crohn’s, celiac disease, rheumatoid arthritis are associated with accelerated bone loss.
- Nutritional: A diet of excessive animal protein (especially in the absence of adequate plant-based food) or processed foods can increase the risk for bone loss.
- Metabolic: Hyperthyroidism, disordered eating, some kidney and liver diseases.
- Medications, including steroid use, chemotherapy, aromatase inhibitors, like femara and arimidex; proton-pump inhibitors, like Nexium or Prilosec; some anti-depressants; overuse of thyroid hormone; and some diabetes drugs, like Avandia and Actos.
- Having a slight build or low body weight—especially if Caucasian or Asian.
- Inactive lifestyle
- Excessive alcohol consumption (more than two drinks a day).
- Tobacco use either current or former smokers (though current smokers have a significantly higher risk than former smokers)
2. While you can’t change your family history or past risk factors, you can affect your future bone health.
- While there has been controversy discussed in the media about whether or not calcium supplements cause more harm than good, (J Intern Med. 2015 Oct;278(4):354-68. doi: 10.1111/joim.12394. Epub 2015 Jul 14), it is certainly important to have adequate calcium intake from the diet. You can find a list of calcium-rich foods here. Although calcium requirements differ for different people, aiming for 600 to 1000mg of calcium a day should be adequate. Most people consume about 500mg of calcium in their regular diet. Mindfully adding one extra serving of calcium containing food (ie: a yogurt or a serving of leafy greens) a day usually helps each of us to reach the needed daily requirement of calcium. Note, however, that oxalate, which is found in spinach, rhubarb, chard, and beet greens binds with the calcium in those foods and reduces its absorption. Also, note that if you are lactose intolerant you will likely still be able to eat Greek yogurt. Because it’s strained several times, it has one-third the lactose content of regular milk. More important, yogurt is fermented, which means that the lactose is already broken down by yogurt’s natural probiotic. But if you really cannot get enough calcium in your diet, which should only happen in very unusual circumstances, you can consider taking a 500mg calcium citrate supplement. The bottom line, however, is that if you are at average risk for osteoporosis and consume a healthy diet that is rich in plant-based whole foods, you should not yet need a calcium supplement.
- Most people do need to take supplemental Vitamin D3. Lack of adequate vitamin D prevents your body from absorbing calcium from your diet so maintaining adequate levels of vitamin D is absolutely essential. It is most effective to choose a dose of Vitamin D based on blood levels, but 1000 to 2000 units of Vitamin D3 should be safe for most people.
- If you have had kidney stones or any disorder involving too much calcium in the blood or urine, do discuss the safety of calcium and Vitamin D supplementation with your health care provider before beginning these supplements.
- Bones respond to weight-bearing. While many people may do enough walking in their daily lives to protect their hips and spine, this is the decade to mindfully increase daily walking. Exercise that improves the bone density of the wrists tends to get neglected. Add push-ups, either on the floor or against the wall to strengthen the bones of the wrist. Three sets of 10 reps takes less than five minutes and can create a big impact. Yoga is very good to increase or maintain bone density.