During menopause, women are advised to take calcium and vitamin D supplements and lift weights, but why is that?

It’s because women can experience weakened bones due to the changes in their hormone levels. The main hormone at play is called estrogen. When women go through menopause, estrogen decreases significantly. However, estrogen is critical to the formation of bone.

In this blog, we will talk about what estrogen is, how it relates to bone density and menopause, and how you can maintain bone density, even if your estrogen levels have dropped.

What is Estrogen?

Estrogen (also referred to as estrone, estradiol, and estriol) is one of the main sex hormones involved in female reproductive processes¹. When girls start puberty, estrogen levels increase to give them female characteristics. Throughout their lives, estrogen and progesterone will naturally fluctuate over their menstrual cycles until menopause when their cycles end.

At around age 52, women begin to experience symptoms of menopause. Most of the symptoms women experience, like hot flashes, dizziness, heart palpitations, mood changes, and new hair growth, can be explained by a large drop in estrogen². These symptoms are very noticeable in women, however, an important consequence of low estrogen can go unnoticed. A drop in bone density may only be noticed because of pain or after an injury.

While lower than women, men have estrogen as well. Estrogen plays an important role in regulating bone density for men.

Bone Density Explained

Bone density refers to the amount of calcium and other minerals in the bone³. Bones with more minerals are denser and therefore, stronger and break less. Bones build their density while individuals grow during childhood through early adulthood with peak bone density occurring between ages 25 and 45 in both men and women⁴. Things that influence bone development include physical activity, calcium and vitamin D deficiencies, and hormones⁵.

Bone Density and Menopause

Naturally, both men and women lose bone density as they age. However, women will lose bone density at a significantly faster rate due to menopause when their estrogen levels decline⁴.

Estrogen levels are tightly correlated to bone density. The main effect of estrogen is to prevent bone breakdown called “remodeling”, a naturally occurring process of the bone life cycle⁶. Remodeling refers to the process by which old or damaged bone is broken down and new tissue is formed⁷. However, bone can be abnormally broken down due to nutritional deficiencies in calcium or low estrogen levels.

As estrogen levels drop in women, their body increases the rate of bone remodeling⁷. Without a steady supply of calcium and other minerals, the bones are worn away until they resemble the inside of a sponge. This condition is known as osteoporosis.

What is Osteoporosis?

Osteoporosis is a progressive condition in which bones break down faster than they are built. It causes the bones to become weakened and more likely to fracture or break³. Women are more likely to experience osteoporosis because of menopause.

Unfortunately, women are at a high risk of developing osteoporosis. Things you can do to decrease your chance of developing osteoporosis include⁵:

Supplementation: Increasing daily calcium and vitamin D consumption is critical to bone formation. Calcium cannot be absorbed into the body without vitamin D, so it is best to take a vitamin with both.

Weight-bearing exercises: Exercises that promote good posture and balance are great for increasing bone mass, like weight lifting, walking, running, jumping, and dancing⁵.

In Summary

Women experiencing menopause are at a high risk of developing osteoporosis, a progressive condition that decreases bone density. This process is strongly correlated with the drop in estrogen levels that occur during menopause. While genetic factors play a considerable role in bone density loss, there are a few lifestyle factors that you can incorporate to prevent it from getting too severe, like exercise and supplementation.

Sources

1. Delgado BJ, Lopez-Ojeda W. Estrogen. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
2. Introduction to Menopause. Johns Hopkins Medicine. (2024, March 18). https://www.hopkinsmedicine.org/health/conditions-and-diseases/introduction-to-menopause#:~:text=During%20this%20transition%20time%20before,of%20the%20symptoms%20of%20menopause.
3. Endocrine Society. (2022, January 24). Menopause and Bone Loss. https://www.endocrine.org/patient-engagement/endocrine-library/menopause-and-bone-loss#:~:text=Since%20estrogen%20helps%20prevent%20bones,seen%20in%20women%20experiencing%20menopause
4. 6.6 Exercise, Nutrition, Hormones, and Bone Tissue”. Anatomy & Physiology. Openstax CNX. 2013. ISBN 978-1-938168-13-0. Archived from the original on 10 January 2017.
5. Mayo Clinic Staff. (2024, February 24). Osteoporosis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968
6. Khosla, S., Oursler, M. J., & Monroe, D. G. (2012). Estrogen and the Skeleton. Trends in Endocrinology & Metabolism, 23(11), 576–581. https://doi.org/10.1016/j.tem.2012.03.008
7. Rowe P, Koller A, Sharma S. Physiology, Bone Remodeling. [Updated 2023 Mar 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www-ncbi-nlm-nih-gov.proxy.library.cornell.edu/books/NBK499863/