How does menopause affect bone health?

It's World Menopause Day tomorrow. The aim of the day is to raise awareness of menopause and the support that is available to help women improve their health and well-being.

Eating well and following a healthy lifestyle can help you to minimise many menopause-related conditions, including weight gain, developing heart disease and osteoporosis.

In this blog article, I will be exploring osteoporosis and why good nutrition plays an important role in osteoporosis prevention.

What is osteoporosis?

Osteoporosis is a condition where your bones become weaker and thinner, causing them to break or fracture more easily. It occurs when the bones lose minerals (such as calcium) faster than your body can replace them which makes them less dense and not as strong.

What's the menopause got to do with osteoporosis?

Bone density starts to decrease with lowered oestrogen levels during menopause, which can increase the risk of developing osteoporosis. On average, women lose up to 2% of their bone mass each year following menopause. After this, the rate of bone loss slows down.

What can I do to reduce my risk?

There are steps that you can take to reduce your risk of getting osteoporosis, like having a healthy balanced diet with plenty of calcium, vitamin D and doing some weight-bearing exercise every day.

How much calcium do we need each day?

Adults aged 19 to 64 and over need 700mg of calcium a day.

Where do I get calcium from?

The best sources of calcium are found in milk and dairy foods, such as cheese and yoghurt. To get 700mg of calcium each day you need to eat approximately 2-3 servings of dairy foods each day. You'll find the amounts of calcium displayed in the table below:

Smaller amounts of calcium can be found in non-dairy foods, however, these are not absorbed as well as the calcium found in dairy foods. Therefore, try not to rely on these foods as your only source of calcium, and only use them to top up the amount of calcium in your diet. It’s also important to know that cream and butter are not high in calcium.

I have a high cholesterol level, and I’ve been advised to avoid foods which are high in saturated fat.

Does this mean I need to avoid dairy products?

There are different types of fats, some that are healthy and some that are unhealthy. The unhealthy ones are the saturated fats and having too much saturated fat can increase your cholesterol levels. Saturated fats are found mainly in animal products, such as butter, processed meats, cakes, biscuits, pastries, fried foods and full-fat dairy products. The good news is that you can choose low-fat dairy products to manage your cholesterol level and you will still get enough calcium as low-fat dairy products have just as much calcium as full-fat varieties. Some hard cheeses, such as reduced-fat cheddar cheese, also have a higher concentration of calcium than softer varieties, such as ricotta.

Why do I need vitamin D to keep my bones healthy?

You need vitamin D to help your body to absorb calcium. Sunshine is the main source of vitamin D. Vitamin D is produced under your skin when you are outside in daylight, which is the reason why vitamin D is sometimes called the ‘sunshine vitamin’. The required sun exposure times will vary based on season, location, the area of your skin exposed, and your skin type.

I don’t think I’m getting enough calcium in my diet. Which type of supplement do I choose?

The two main types of calcium supplements are calcium carbonate and calcium citrate, which are available in a variety of forms: tablets, chewable tablets, effervescent tablets, or soluble powder. It is recommended that if you’re not able to obtain the required amount of calcium from your diet then a supplement of 500-600mg calcium per day is necessary. It is important to consider the amount of elemental calcium when choosing a supplement. Elemental calcium is the exact amount of calcium that is available for your body to absorb. For example, a 1200mg tablet of calcium carbonate actually contains 500mg of elemental calcium, so always check the amount of elemental calcium on the label of a supplement to work out your daily calcium intake and speak to your doctor or pharmacist for more information about which supplement you should be taking.

I’ve heard that caffeine affects the absorption of calcium, is this correct?

Excessive amounts of caffeine of over 300mg of caffeine per day, (which equates to drinking more than 4 cups of percolated/plunger coffee; or 5 cups of instant coffee, or 3 shots of espresso coffee per day), may cause an imbalance between calcium intake and loss from the body. Caffeine acts as a diuretic and flushes out calcium through the kidneys; therefore, it is recommended to limit your caffeine intake.

References

The Menopause Charity: 'Let's Talk About Bone Health'. Accessed online at: https://www.themenopausecharity.org/2021/05/26/lets-talk-about-bone-health/

National Health and Medical Research Council (2006). Accessed online at: https://www.nhmrc.gov.au/guidelines/publications/n35-n36-n37

British Dietetic Association: Calcium Food Factsheet. Accessed online at: https://www.bda.uk.com/resource/calcium.html

Stewart R. (2011). Griffith Handbook of Clinical Nutrition and Dietetics. 4th Edition. Griffith University.

National Institutes of Health. Office of Dietary Supplements (2013). Dietary Supplement Fact Sheet: Calcium. Available at: http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/