What Is Postmenopausal Osteoporosis?

<p>AND-ONE / Getty Images</p>

AND-ONE / Getty Images

Medically reviewed by Scott Zashin, MD

When osteoporosis develops after menopause—the stage when menstruation officially stops after 12 straight months without a period—it's known as postmenopausal osteoporosis. A drop in the body's production of estrogen during this time is responsible, as the sex hormone is essential for protecting bone health.

Fortunately, there are ways to help manage postmenopausal osteoporosis and prevent further bone loss from happening. This article provides an overview of postmenopausal osteoporosis, offering tips on treatment options and coping with the condition.

<p>AND-ONE / Getty Images</p>

AND-ONE / Getty Images

Postmenopausal Osteoporosis Symptoms

The symptoms of postmenopausal osteoporosis usually aren't obvious. Osteoporosis tends to develop slowly and silently, and many people don't realize they have the condition until a bone fractures, or breaks, suddenly.

In addition to the traditional menopause symptoms, some people might notice the following signs and symptoms with postmenopausal osteoporosis:

  • Severe or sudden back pain

  • Bone pain

  • Joint pain

  • Height loss

  • Hunched posture

Causes

Bone loss causes osteoporosis. In postmenopausal osteoporosis, this bone loss is due to extremely low estrogen levels.

After menopause, the ovaries don't make as much estrogen—and the hormone is key for building and protecting bone density. This sudden estrogen decrease leads to stages of bone loss, which starts a year before menopause and can last for roughly three years.

Plus, in general, women have a greater risk of developing osteoporosis than men. Experts think this is due in part to having smaller, thinner bones and a longer life span, on average. (Note that when health authorities or research is cited, the terms for sex or gender from the source are used.)





Osteoporosis is the most common bone disease. Worldwide, it's estimated that 1 in 3 women and 1 in 5 men over the age of 50 will experience a broken bone due to osteoporosis.




Other causes of osteoporosis are medications, such as steroids, proton pump inhibitors (used for acid reflux and peptic ulcers), and the overuse of thyroid hormones.

Diagnosis

A healthcare provider may use a few different tools to help diagnose a case of postmenopausal osteoporosis. These might include one or more of the following:

  • A bone mineral density test called a dual-energy X-ray absorptiometry test (DEXA scan): This is a noninvasive X-ray procedure that measures how much calcium and other minerals are present in the bones. If the results of the DEXA scan show a low "score" compared to average bone density in a healthy individual, this likely points to a postmenopausal osteoporosis diagnosis.

  • A history of fragility fractures, which are defined as a bone fracture that happens from a low-impact activity, may indicate osteoporosis.

  • A fracture risk assessment tool (or FRAX) score is a tool that calculates the likelihood that an individual will have a major bone fracture in the next 10 years.

  • Blood tests to measure the presence of nutrients in the blood may also be taken to help determine whether there's a major absence of bone-protecting calcium or vitamin D.





Experts recommend postmenopausal people older than age 65 should have a bone mineral density (or BMD) test done. Those who are past menopause but younger than 65 should still consider getting a BMD test performed, particularly if they have a high risk of bone fractures. People who are transgender should discuss screening with a healthcare provider.

Following your first BMD test, a healthcare provider will be able to recommend timing for the next test, depending on your results, age, and fracture risk.




Treatment

Treatment plans for postmenopausal osteoporosis typically include some combination of medications and lifestyle changes, and may have a particular emphasis on menopausal hormone therapy.

The following options are common for treating osteoporosis:

  • Prescription medications like bisphosphonates or Prolia/Xgeva (denosumab) are often prescribed to help decrease bone loss. They work by strengthening bones to reduce the risk of fractures and also cut down on pain.

  • Hormone therapy can help boost estrogen levels, preserving bone density. This option may be particularly effective for people with postmenopausal osteoporosis, given the reduced estrogen levels.

  • Diet modifications, such as implementing diet changes to include specific nutrients like calcium, vitamin D, vitamin K, and protein, can help build bone strength.

  • Lifestyle adjustments like making sure you're getting plenty of exercise or adding bone-strengthening resistance exercises to your workout routine. This might also include quitting smoking and reducing alcohol intake. Vitamin D may also be absorbed with an appropriate amount of sunlight.

  • Surgical procedures, including vertebroplasty and kyphoplasty or spinal fusion, may be used in severe cases to improve symptoms in those with bone fractures.

Your healthcare provider will likely continue to use DEXA scans to help monitor how your treatment plan is going. Because it can take time to see improvements in bone health, another DEXA test may be performed a year or more after treatment begins.

Prognosis

While anyone can develop osteoporosis, it disproportionately affects women compared to men. For example, statistics estimate that postmenopausal osteoporosis affects roughly 1 in 4 women.

Because of this risk, experts stress the importance of sticking to a long-term treatment plan for postmenopausal osteoporosis patients. Some studies have shown that people with osteoporosis who experience bone fractures may have an increased mortality risk compared to the general population.

While postmenopausal osteoporosis can't be reversed, it's still possible to prevent further bone loss by following the nutrition and lifestyle changes recommended by experts.

Coping

Living with postmenopausal osteoporosis can be a challenging and painful experience. In addition to the stress that can come along with the diagnosis of a bone disease, osteoporosis often causes several painful bone fractures that can take months to fully heal.

To help you cope, experts recommend working with a healthcare provider to maintain a chronic pain management plan that's best for you. This might involve components like:

  • Medications to treat pain

  • Heat or ice to help relieve residual pain from injuries

  • Braces for support during everyday activities

  • Regular exercise to boost muscle strength

  • Physical and/or massage therapy

  • Individual or group therapy to help with emotional stress

Prevention

While postmenopausal osteoporosis happens after menopause, it's not too early to protect your bone health. Keep your bones strong at any age by staying active, getting plenty of recommended vitamins and nutrients, and limiting alcohol consumption.

Locking in those habits will help prepare you for any menopause-related bone changes when you reach that stage.

Summary

Postmenopausal osteoporosis happens when a decrease in the sex hormone estrogen is triggered by menopause, the point in time when a person stops menstruating.

Symptoms aren't typically noticeable, but may include severe bone or joint pain, a hunched posture, or loss of height. These signs may not be obvious unless a sudden bone fracture or break happens during a routine, low-impact activity.

A healthcare provider will use a bone mineral density scan to help diagnose postmenopausal osteoporosis. Treatment plans usually include a combination of medications, dietary changes, and lifestyle adjustments. Menopausal hormone therapy will also be considered to help replenish estrogen levels.