An expert guide to bone health and menopause

Dr May Al-Araji of Mayo Clinic Healthcare on the simple steps to reducing problems with bone health during perimenopause and after menopause

Menopause affects women all the way to their bones, and that is why building skeletal health is especially important during perimenopause and after menopause, says Dr May Al-Araji, a women’s health and family medicine expert at Mayo Clinic Healthcare in London.

This is a good time to add strength-training activities such as weightlifting to your exercise routine, she explains: “Menopause has a multisystem effect. It can affect you literally from top to bottom, including your skin, hair, brain, central nervous system, heart, organs and skeletal system.”

Putting stress on bones during perimenopause and after menopause can increase bone density and reduce the risk of osteoporosis. “Weight-resistance exercises are really key for bone health,” Dr Al-Araji says. But that doesn’t mean that you must become a bodybuilder. “It’s all about resistance. You build it up gradually.”

Dr May Al-Araji of Mayo Clinic Healthcare

For example, rather than starting out with barbells or dumbbells, try exercising with resistance bands, also called resistance tubing. You can also use your bodyweight to create resistance while exercising. From lunges using the body as resistance to resistance-band workouts, to exercises with free weights and weight machines, the strength-training options are many and varied.

Women approaching or passing menopause can also build bone health by not smoking and by adopting a healthy diet high in vitamin D, including fortified milk and fatty fish such as salmon, mackerel and sardines, and high in calcium, including dairy products, almonds, broccoli, kale, salmon, sardines and soy products. If you are not getting enough vitamin D from your diet, talk with your healthcare team about supplements, Dr Al-Araji advises.

It’s also important to achieve and maintain a healthy weight, with one important caveat: “Try to avoid rapid weight loss. The bones don’t like it. Our bones like very gradual weight loss, built over time.” If you’re trying to lose weight rapidly, it’s important to work with your healthcare team on a plan to minimise bone loss, she adds.

Hormone replacement therapy and other medications may also be considered when osteoporosis is diagnosed in women who are experiencing perimenopause or menopause, Dr Al-Araji says.

When should a woman approaching perimenopause or in her postmenopausal years be concerned that she might be having bone problems? There are several signs that should prompt a visit to your healthcare team, Dr Al-Araji says:

— If you are experiencing burning pains in your bones.

— If your bones ache.

— If you break a bone from a simple fall. This is known as a fragility fracture. For example, if you fall from your own height (such as a fall from slipping or tripping) and break a bone.

— If you’re on medications that suppress your immune system, known as immunosuppressants.

— If you’re taking corticosteroids.

— If you have a family history of osteoporosis.

— If you have an autoimmune disease such as rheumatoid arthritis.

— If you had an x-ray and it showed bone thinning, known as osteopenia.

In general, though, concern about bone health shouldn’t prompt women to avoid exercise for fear of damaging their bones, Dr Al-Araji says. “As long as you’re doing something that you are comfortable with, then I would encourage any form of exercise, even as simple as walking. Brisk walking is ideal. Just get your heart pumping a bit more than usual and get a bit of sweaty skin. That is the ideal exercise really, and the general advice is to walk 30 minutes at least five times a week, if possible.”