Bone loss rate in healthy women during menopause

The annual loss rate before menopause is generally 0.3% to 0.5%, which is basically the same as in young adults.； Entering the rapid loss period in the first 5 to 10 years after menopause, the annual loss rate can soar to 2% to 5%. Among them, the cancellous bone of the spine and hip (the honeycomb-shaped part of the bone, which is more fragile than the outer hard bone) loses the fastest, up to 8% per year. After 10 years, the loss rate will gradually fall back to a low level of 0.5% to 1% per year.

I just met 49-year-old Sister Zhang in the clinic last week. She has just gone through menopause for 18 months. Last year, the bone density T value during the unit physical examination was still within the normal range of -0.8. However, this year's reexamination dropped directly to -1.7, which is a difference of 0.3 to the critical value of osteoporosis. She was very confused when she took the report. She said that she drank a pound of milk every day and took extra calcium tablets. How come her bones were falling so fast?

In fact, the core reason why this happens to most people is the cliff-like drop in estrogen. Estrogen is equivalent to the "protective umbrella" of bones. It usually inhibits the activity of osteoclasts and prevents bones from being absorbed and consumed too quickly. After the ovarian function declines during menopause, the estrogen level directly drops to 1/10 or even lower than before menopause. Osteoclasts are not restrained, and bone mass will naturally be lost rapidly.

However, the industry also has different views on the core causes of bone loss. Some sports medicine researchers believe that the impact of declining estrogen has been overestimated - many women subconsciously reduce the amount of exercise after entering menopause for fear of being tired and injured. Muscle mass decreases by 1% to 2% every year, and the pulling stimulation of muscles on bones is reduced, which is the core reason for the decline in bone density. Their research data is also very convincing: postmenopausal women who insist on resistance training (such as lifting small dumbbells and doing squats) three times a week for 40 minutes each time can control the annual bone loss rate within 1%, which is more than 60% lower than women who only take calcium tablets and do not exercise.

Don't tell me, individual differences are really huge. Last year I met a 54-year-old aunt who was postmenopausal for 6 years. She usually danced for an hour every day and climbed mountains once a week. Her bone density was better than that of many 30-year-old girls. Her annual bone loss rate was only 0.4%, which was the same as before menopause. But there are also negative examples. There is a 51-year-old elder sister who lost 18 pounds in three months on a diet to attend her daughter’s wedding. She also drank strong black coffee every day to stay awake. Her bone density dropped directly from -1.2 to -2.3 during the review. She was diagnosed with osteoporosis, which even shocked us.

Oh, by the way, many people have a misunderstanding that as long as they eat enough calcium, they will not lose bones. In fact, this is not the case at all. It is true that calcium is a raw material for bone synthesis, but without the help of vitamin D for absorption, most of the calcium eaten will be excreted along the intestinal tract, which is equivalent to a wasted supplement. There are also many women who are afraid of getting tanned in the summer, so they cover their entire body tightly when going out and apply SPF50+ sunscreen. The ability of the skin to synthesize vitamin D is directly reduced by 90%, which is equivalent to "stealing" the raw materials of the bones in disguise.

When it comes to intervention programs, the controversy is even greater. Most gynecological endocrinology doctors will recommend that if menopausal symptoms are obvious (such as hot flashes, night sweats, insomnia and irritability) and there are no contraindications to hormone supplementation, appropriate estrogen and progesterone supplementation for 3-5 years can not only relieve discomfort, but also directly reduce the bone loss rate to premenopausal levels. It is currently recognized as the most effective intervention method. However, many orthopedic surgeons prefer conservative intervention. They feel that hormones have potential risks to the breast and endometrium, and it is safer to rely on exercise + calcium supplementation. In fact, the current consensus is that there is no unified standard answer. It all depends on the individual situation: if you have a family history of breast cancer or a history of blood clots, then it is definitely not recommended to take hormones. ； If your menopausal symptoms are particularly severe and your bone density is losing particularly quickly, the risk is estimated to be low and the benefits of using hormones will be much greater.

To be honest, there is no need to be overly anxious about bone loss during menopause, and don’t just follow what others are doing. Taking the time to check your bone density every year, spending 10 more minutes in the sun, drinking less strong coffee and tea, and even walking an extra half hour a day are much more useful than taking a bunch of messy health supplements. After all, when it comes to bones, it depends on how you deal with them.