Women after menopause (postmenopausal) are most at risk of developing osteoporosis due to the reduced production of the female hormone estrogen. If peak bone mass isn’t reached during adolescence or built up in the early adult years then bones may be at a disadvantage during menopause when bone loss is at its most rapid stage.
Osteoporosis Prevention:
Eat a calcium rich diet, including low fat dairy foods such as milk, yoghurt and cheese. (see Nutrition)
Regular exercise, especially weight bearing activities such as aerobics and resistance training, which builds muscle and bone strength and assist in improve balance. (see Exercise)
Taking medication (bisphosphonates) as prescribed by your doctor to preserve your bone density
Have adequate calcium or supplements as recommended by your doctor
Taking Hormone Replacement Therapy to restore lost estrogen caused by menopause – see your doctor
Get 20 minutes of sunshine (Vitamin D) every day
Take extra prescribed medication as recommended by your doctor (strontium ranelate, tibolone and parathyroid hormone when necessary)
Hormone Replacement Therapy (HRT) is the replacement of estrogen in many cases estrogen plus progestogen, which has been used worldwide to relieve menopausal symptoms (vaginal dryness, hot flushes, night sweats). If taken when menopause begins, research has shown it can reduce spinal fractures on average by 40 per cent.
There have been at least 10 large studies on the long term effects of HRT in women (The US Women's Health Initiative study (USA)-2002 & 2003, the Million Women Study (UK) 2003 and the Women's International Study of Long Duration Estrogen after Menopause (WISDOM) 2007 are the main ones) which have all found a small increased risk of breast cancer, coronary heart disease, stroke and clotting in lungs and legs.
The Australian Drug Evaluation Committee (ADEC) reviewed HRT research and recommends it shouldn’t be used as a preventative osteoporosis treatment and should only be considered for relief of severe hot flushing for short periods of time, in light of the increased breast cancer risk.
There are a few things to remember about HRT:
Bone loss will begin once HRT is stopped.
If you do take it, have it reviewed every six months to a year with your specialist to make sure your dose is right for you and to consider other options if you need a break from taking it.
Inform your doctor of any family history of cancer especially breast cancer and heart disease as there is an increased risk for those women who take HRT and have a family history of these diseases.
Strontium ranelate is a natural trace element in soft tissue, blood, teeth and bone which scientists believe assists in a decreased bone loss rate and may even improve bone formation. Research has been promising with reduced fracture rates especially in the spine and hip. Your specialist may prescribe this granulated medication on a private script but it is expensive and is not listed for subsidy on the Pharmaceutical Benefits Scheme.
Parathyroid hormone injections increase bone renewal and calcium absorption from the stomach and kidney in post-menopausal women.
Generally, calcium and vitamin D supplements should be taken daily with the injections to increase its efficiency. There is some caution attached to Parathyroid hormone treatments, as this is a very new drug with no long term side effects studied in humans yet.
In Australia it’s available only by prescription form an osteoporosis specialist for once only 18 month course. As its not listed on the PBS, the availability is limited because of its expense.
Tibolone is an alternative hormone therapy for the relief of menopausal symptoms, which has shown increases the density of bone minerals but extensive clinical trial evaluation is still needed on the long-term effects.
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Osteoporosis Overview 
