The following are important for maintaining healthy bones:
- Calcium is the key mineral in bone. 1000-1300mg per day is required and can be obtained from the diet. However, up to 60% of postmenopausal women do not meet dietary calcium requirements.
- Vitamin D. Vitamin D is required for calcium to be effectively used in bone formation. Adequate vitamin D levels can be derived from sufficient exposure to sunlight (5-15 minutes of exposure per day). In Australia, 30-50% of postmenopausal women are deficient in vitamin D.
- Physical activity. Weight-bearing exercise such as walking, jogging and dancing help stimulate bone growth.
- Avoidance of smoking and reducing caffeine intake.
Treatments for preventing bone loss and strengthening bone include:
- Combined calcium and vitamin D supplements. This may be necessary if dietary intake is inadequate.
- MHT can increase bone density by about 5% after 2 years and reduces the risk of spinal and hip fractures by approximately 40%.
- Tibolone (see above section “What are the treatments for menopausal symptoms?”)
- Selective Estrogen Receptor Modulators (SERMs). These drugs (e.g. Raloxifene) act like oestrogen on bone leading to an increase in bone mass and reduced fractures. Unlike oestrogen, raloxifene does not stimulate the womb lining. Raloxifene may block oestrogen effects at other sites and so may cause hot flushes.
- Bisphosphonates. These drugs (e.g. Alendronate [Fosamax]) reduce bone loss and fractures.
- Denosumab (Prolia). This also reduces bone loss and fractures.
- Teriparatide (Forteo). This is the bioactive fragment of the hormone known as parathyroid hormone. It increases calcium absorption and bone formation. It may need to be used in conjunction with calcium and vitamin D supplements.