Sarah had been at a circus school workshop a few years ago, doing training on a trampoline, and had hurt her back. Now. Sarah and I met in the late 90s while working for Cirque Du Soliel, so this was not unusual to hear. However, hearing that she was injured from doing a simple back bounce on the trampoline was SHOCKING. She was 55, very active, and took excellent care of herself.
Initially, she assumed she had pulled something and that the pain would dissipate once healed; however, some time went by, and the pain was not resolving, so she finally went to see a doctor. That was when she found out that she didn’t just hurt her back; she fractured her spine, and with that also came the shocking news that she had full-blown Osteoporosis.
She was devastated.
When she came to me with this news, she wanted to know how and why! She was only 55; how could this be??
Osteoporosis is a disease that causes bones to become weak and more likely to break. It's often called a "silent disease" because it doesn't usually cause symptoms, and you might not know you have it until you break a bone…while taking a circus trampoline workshop.
Risk factors include age, race, genetics, thyroid issues, and body frame size (men and women with small body frames tend to have a higher risk). However, the most common cause of the disease is simply being a woman. The drop in estrogen levels in women at menopause is one of the highest risk factors for developing osteoporosis.
Estrogen regulates bone metabolism and promotes the activity of osteoblasts, which are the cells that make new bone. When estrogen levels drop, a person may lose bone density. This is why a DEXA scan (bone mineral density test) is recommended for women between 50 and 65.
While it is not guaranteed that you will get osteoporosis if you are a menopausal woman, The National Osteoporosis Foundation estimates that half of all women over 50 will eventually develop the disease.
Initially, Sarah and I were texting. We went over lifestyle interventions and her concerns over side effects associated with the drug Fosamax, a drug her doctor prescribed her that slows bone loss. I knew there was more to her story and much to be done here, so I scheduled a Zoom with her to get the entire background.
Sarah had gone through early menopause about 15 years ago. Menopause is considered “early” when it occurs between the ages of 40 and 45. Given the fact that this was around 2009, she was not offered HRT (Hormone Replacement Therapy), which is currently the gold standard of care for menopause.
You have to remember that in the late aughts, people were not discussing menopause as they are today. Not only that, but it was also only a few years earlier (2002) that the Women’s Health Initiative published a very flawed and misinterpreted study on the use of HRT and its health risks, which had doctors up in arms about prescribing HRT for fear of giving their patients cancer.
This was debunked years later. You can read the NAMS repositioning statement here.
Sarah’s timing was unfortunate, and now her bones were paying the price for that lack of estrogen!
We’ve all heard stories or had a female elder in our life who was doing “fine” but then fell and broke her hip, and that’s when it was “over.” Sarah was aware of this and was (rightfully so) completely freaked out that she was officially frail and could break a bone at any moment from the slightest movement, and she was only 55!!
She was scared and felt “hopeless,” but I assured her it wasn’t over.
We had a long talk about Menopause Hormone Therapy (MHT/HRT) and the effect of estrogen on bone density. She had already started lifting weights and taking calcium, vitamin D, and Fosamax.
She was doing all the right things! The only thing missing was estrogen, which (according to the latest data) is associated with a 3.4%-3.7% increase in BMD (Bone Mineral Density) within one to two years of use.
Last we spoke, she had an appointment with a NAMS provider to get her MHT prescription and felt hopeful about her future. I plan to check in with her periodically and am excited to see how things are going.
In the meantime, here are some tips for avoiding osteoporosis:
Begin using MHT while in perimenopause if appropriate for you. Estrogen remains the “treatment of choice” for osteoporosis prevention.
Start lifting heavy sh*t! Lifting weights increases bone density and muscle strength
Eat adequate protein
Maintain a healthy weight
Amp up your calcium
Amp up your vitamin D
Crowd out alcohol
This blog offers general information about health and related topics. The information and other content provided in this blog, website, or any linked materials are not a substitute for medical advice, diagnosis, or treatment. If you have a medical concern, please consult your healthcare provider or seek professional medical treatment immediately.
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