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What Actually Happens To Our Bones In Menopause?


The female reproduction system is complex with several hormonal axes and feedback loops. When a woman goes through menopause, the production of certain hormones plummets, triggering a number of clinical manifestations, including reduced bone mineral density.

Here are the hormones that control female reproduction:

  • Gonadotropin-releasing hormone (GnRH)
  • Follicle-stimulating hormone (FSH)
  • Luteinizing hormone (LH)
  • Estrogen
  • Progesterone

These five hormones work within an interconnected loop that stimulates and suppresses one another.

GnRH is released by the hypothalamus, which is a small gland located above the pituitary gland, to stimulate the secretion of FSH and LH. These two hormones upregulate the production of estrogen and progesterone by the ovaries and adrenal glands.

In this article, we will cover the physiological changes that occur in females during menopause, with more focus on the accelerated process of osteolysis.

What is menopause?

Menopause is a natural process that females undergo when their menstrual periods stop. Once the ovaries stop making estrogen, the menstrual cycle gets disrupted. On average, women undergo menopause between the ages of 50 and 52.

Postmenopausal women are very susceptible to primary osteoporosis triggered by estrogen deficiency. You see, estrogen typically increases the lifespan of osteoblasts and lowers their apoptotic rate. Consequently, bone resorption occurs at a much slower pace.

Removing estrogen from this equation tips the scale toward osteoclast activity, which is responsible for bone resorption.

Diagnostic tests for menopause

Blood tests

Blood tests will detect the levels of FSH, which tends to increase during menopause.

Patients must inform their healthcare provider if they are taking progesterone-containing contraceptive pills since they influence the normal levels of FSH.

Urine tests

Urine tests are also available to measure FSH concentrations. Depending on the degree of elevation, it is possible to determine whether the patient is in perimenopause or menopause.

Saliva test

Saliva tests are useful to measure the levels of estradiol, estrone, estriol, testosterone, and progesterone. After that, we can calculate the progesterone/estradiol ratio, which is an important indicator for menopause symptoms.

The DUTCH test

This is an advanced diagnostic tool that provides a comprehensive review of the patient’s hormones. It also offers valuable information about crucial enzymes and compounds for the body, allowing healthcare providers to create personalized health plans.

Based on sex hormone levels, the DUTCH test can accurately diagnose menopause.

What are the signs and symptoms of menopause?

Aside from irregular menstrual cycles, patients may not experience any symptoms. However, the following signs during menopause could develop:

Hot flashes – This describes an abrupt feeling of heat that rushes through the face and neck. Each episode lasts for a few seconds to minutes. The cause of hot flashes is the massive vasodilation of your blood vessels. Most women report having these episodes at night.

Sleep problems – Insomnia is the most common sleeping disorder associated with menopause. There are two types of insomnia – Having trouble falling asleep or waking up too early. Hot flashes play an important role in disrupting sleep.

Vaginal and urinary tract changes – Once estrogen starts to drop, the lining of the vaginal canal becomes less elastic and more dry. As a result, women may feel discomfort or pain during sexual intercourse. We refer to this symptom as dyspareunia.

What is osteoporosis?

Osteoporosis is a very prevalent condition that affects the bones. The spongy bone is responsible for maintaining the structural integrity of bones. The size of these honeycomb-like structures is generally very small. However, osteoporosis enlarges these spaces due to the accelerated osteolytic activity.

Postmenopausal women are particularly susceptible to osteoporosis due to the absence of estrogen’s bone-protective properties.

Menopause and the risk of osteoporosis

Both women and men lose some of their bone tissues after 35 years old. This is a physiological process that requires no medical intervention. However, menopause starts a rapid osteolytic cascade that leads to significant bone loss.

The cause of these changes is estrogen decline. To address this condition, doctors may prescribe hormone replacement therapy (HRT) to gradually adapt the body to new estrogen levels.

Causes of osteoporosis

Aside from menopause, other risk factors may also contribute to the occurrence of osteoporosis, including:

  • Advanced age
  • Race (e.g., Caucasian, Asian)
  • Poor nutrition
  • Sedentary lifestyle
  • Smoking
  • Low body mass index

Signs and symptoms of poor bone mineral density

In general, early osteoporosis rarely presents with any clinical manifestations. A large number of patients receive the diagnosis after a fracture that is not preceded by a traumatic accident.

Early signs of low bone mineral density include:

  • Weakened grip strength
  • Brittle nails
  • Receding gums

Once the osteolytic activity advances, patients may develop:

  • Severe pain in the back and neck
  • Fractures triggered by benign factors, such as coughing or sneezing

Treatment of osteoporosis

Osteoporosis treatment revolves around lifestyle modifications, pharmacological drugs, and physiotherapy. The aim is to increase bone mineral density and reduce the risk of fractures. After 3 to 4 years of taking medications, bone mineral density increases by 3% in the hip and 8% in the spine.

This lowers the risk of spine fractures by up to 70% and hip fractures by 50%.

However, physical therapy remains fundamental for reducing these risks. Therapists may recommend:

General exercises

Walking or hopping are excellent ways to stimulate osteoblast activity.

Flexibility and strengthening exercise

Improving physical function and postural control by practicing GYROTONIC can lower the risk of fractures.

Postural exercise

Postural exercises are indispensable to preventing osteoporosis-related complications, such as kyphosis. The physiotherapy program must include extension exercises (e.g., hip extension, scapular retractions, chin tucks).

High-intensity exercise

High-intensity training is a powerful tool to prevent bone resorption in menopausal women.

Takeaway message

The bones undergo many physiological changes during and after menopause. The lack of estrogen and the increased activity of osteoclasts lowers bone mineral density, predisposing patients to fractures and non-traumatic injuries.

We hope that this article managed to explain the pathophysiology of osteoporosis and how menopause contributes to this disease.