DEAR MAYO CLINIC: I am 49 and in good health but am concerned about osteoporosis since I went through menopause at an early age (44). Are weight-bearing exercises sufficient to prevent osteoporosis, or should I also take calcium supplements? Should I have a bone density test earlier than the typical recommended age of 65?
ANSWER: Menopause does increase your risk of osteoporosis. Exercise may help lower that risk. Getting enough calcium and vitamin D can make a difference, too. Your doctor can assess your diet to see if you need supplements. To help you understand your overall risk of developing osteoporosis, an early bone density test may be useful in your situation.
Your body regularly makes new bone and breaks down old bone. When you’re young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. Most people reach their peak bone mass in their mid-20s to mid-30s. The higher your peak bone mass, the more bone your body has to sustain bone health throughout the rest of your life.
Osteoporosis risk rises with age because as you get older, you lose bone faster than your body can make it. Osteoporosis occurs when the body’s creation of new bone can no longer keep up with the breakdown of old bone. Bones then become weak and brittle and can break easily. Menopause raises your risk of osteoporosis because during the first few years after menopause, women tend to lose bone density at a rapid rate.
Regular exercise may help slow bone loss. A combination of strength training exercises with weight-bearing exercises is usually best. Strength training helps strengthen muscles and bones in your arms and upper spine. Weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope or skiing — have a positive effect on the entire skeleton, and particularly benefit the bones in your legs, hips and lower spine.
Getting enough calcium and vitamin D in your diet also can help keep your bones healthy. Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day. That increases to 1,200 milligrams when women turn 50 and when men turn 70. But because you have already gone through menopause, your calcium requirements may be at the higher level even though you’re still in your 40s.
Good sources of calcium include low-fat dairy products, dark green leafy vegetables, canned sardines with bones, canned salmon and soy products. Many cereals and juices are calcium-fortified. If you can’t get enough calcium in your diet, your doctor may recommend a supplement.
Vitamin D is necessary for your body to absorb calcium. Many people get all the vitamin D they need from sunlight. To make sure, your doctor can do a blood test to determine your vitamin D level. If it is too low, you may need a vitamin D supplement. At your age, the recommended daily intake of vitamin D or exposure to it via sunlight is 600 international units.
A bone density test is one way to check the health of your bones. It measures how many grams of calcium and other bone minerals are in a segment of your bone. The higher the bone mineral content, the denser the bones are. The denser the bones are, the stronger they generally are and the less likely they are to break.
In women who have never broken a bone and who don’t have other osteoporosis risk factors, a bone density test to screen for osteoporosis is recommended at age 65. Because you are post-menopausal in your 40s, it’s likely you will need this test sooner even if you haven’t had a bone fracture. Depending on your level of osteoporosis risk, it could be as soon as age 50. Talk to your doctor to find out what’s best for you. — Dr. Bart Clarke, Endocrinology, Mayo Clinic, Rochester, Minn.