Why Is My Grandma Shrinking? Postmenopausal Osteoporosis Explained

This is a re‑airing of one of the most important episodes I’ve done — because postmenopausal osteoporosis is something I see every single week in practice, and most women don’t realize it’s happening until it’s too late.

If you’ve ever noticed your grandmother or mother getting shorter, developing a rounded upper back, or seeming more fragile over time, this episode explains why. After menopause — which happens on average around age 52 — estrogen levels drop, and that changes how your bones remodel. Bone resorption starts to outpace bone formation. In plain English? You lose bone faster than you build it.

That’s how osteopenia progresses to osteoporosis.

In this episode, I break down the difference between osteopenia vs. osteoporosis, what low‑trauma fractures really mean, and why hip fractures, wrist fractures, and vertebral compression fractures are such a big deal in older women. We talk about vertebral wedge fractures — the small spinal collapses that cause height loss, that classic “dowager’s hump,” and even reduced lung and abdominal space that can affect breathing and digestion.

Osteoporosis is often called a silent disease because you don’t feel bone loss happening. Most women find out after a fracture. And unfortunately, hip fractures especially can dramatically affect independence and long‑term survival.

The good news? Osteoporosis prevention is possible.

In this episode I walk through:

• How much calcium women actually need (1,000–1,200 mg daily)
• Safe vitamin D dosing (600–1,000 IU — and why more isn’t always better)
• Why adequate protein intake matters for bone strength
• The importance of weight‑bearing and resistance exercise
• Major osteoporosis risk factors
• How we diagnose bone loss with a DEXA scan
• How the FRAX score estimates 10‑year fracture risk

We also touch on estrogen and hormone therapy as part of the larger conversation around menopause and bone health — something I’ll cover more deeply in another episode.

If you’re postmenopausal, approaching menopause, have a family history of osteoporosis, or are wondering whether you need a DEXA scan, this is essential information.

Bone health after menopause is not cosmetic. It’s structural. It’s survival.

If this episode helps you, send it to your mom, your aunt, your sister — prevention works best when we start early.

You can write to us at Questions@GynoInfo.net

And follow us on: 

• Instagram @gynoinfo

Transcript

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Welcome to Gyno Info, Frank Talk with Dr. Burkey, the podcast dedicated to teaching everyday women what they need to know about their body and how it works to successfully deal with the healthcare system and communicate with their doctors. Each week, I'll provide you with new information and practical tips about gynecology and women's health care. I want to prepare you for your doctor's appointments by teaching you what to expect, what information your doctor will need to know from you, and what questions you will need and should ask her so you can be confident and make the most out of every visit. Gyno Info will give you the knowledge you need to take charge of your health and do this in a clear and frank way that you can understand without having a medical degree, one episode at a time. So now let's begin. Hello. Welcome back to Gyno Info, the podcast about women's health in normal everyday language that a normal, everyday person can understand. No special medical words, no doctor speak. And a special welcome also to those who just discovered us and are listening for the first time. Please take a moment now and subscribe to BinoInfo. It will make it easier getting back to this episode in case you have to interrupt it in the middle and would like to finish the podcast later on. The same episode might not show up in your feed anytime soon. Today's episode is actually a rerun of one we produced about a year ago explaining all about osteoporosis and why it makes older people shrink and get a humpback. Josh and I decided to slow down our GynoInfo podcast a little bit over the summer and run a new episode only every other week. So here's an episode called Why is My Grandma Shrinking? Enjoy it, learn from it, and please talk about it to as many people as you possibly can. Osteoporosis is a very serious and deadly disease, often ignored by doctors and certainly not paid enough attention to by those who will suffer a lot from it if they don't do anything to prevent it. Did you know that more women die of osteoporosis than die of breast cancer? Most women don't know that. They worry about breast cancer and do nothing about osteoporosis. You might also want to check out a second podcast on osteoporosis, episode 108, which is called Beating Osteoporosis, Strong Bones, Strong Future. It talks about what you yourself can do to prevent osteoporosis and all that suffering. It also gives you an overview about modern treatment options with powerful and effective prescription medications. But first watch, and I say watch because both of these episodes have a lot of slides. Today we're going to answer the questions why do older women shrink and get shorter? How do we turn from strong women into frail little old ladies? Why have many older women a rounded back and their head tips forward? What is a dowager's hump? And what is a dowager for that matter? First, a dowager is a very British term meaning a widow with a title or property derived from her late husband. You will find many dowagers in TV shows such as Downton Abbey or Bridgerton's. In any case, it's just another term used in England mostly for an old woman who might or might not have a humpback. The answer to the other three questions is that they all have to do with osteoporosis, postmenopausal osteoporosis specifically. The loss of bone in older women after their ovaries stop working and their period stop, which on average happens about at 52 years of age, somewhere between 45 and 56. This is why postmenopausal osteoporosis, an osteoporosis of old age, is a relatively new disease. At the beginning of the last century, let's say about 100 years ago, postmenopausal osteoporosis just did not happen because women didn't live long enough past their menopause to even get osteoporosis. In the year 1900, the average life expectancy was 52, exactly the average age of menopause. This average age of menopause has remained stable ever since people first started recording and writing about it, and it is still at 52. But the average life expectancy has steadily increased to about 62 in the 1950s, and now is around 80 or more in the richer countries. How long a woman lives, even in the richer countries, depends very much on how well-to-do a woman is. With good access to good nutrition and regular medical care and enough time to exercise and take care of herself. This is a sad fact, but unfortunately very true. Living in a rich country doesn't automatically guarantee that you yourself have the benefits of being well-to-do. So today's episode is about postmenopausal osteoporosis, about the loss of bone leading to lower amounts of bone, decreased bone mass, and lower bone strength, fragile thin bones, and ultimately bone fractures after the ovaries stop producing estrogen in the postmenopausal phase of a woman's life. Bone is a living tissue. Old bone gets broken down in the body and replaced with new bones. Because bones are on the inside of your body, you cannot really see that. It's not like skin, where you can see the dead old skin that was replaced with fresh new skin as a ring in your bathtub. There are specialized cells inside the bones that build new bone, the so-called osteoblasts. And then there are those that break down the bone, the old bone that needs to be replaced, the so-called osteoclasts. After the bones have stopped growing around age 20, for the next two or three decades, the building and breaking down of bone is in perfect balance. No more bone is being acquired, but the bone that you have is being well maintained, and old bone is replaced with new bones. As long as you provide your body with the right ingredients to make bone, that is, enough calcium, enough vitamin D so you can absorb the calcium and enough protein, healthy food, good nutrition. At the time of menopause, the time when a woman's ovaries stop producing eggs and in the process of that stop producing hormones, the most important one being estrogen, the body starts losing bone. In the first two or three years, that bone loss amounts to at least one to two, even three percent per year. Later it slows down to about 1% a year or maybe even less, but you are gonna keep losing bone for the rest of your life. And if you live long enough, as we do now, almost half of our lives after menopause, over the course of three, four, five decades, you will lose a lot of bone. That's because the osteoclasts, the cells that break down old bone, are working overtime. And the bone-building cells, the osteoblasts, cannot keep up anymore with building new bone, and so the net result is bone loss. The cells breaking down bones used to be held in check by estrogen produced by the ovaries, but after menopause, when the ovaries no longer produce estrogen, the bone resorbing cells are out of control and you lose bone. We call this process of breaking down bone bone resorption, as the material that made up the bones is reabsorbed, sucked up into the rest of the body, and carried away in the blood to be used elsewhere or discarded through the kidneys, in the urine, or the intestines in the poop. So no ring in the bathtub for bone. Depending on how much bone is lost, we either talk about osteopenia, or if even more bone has been absorbed, then we call it osteoporosis. But they're both really parts of the same process. And at a certain point, we just switch the name from osteopenia, which means little bone, penia means little or few, to osteoporosis. Bone with lots of pores, lots of holes, where parts of the bone are missing. So this combination of decreased quantity of bone plus the decreased quality of bone, that is the increased fragiless and decreased bone strength of the aging bone, which is no longer being replaced by new fresh bone, leads to osteoporotic bone fractures, the breaking of bones. If you fall out of a second-story window or you crash your bike, or you have a skiing accident and then break some bones, that is considered a normal and expected fracture. If, on the other hand, you trip over a rug and fall and either break your hip or your wrist while trying to catch yourself or crack a vertebral bone in your back, that is a typical osteoporotic fracture, a fracture from a minimal trauma. When a younger person with healthy bones would just only had a bruise but not a fracture. Such a hip fracture is often the beginning of the end for an older person. At gynoinfo, we're talking about osteoporosis in women. But men too can get osteoporosis and break their hips or their backs. But it's just five times more frequent in women than in men. After a hip fracture, an older person has only a 25% chance of returning to their own home. About half of them end up in a nursing home or some other assisted care facility, and a quarter end up dying from the complications of the hip fracture and the surgery needed to repair it. They might get a blood clot, they might get infection, or just putting an older person in bed for, let's say, the time it takes to heal and recover can make it so they never walk again right. Then not being able to move leads to social isolation and depression, and people give up and die. It's very, very common. So a hip fracture often is the beginning of the end. Sometimes you don't even need to fall if your bones are really weak and fragile. Sometimes just leaning forward and lifting something heavy may cause the front of your vertebra, the square bone blocks that make up your backbone, your spinal column, to break, resulting in a wedge-shaped bone. If you do that with several bones in a row, eventually your back will start looking like the arch in an old church and you can no longer stand up straight, you develop this hump, especially if most of the breaks happen in the upper part of your back. That's the classic Dalwager's hump. If the breaks in your spine involve your lower back as well, you get bent over sometimes to the point of being almost folded over. And if you want to look forward instead of staring down at the front of your feet, you have to lift your head and move it forward in an awkward and often painful angle. Sometimes your vertebra that used to be about an inch and a half high just crack and crash flat into themselves, not a wedge shape, but just flat without forming this wedge. We then talk of collapsed vertebra. Each cracked and collapsed vertebra is now only half an inch tall instead of one and a half inches, and then your spine just gets shorter while still remaining pretty straight. This translates into a loss of height. Half an inch for one collapsed vertebral bone, four inches for eight. From a normally tall or average woman, you turn into a little old lady. And if you were tiny to begin with, you get even tinier. I used to tease my mother that she didn't feed us well during adolescence because both my sister and I are shorter than our mother. But by the time she died at 86, I could look down on her. She was so much shorter. And not because I didn't try to treat her osteoporosis, she just wouldn't do it. Just to in my defense. And what is bad as well is that all the flesh, such as your belly, your chest, your back muscles that used to hang on a tall skeleton are now crunched together because the back that they used to hang from is much shorter. So the breasts are moving closer to the waist, and the belly is sticking out even when a woman is normal weight or skinny. And the inside of the chest cavity gets smaller, the lungs no longer fit well, and breathing gets more difficult, and you tend to get more pneumonia, which also kills you. The inside of the belly gets smaller too, and bowels, stomach, liver, and whatever else is in there gets crowded together and uncomfortable. Constipation becomes an issue in those cases. So osteoporosis is pretty miserable, and it is sometimes even called silent killer because it sneaks up on you without you feeling anything. The ages and pains you may be feeling as you age are from osteoarthritis. That's the wear and tear in your joint. It's not the osteoporosis that hurts. The first actual symptom of osteoporosis is most often a fracture, such as a hip fracture or the loss of height from vertebral collapse. But unfortunately, that usually just gets written off as a normal part of aging, which it doesn't have to be. So the good news about osteoporosis and its precursor osteopenia is that they're almost completely preventable. And that's the part I find so incredibly frustrating and infuriating. All this suffering is absolutely not necessary. All that has to be done is think about it. Think about osteoporosis. It can be mostly prevented, and they are effective medical treatment for it. As with everything, prevention is of course better than doing nothing and then having to treat. And as always, treating early and in time before any major fractures occur is better and more effective than waiting and doing nothing. Waiting and doing nothing is generally not a good idea in any kind of health context and probably life either. So let's just talk now about what can be done. A lot can be done. And for now, we're going to be talking about prevention. I will do a separate episode on actual treatment of osteoporosis when I have more time for that. Prevention actually starts with good nutrition as a child and during teenage years. You build most of your bones until about 20 and maybe a little more until about 25. And then that's it. Those are the bones you're going to go live with for the rest of your adult life. To build bones, you need to eat enough calcium and vitamin D to help the body absorb the calcium. And then you need protein. And to maintain those bones as an adult, you have to keep eating right for the rest of your life. Eating disorders such as anorexia as a teenager lead to incomplete bone formation and weak fracture prone bones for the rest of one's life. Since milk products are a major source of calcium, being lactose intolerant or on a vegan diet without calcium supplement leads to lack of bone mass, osteopenia, which puts you at risk for osteoporosis down the lane. And just being vegetarian without paying close attention to a balanced nutrition will result in a lack of bone building as well, when you can still build bones and bone loss later on after you've completed your bone formation. Leaving off pepperoni on your pizza is not an adequate vegetarian diet, but it is malnutrition. Those bits of mozzarella on the margarita are not enough to build bones. You really have to pay attention that you get enough calcium. So let's talk about what ingredients you need to build bones and to maintain bones, either from what you eat or what you add as supplements. You will need about a thousand to twelve hundred milligrams of calcium a day, the mineral that makes bones hard. 100 grams, that's three and a half ounces of hard cheese, or half of that plus a yogurt and a cup of milk will get you about your daily calcium needs. More as you get older, is the other thing you need. In some countries, vitamin D is added to some foods like milk and cereals, but not to yogurt or cheese. Ocean fish is also rich in vitamin D, but the oceans are so polluted that you can't eat too much fish anymore. You should maybe limit that to once a month. Vitamin D also gets produced in the skin when it is exposed to sunshine. But if you wear the sunblock that you should be using to prevent skin cancer and wrinkles, you're blocking the vitamin D production in the skin. So again, you're probably going to have to use vitamin D supplements. Most people need to take a dose of vitamin D, but here, bigger is not better. Those monster doses that you can see in the grocery store of 5, 10, or 20,000 international units. If you take them daily, you will destroy your kidneys with stones and calcify, harden the arteries in your heart and your brain. So not always bigger is better. Just take the recommended daily amount and pay attention to your other diet ingredients. The third ingredients for bone growth and maintenance you need is protein. That is used to make the scaffolding that the calcium is then attached to. Good sources of protein are meat, fish, dairy products, and so called legumes or pulses, such as beans, lentils, chickpeas, and then, of course, nuts. You need almost a gram of protein per kilogram of body weight, that is about half a gram of protein. Per pound. Start reading those nutrition labels and ask the internet how much protein is in what portion size of food. This is absolutely necessary. The older you are, the more protein you will need to eat because your body gets less efficient in taking it up. And you can't just have your whole protein dose for the day in one sitting. You need to distribute it over the day. Breakfast, lunch, and dinner, or a late night snack with a little bit of a protein drink. Your body can't do it all at once. And the last thing you need to prevent bone loss is so-called weight-bearing exercises, muscle training, bodybuilding, weight training. When the muscles pull on the bones, where they are attached to it, this stimulates the bone-building cells, the osteoblasts that we talked about. As we age, we tend to lose muscle mass. This is called sarcopenia. We need to pay extra attention to using and exercising our muscles the older we get. Pilates, weight training are good options. I wear a weighted 10-pound vest for walking to work and all day while I'm working, just to get a bit of weight training in. I noted that the difference between my right and my left wrist have disappeared in the 20 years since I no longer have a garden and I'm pulling weeds and I do mostly desk work. I'm not the biggest fan of exercise machines. The vest also forces me to sit up straight in front of the computer. Slouching with it is uncomfortable, so I don't do it. If you lift it up, it feels pretty heavy, but once you just clip it on, it stays here, then it makes you sit up straight. This brings me to the risk factors for osteoporosis. One of them is being underweight. Then there is age, being female, being menopausal, having a fair and delicate skin, having other people in the family with osteoporosis, and worse yet, osteoporosis fractures, being Asian, while African American descent is actually protective, smoking, inactivity, poor diet now, and especially as a child, vitamin D deficiency, lactose intolerance, and certain medications such as thyroid medications and steroids, stuff you have to take for asthma, that you can't do anything about. But this will be part of my next episode on osteoporosis and its treatment with medication. Stay tuned for that. Now we have talked about what causes osteoporosis, how it looks like and how it feels like, and answered the original question: why do older women get shorter? And what we can do to help prevent osteoporosis. The only thing we still have time for today, and the questions I'm sure you're all dying to know, is how do I know if I have osteoporosis? To know if you have osteoporosis or have lost some of your bone already, you need an exam that is called DEXA, dual energy x-ray absorptimetry. Better just stick to saying DEXA or just measuring your bone mass. That will do too. A DEXA is an X-ray exam with absolutely minimal radiation, completely painless, and you don't even have to take your clothes off. It's really a cinch. If you have mild bone loss on your DEXA measurement, you can intensify all those preventive measures we discussed and recheck in two years and see if your bones have remained stable or have gotten a little bit better. Or if you continue to lose bone and should start thinking about medications to improve them and avoid severe osteoporosis with fractures. To get a DEXA examination, you will need a doctor's order. If you need ammunition to convince your doctor to order a bone density measurement, type in FRACS F R A X fracture risk assessment tool in the search bar of any computer and start filling in the blanks. And then you just press the calculate button. This tool will then give you your fracture risk and make some recommendations that you can print out and stick it in your doctor's face. So that is all the time there is for today. I hope you found this episode useful and I was able to convince you that it is high time to begin to think about your bone health. Please tune in next time to GynoInfo and tell your friends about it and give it a like. It will make it easier for others to find us. And as always, send us your questions about this and any other topic to questions at gynoinfo.net. Again, that's questions at gynoinfoinoneword.net. Until next time, thank you for listening. And remember that you and your health are super important and deserve your full attention. Don't ever put off contacting your doctor because you're scared or embarrassed when something feels wrong about your body. Doctors are here to help you, not to judge you. And also, regular Well-woman visits are always a good idea that you should make time for. You deserve it and you owe it to yourself, and you owe it to your body and your health. This podcast is part of Pride House Media, hosted by me, Dr. Burke, produced and edited by Josh Rosenzweig. Original music composed by Nell Balaban. If you enjoyed this episode, please subscribe wherever you listen to podcasts. And while you're there, leave us a rating and a review. It really helps others discover the show. Stay connected and join the conversation by following me on Instagram and Facebook at gyneoinfo and on LinkedIn at gynoinfopodcast. Remember, any questions that I answer or information that I give you on this podcast are to be understood as information only, not treatment of your medical problems. While I'm a very knowledgeable gynecologist, I'm not your gynecologist who has talked to you and examined you personally and is therefore actually able to treat you. So please consult your own healthcare professional with any medical questions or concerns.