Osteoporosis Kills: What Every Woman Needs to Know After Menopause

This is a bonus episode that is a follow up to this week’s re-airing of another episode on osteoporosis.   

Osteoporosis is one of those things people ignore… until someone breaks a hip. And by then, we’re playing catch‑up.

Let me say this clearly: osteoporosis is not just “getting older.” It’s real bone loss. And yes — it can absolutely shorten lives.

After menopause, when your ovaries stop making estrogen, bone loss speeds up. Fast. What starts as osteopenia (which just means early bone thinning) can turn into full osteoporosis. That’s when bones get fragile enough that a simple fall — or sometimes just bending the wrong way — can cause a fracture.

I see this every week. Height loss. Rounded upper backs. Vertebral compression fractures where the spine literally collapses a little. And hip fractures? Those can completely change someone’s independence.

In this episode, I walk you through what’s actually happening in your bones after menopause and how we diagnose it with a DEXA scan (that’s the bone density test). I also explain why you don’t feel osteoporosis happening — it’s silent until something breaks.

The good news? There is a LOT you can do.

We talk about prevention starting way earlier than people think — even in the teen years. Protein matters. Calcium matters. Vitamin D matters (but more isn’t always better). Strength training and weight‑bearing exercise are huge. And balance training reduces falls, which reduces fractures.

Then I break down treatment options in plain English. Some medications slow bone breakdown (like bisphosphonates and raloxifene). Some build new bone (like the daily injection anabolic medications). Some do a little of both. We talk about Prolia and why you can’t just stop it abruptly without a plan. And yes — we talk about estrogen, which is the most natural treatment for bone loss and also helps with other menopausal symptoms.

My goal with this episode is simple: I don’t want you to wait for a fracture to take your bone health seriously.

If you’re postmenopausal, nearing menopause, have a family history of osteoporosis, or you’re wondering whether you need a DEXA scan — this episode is for you.

Your bones are your frame. Protect them.

You can write to us at Questions@GynoInfo.net

And follow us on: 

• Instagram @gynoinfo

Transcript

SPEAKER_00 0:00

Welcome to Gyno Info, Frank Talk with Dr. Berkey, 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. GyneInfo 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. Welcome back to Gyno Info, the podcast about women's health in normal, everyday language that normal, everyday people can understand. No special medical words, no doctor speak. A special welcome to those who just discovered us and are listening for the first time. And please take a moment now to subscribe to GynoInfo. 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 a rerun of one we produced about a year ago on an important and often overlooked serious disease called osteoporosis. Osteoporosis actually is the only disease I know of for which men get treated even worse than women. It is almost always the other way around for just about any other illness. This podcast is called Beating Osteoporosis, Strong Bones, Strong Future. It talks about what you yourself can do to prevent osteoporosis and prevent all that suffering. It also gives you an overview about modern treatment options with powerful and effective prescription medications. Josh and I decided to slow down our Gaino Info podcast a little bit over the summer and run a new episode only every other week. So here is an episode called Osteoporosis Kills. Enjoy it, learn from it, and please talk to as many people as possible about it. Osteoporosis is a 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. You might also want to check out a second podcast on osteoporosis, episode 107, which is called Why is My Grandma Shrinking? It explains all about what osteoporosis is and why it makes older people shrink and get a hump back. You might even want to watch this one first. I say watch because both these podcasts have a lot of slides. Hello. Welcome back to Gyno Info. And if this is your first time, just welcome. I'm so glad you discovered us. In this podcast, we discuss common gynacological problems in a frank and open way that everyday women can understand without having to use a medical dictionary. Last time we talked about postmenopausal osteoporosis. There are also other types of osteoporosis and osteoporosis in men, but since this is gyno info, we'll leave those out for now. If you have not yet seen or heard my episode on why older women shrink, you might listen to that first because today we'll mostly talk about how to treat postmenopausal osteoporosis. So first I'm gonna give you a little recap. What is postmenopausal osteoporosis? It is the loss of bone substance and bone strength that happens after woman's ovaries stop producing estrogen. That is, after a woman enters menopause. This leads to weak and more fragile bones, first to osteopenia, beginning bone loss, and then to full blown osteoporosis, and eventually, of course, to bone fractures, even with minimal accidents, such as tripping over a carpet, or even fractures spontaneously. When the vertebral bodies, those are the bones that make up your backbones, simply collapse in themselves. They can do that like a pancake, then you just get shorter, or in a wedge shape like this, then your back gets bent. How do you know you have it? That's easy. In the first place, you need to think about it. That's the most important thing. And then you can ask your doctor to order a bone density test, a so-called DEXA study. For that you need a prescription. And of course, if you broke some your hip stumbling, or your wrist when you tried to catch yourself, or you have shrunk three inches, you also have the diagnosis. That's osteoporosis, and it's not normal. Now, how can you try to prevent postmenopausal osteoporosis? First, you will need to eat well when you're a teenager, the time when you build most of the bones that you will have as an adult. After about age 25, you can unfortunately never catch up and make up for what you missed by not eating right earlier on. You will also need to eat well and provide your body with the right ingredients to maintain your bones for the rest of your life as an adult and as an old adult. You will need protein, calcium, vitamin D so you can absorb the calcium. How much of each and in what foods you can find these ingredients I discussed in my previous episode on postmenopausal osteoporosis. The other extremely important thing for both prevention and treatment of osteoporosis is exercise. And I'm not talking about cardio, I'm talking about weights or hard physical work. Incidentally, this is why astronauts all lose bone and muscle in space. They don't need to use their muscles much in a weightless state. In the olden days, astronauts could hardly walk when they came back to Earth. But now we know more about it and they have rigorous isometric exercise regimens where you consciously contract your muscles and they are given preventive osteoporosis medications. But now back to women on Earth. Because at least hip and wrist fractures generally happen with a fall, you should really practice your balance so when you trip, you can catch yourself before you crash and break a bone. Now let's discuss the specific medications used to treat postmenopausal osteoporosis. As I discussed at length in my last week's episodes on osteoporosis, one of the major problems which leads to bone loss and postmenopausal osteoporosis is that after menopause more old bone is absorbed, removed, then new bone is being built, formed a new. Bone is a living tissue where old bone is constantly replaced by new bone. And between the early 20s, when the bone building process is finished, and menopause, when you start losing bone, this process is in perfect balance and the amount of bone remains pretty much the same. One of the most important regulators of this so-called bone turnover process is estrogen, a hormone that women produce in their ovaries. On the one hand, estrogen stimulates the bone-building cells, and on the other hand, estrogen keeps the cells that are breaking down old bones in check. So the bone-building cells can keep up. When both egg and estrogen production stops with the menopause, this important estrogen action falls away, and the result is bone loss. The cells removing old bone are out of control, remove too much bone, and the building cells cannot keep up. This basic mechanism is really what defines all osteoporosis medications. There are medications that inhibit the bone removing cells, the bone absorbing cells. These are the so-called anti-resorptive medications. Then there are medications that stimulate bone growth. They stimulate the bone-building cells. Those are called anabolic medications. And then there are the medications that do both. That's it. The other way you can divide osteoporosis treatment medications is into those that work just on the bone. They're called the bone-only medications. And some that have additional positive effects and other symptoms of menopause, such as hot flashes. We call those the bone plus medications. The oldest group of the antiresorptive medications are the bisphosphonates. They can be taken daily or weekly as pills, or then as shots every three months or every 12 months, and they only affect bones without any effect on other menopausal symptoms. So they're bone-only medications. The main drawback is that the pill form of these anti-resorptive medications is poorly taken up by the body, and it's also very irritating to the stomach. So nowadays they're mostly given as infusions directly into the vein. In the higher doses given every three or 12 months, very few people will get some flu-like ages and pains that generally respond to acetominophens such as Tylenol, and they don't happen after the first time. In some people, only about 1%, but some other people can be up to 6%. Importantly, bisphosphonates are built into the new bone and are reused by the body even after the treatment is stopped. For that reason, they continue to keep the bone stable for a couple of years after the end of treatment. You can treat for a while with them and then you stop them for a couple of years and you can restart them again, or you can restart a different medication before you again give bisphosphonates. Those are various options that they're useful for. And this is very important as postmenopausal bone loss lasts as long as the menopause, as long as you live for the rest of your life. A second type of anti-resorptive medications is raloxifen. Raloxifen is a cousin of tamoxifen, a drug that is used in the treatment of breast cancer and also to prevent recurrence of breast cancer. Raloxifen not only inhibits the cells that break down bone, but it also inhibits breast cancer cells, at least some of them. Not the worst of breast cancers, but it's nevertheless a very positive side effect. They're slightly less effective than bisphosphonates as far as bones are concerned. The main drawback of rhiloxifen is that it does not treat hop flashes. You would think it'd be the perfect medication. It lowers risk of breast cancer, it helps the bones, but it does not treat hop flashes, also doesn't treat other menopausal symptoms such as dry vagina. And it also slightly increases the risk of blood clots, so it cannot be used in women with blood clot problems and thrombosis. Another very effective osteoporosis treatment are the so-called monoclonal antibodies. One of the best known of those is sold under the brand name Proia. They're not only anti-resorptive medications, but also have an anabolic effect. They also stimulate bone building cells. For that reason, they lead to greater bone gain than the bisphosphonids, but being newer are also much more expensive. And they too are bone-only medications. They're given as a shot under the skin with a tiny needle either every month or every six months. And very few patients have any kind of major side effects. But as soon as you stop them, you will start losing all the bone you gained and quite rapidly, which sometimes can lead to fractures. For this reason, the monoclonal antibodies need an after-treatment with a bisphosphonate to consolidate the bone that you have gained, to stabilize your bone. They're also highly effective, purely anabolic medications, but they have to be given as a daily shot, which is not really everybody's cup of tea. And they're ungodly expensive. But they're highly effective, and you can gain more than 10% of bone per year. The insurance companies will usually only agree to pay them in people who are continuing to have fractures under less expensive treatments because they're so expensive. All the osteoporosis medications I mentioned up to now not only improve bone mass, but they also reduce fractures, which is what we really care about. And all these medications are very effective, artificial pharmaceutical compounds designed in a lab, and they require a prescription. They're all great options for people who have severe osteoporosis with multiple fractures that require the most potent medications and also for people who couldn't take estrogen. But the most natural way to prevent and treat postmenopausal osteoporosis is hands-down estrogen. It's the lack of estrogen which after all causes the problem in the first place. And estrogen, of course, treats all the other menopausal symptoms at the same time. Luckily, human estrogen, and we're not talking about plant estrogens, as you're neither a red clover nor a soybean, but a human. These identical human estrogens that are produced by the ovaries before menopause are now available by prescription in the form of pills, sprays, patches, or gels. The marketing buzzword often uses bioidentical, but it just means they're the same as what the ovary produces. We will talk about the ins and outs of menopausal hormone treatment another time. This here is just a general overview of treatment options for postmenopausal osteoporosis, and estrogen is one of them. But that is all there is time for today. I hope you found this information on postmenopausal bone loss and its treatment useful. And we'll tune in next week again to GynoInfo and tell all your friends about it and give us a few likes, which makes it easier for other people to find us. And remember, you can send in any questions you might have or even suggestions for future episodes to questions at gynoinfo.net. That is questions at gynoinfooneword.net. And now my life tip for the day make somebody a compliment today. It will make both of you happy. And it sets the mood for anything you will want to talk with that person after that. It works. Thank you for listening and have a good day and a good week. 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 Wellwoman 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. Berkey, 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 gynoinfo and on LinkedIn at gynefo podcast. 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.