Author: Dr. Bryce Hendy, DC, DNCert
When women are perimenopausal or already in menopause there is a drastic decrease in estrogen production. This is due to the ovaries’ decreased function and decrease in follicle production. The follicles in the ovaries are responsible for producing eggs and the main source of estrogen in the female body. When the follicle production decreases with menopause, the pituitary gland tries to help stimulate production by releasing follicle stimulating hormone (FSH) and Luteinizing Hormone (LH), but the ovaries are no longer responsive to the stimulation from these hormones.
There are two main hormones involved with osteoporosis in menopausal women. Both are produced by the parathyroid gland, Parathyroid Hormone (PTH) and Calcitonin. Parathyroid hormone is indirectly responsible for causing bone resorption and releasing calcium into the bloodstream. PTH does this to help increase levels of calcium in the bloodstream. PTH indirectly activates osteoclasts which are bone-resorbing cells, by blocking or deactivating osteoblasts, which are cells that help build new bone. Calcitonin is a hormone that helps to take calcium from the bloodstream and store in the bones and help maintain levels of calcium in the blood. Calcitonin also inhibits the osteoclast cells in the bone. PTH and Calcitonin have opposing
actions, PTH pulls calcium from bones into blood and Calcitonin pulls calcium from the blood into the bones.
Due to the opposing actions of PTH and Calcitonin, the parathyroid gland only releases one hormone at a time. With a healthy range of estrogen in the blood, PTH is regulated and is only released when the blood calcium levels are low. When estrogen levels are below a healthy range, PTH starts to go un-regulated and can be released when blood calcium levels are within a normal range. Calcitonin is then released less so blood calcium levels start to regularly increase along with bone resorption via the osteoclasts. The decrease in bone calcium levels leads to a breakdown of the matrix inside of the bones, which decreases the density of the bones.
Osteoporosis is defined as a decrease in the density of the bones. This can be measured with a DEXA scan, which gives a Z-score and T-score for bone density. T-scores are compared to the bone density of a young adult of the same sex, while z-scores are compared to bone density levels of a person of your same age and sex. A Z-score and T-score of -2.5 is considered osteoporosis.
Women who are in menopause and have osteoporosis can experience pain and discomfort related to the lower bone density. They are also at a higher risk for falls and due to the decrease in bone density, also a higher risk for fracture. Chiropractic care that takes into consideration the decrease in bone density can help with pain management and care that incorporates activity modifications, can help to manage fall risk. Increased activity levels also cause increased stress on bones which stimulates osteoblast production of new bone and can help to increase bone density. Supplementation can also help to manage hormone levels to help better regulate blood calcium levels and bone resorption. Women who are in menopause and over the age of 65
should have a DEXA scan done every 2 years and anyone who has been previously diagnosed with osteoporosis should have a DEXA scan done every year.
