April Falls
As we get older, our bodies undergo various changes, due to hormonal shifts, lifestyle habits and natural ageing processes. For women, the decline in oestrogen levels in the post menopause period can significantly impact bone health, leading to increased risk of conditions like sarcopenia, an age related disease of of low muscle mass and low muscle strength or function and osteoporosis, a skeletal disease marked by low bone mass and skeletal fragility.
Hormone changes
Oestrogen, the primary female sex hormone, plays a crucial role in maintaining bone strength. During puberty, oestrogen levels rise, and peak bone mass is achieved around the age of 30. However, during the post menopause period the decline in oestrogen levels coincide with bone loss and an increased risk of osteoporosis. Additionally, the decline of Impact Growth Hormone and Muscle Protein Synthesis during this time, contribute to reduced muscle mass, and muscle strength.
Lifestyle changes
Additionally, it is inconclusive if it is hormonal changes or the role of natural ageing and lifestyle changes that primarily contributes to loss of muscle mass. Research suggests that post-menopausal women are more likely to report lower levels of physical activity and reduced protein intake, both of which contribute to decreased muscle mass and function.
Understanding the Risks:
The reduction in bone mineral density, functional capacity and muscle strength, due to ageing and during the menopause transition, are all major factors contributing the the prevalence of falls. This is a major concern in Australia, with falls being the leading cause of hospitalizations for individuals over the age of 45. It is estimated that 4.7million Australians over the age of 50 years have a diagnosis of osteoporosis and osteopenia - often this diagnosis occurs after individuals have already experienced a fall and a fracture. In Australia, on average 1 in 2 women over the age of 50 experience a bone fracture due to a fall, with 30% of these falls often resulting in severe injuries such as head trauma or hip fractures.
Strategies
This is where we come in! And more importantly the role of exercise! We know exercise can improve muscle strength and bone mineral density. This can look like:
Strength training: It’s never too late to start making bone changes! Research suggests that exercise training can prevent fracture risk even when started post menopause. In-fact, exercises done with higher load and less reps, are more effective for bone health than more reps.
Balance Training: This can look like exercises that alter and reduce the base of support, change the centre of gravity, reduce the need for arm support and incorporate dual tasking. Volume is important with balance, the more often and the more variety - the better.
https://www.aihw.gov.au/reports/injury/falls
https://www.aihw.gov.au/reports/injury/hip-fracture-injuries/contents/key-findings
https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoporosis
Farlie, M. K., Robins, L., Keating, J. L., Molloy, E., & Haines, T. P. (2013). Intensity of challenge to the balance system is not reported in the prescription of balance exercises in randomised trials: a systematic review. Journal of physiotherapy, 59(4), 227–235. https://doi.org/10.1016/S1836-9553(13)70199-1
Kemmler, W., Bebenek, M., Kohl, M., & von Stengel, S. (2015). Exercise and fractures in postmenopausal women. Final results of the controlled Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 26(10), 2491–2499. https://doi.org/10.1007/s00198-015-3165-3
Mohebbi, R., Shojaa, M., Kohl, M., von Stengel, S., Jakob, F., Kerschan-Schindl, K., Lange, U., Peters, S., Thomasius, F., Uder, M., & Kemmler, W. (2023). Exercise training and bone mineral density in postmenopausal women: an updated systematic review and meta-analysis of intervention studies with emphasis on potential moderators. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 34(7), 1145–1178. https://doi.org/10.1007/s00198-023-06682-1
