Peri-menopause and Osteoporosis
Recently, I had my first DEXA scan to check my bone density. I’m 46 and in the peri-menopause stage of life. If you are wondering why I’m concerned about bone density at this age, you may need to be more informed about the effects of hormones on bone health. According to research, women lose approximately 20% of their bone density during the first five years after menopause. Therefore, establishing a baseline and learning how to prevent or slow this process is crucial for a healthy old age.
Unfortunately, due to a flawed research in the early 2000 that linked Hormone Replacement Therapy (HRT) with increased risk of breast cancer, many women in the US, now in their 60s, were not offered HRT and are now facing surprise diagnoses such as osteoporosis. However, hormone therapy is not the only answer to prevent osteoporosis. Many women who are not interested in HRT, or who have risk factors that prevent them from receiving it, can still age with strong, healthy bones. In this blog, I’m going to share my understanding of various holistic modalities, the importance of exercise and diet, and basic information about bone formation and how to prevent osteoporosis holistically.
Before I start I also want to point that a DEXA scan measures bone density, not necessarily quality or strength. For example, areas with arthritis might appear denser on a scan, but that doesn't mean the bone is stronger. Other blood tests can provide more information regarding the actual quality and strength of the skeletal system.
The Perspective of Chinese Medicine
From the Chinese Medicine perspective, bones exist at the deepest, densest level of our body. The Kidneys store our essence—what we call Jing—and are in charge of our fertility, brain, hormones, and bone marrow. We are each born with a unique Kidney resource, or constitution. You can think of this as our genetics, which includes the quality of our bones as well as other physical traits like hair, skin, nails, body shape, brain and facial features.
As we grow, women go through seven-year cycles and men through eight-year cycles. During the first three cycles of life, our Kidney energy expands until we reach puberty. From the third to the fifth cycle, our essence reaches a plateau; this is when we are at the peak of our fertility and bone density. After that, for women at the age of 35 and men at 40, our resources begin to diminish, and we start to see the effects of our lifestyle. Our immune system is affected, dormant issues may arise, our nervous system becomes more fragile, digestion may slow, and we begin to see the pull of gravity on our skin and muscles.
Preserving the Essence
The premise of Chinese Medicine is that by adopting a lifestyle that preserves our essence, we can not only prevent but even oppose the aging process. We preserve the Kidneys by optimizing all our organs—an idea used in internal martial arts practices such as Qi Gong. Although we cannot change our Jing or genetic makeup, we have full control over the function of our lungs, digestion, liver, and heart.
By breathing deeply and performing exercises that expand our lungs, we increase lung Qi. By eating proper foods, we support our digestion and build muscle to counteract the pull of gravity on our muscular and cardiovascular systems. By reducing stress and being mindful of our sleep and toxin exposure, we support the Liver, which is responsible for the smooth flow of energy and hormones. Finally, by protecting our Heart and maintaining clear relationships with ourselves and others, we help the Heart remain calm and joyful.
All of our organs when they are in a state of imbalance, either stagnant or deficient, they take away resources from our kidney essence to heal themselves. You can think of the essence as an underground source of energy that is there for emergency situation. As long as we are keeping a balanced lifestyle we don’t need to tap into our emergency resource. But when we are sick or under stress, the kidneys get activated and our essence diminishes. In this way our bones, marrow, hormones, adrenals, sexual organs, become the source of what keeps us balanced in life, and they pay the toll at the end of the day.
A bio medical explanation
I’m going to try to explain the biomedical view and my understanding of how the Chinese Medicine translates into our modern understanding of our body. I’ll first explain the biochemistry of our bones. Simply put, there are two main types of cells responsible for bone health: osteoblasts and osteoclasts. The former creates bone, while the latter breaks it down. Every time our muscles are stressed (through exercise), they communicate that stress to the bones. This stimulates both cell types, allowing the body to destroy old cells and replace them with new, healthy ones.
As we age, the work of these two groups falls out of balance. Osteoclasts become more active than osteoblasts, leading to bone loss. New research shows that a hyperactive immune response—due to chronic stress or environmental toxins—creates systemic inflammation that interferes with osteoblasts and bone marrow. Essentially, if we can decrease inflammation, we can preserve and create healthy bone.
Inflammation and "Heat"
In Chinese Medicine, "Heat" is the closest translation to what we understand as inflammation in modern science. There are two types of heat. Excess heat and deficient heat. Excess heat can manifest as physical redness or warmth in the joints and skin, or as restless sleep, strong emotions (especially anger), constipation, acid reflux, UTIs, or anxiety. When our Heart is not at peace—when we are restless, worried, or mentally preoccupied—we create Heat in our body. When our organs are not working optimally, they are either stagnant, which creates heat, or deficient, which can cause imbalance and lead to heat as well. In Chinese medicine we have a lot of modalities and herbs that help with clearing heat. But clearing heat is not the only approach that helps reduce inflammation. Any modality that moves the energy, will help clear stagnation in the body that could lead to heat. And sometimes when there is a deficiency, nourishing the yin element, nourishing kidneys and the essence is the answer to anchoring the deficient heat, the heat that is rising due to a lack of enough cooling. It’s all about balancing yin and yang elements where each hold the other in check. In fact that is also how Chinese Medicine explains hot flushes. A heat that rises due to deficiency of kidney yin in the body.
Looking at bones through this lens, I don’t think of them as inert pieces of wood or metal, but as a living organs that are constantly able to regenerate, heal, and strengthen themselves.
Practical Steps for Bone Health
Reducing daily stress, sleeping well, and optimizing digestion through a balanced diet and bioavailable supplements (including probiotics) are the best ways to preserve bone density. While increasing Calcium and Vitamin D is generally advised, intake should be monitored through routine blood work.
Watching our diet is one of the most important ways to affect our bone health, at the same time it’s totally available to us. In my experience with diet the main key is to listen to your body’s messages. If you crave meat, please eat it. If it makes you uncomfortable and feel indigestion every time afterwards, please don’t eat it! It’s that simple. Most clients that I see with digestive issues have been keeping journals and know exactly what food works or doesn’t work for them. Gluten and dairy are not always culprits of creating inflammation. In fact when I had ezcema a few years ago and I finally did an elimination diet, I learnt that vegetables with salicylates were the source of my inflammation. Green leafy veggies, together with nightshades and garlic were giving me trouble at that time. But my body has changed since, and I don’t have major issues with them at this moment. So the key for me is to listen to my body in present. What do I feel like eating? How do I combine my food? Sometimes one thing by itself is ok, but if I mix too many different ingredient, then problems arise. Eating sugar and processed food is another culprit that affects the liver as well as our digestion and whole body. Having a regular bowel movement that feels completely emptying is another main way to know your body is processing food optimally. So if anything is out of your norm look back at what you ate. Think about it, every time your body is not happy with what you are eating, your bones are going to be affected.
In terms of exercise, a combination of weight training and cardio is ideal. If someone already has osteoporosis (a DEXA score of -2.5 or lower), high-impact exercises or workouts that increase the risk of falls should be moderated. If you are new to exercise, start slow and steady to avoid injury.
I have been a runner since my 20s and have practiced martial arts and yoga for years. These days, I am shifting my routine to target bone health more intelligently. I’ve added a weighted backpack to my hikes and started doing more weighted squats. The key is to vary the routine to activate different muscles and bones so they don’t get used to one thing.
Finally, I am deeply interested in meditation and breathing exercises that visualize and energize the body at the bone/Kidney level. We are not just conductors of electricity; we hold an electromagnetic field. Our bones, being the densest and most "crystallized" part of our body, are affected by this field. Practices such as Qi Gong focus specifically on this connection, using the breath to strengthen the very core of our being and our bones.
I hope you agree with me that getting a DEXA scan at peri-menopause was a great wake up call. Even though my score was not fantastic, I know that now is my time to strengthen my bones and create good habits so that I can enjoy my old age, without injury and pain.
If you are interested in learning more about the biomedical research on bones and osteoporosis:
Great Bones, Taking Control of Your Osteoporosis. By R. Keith McCormick, DC.