Osteoporosis: A Global Pandemic For Postmenopausal Women

Authored By: Celine Kim Art By: Caitlin Sweeney Joan, a woman in her early 50s, was hospitalized after falling off her bicycle and experiencing a sharp pain in her spine. Initially expecting a simple fracture, she was alarmed to discover that she had osteoporosis [1]. Over a decade later, Joan continues to rely on various medications, enduring persistent pain and the constant fear of fractures. Unfortunately, osteoporosis has no cure [2]. Joan represents one of 200 million women worldwide affected by this debilitating disease [3].

Osteoporosis is a non-communicable skeletal disorder characterized by weakened, fragile bones, making them more susceptible to fractures [4]. The term is derived from the Latin words "osteo" for bone and "porosis" for porous, reflecting the condition's trait of bone porosity [5]. Globally, 18.3% of the population is affected [6]. The condition is particularly prevalent among women, with one in five individuals over the age of 50 and one in two postmenopausal women affected [7,8]. Several factors such as family history, age, and lifestyle choices contribute to this condition, but a significant risk factor is the decline in estrogen levels in postmenopausal women [9].

Science Behind Estrogen & Bone Health

Osteoblasts are cells that form the bone and osteoclasts are cells that break down and reabsorbs the bone [10]. The balance between the two is critical in maintaining healthy and strong bone structure. People with osteoporosis suffer from an imbalance – either due to a lack of osteoblasts or an abundance of osteoclasts.

Estrogen is well-known for its role in the development of female sexual characteristics, yet many are unaware of its crucial role in bone metabolism: inhibiting osteoblast apoptosis and enhancing osteoblast lifespan [11]. Estrogen promotes autophagy – cell degradation and reuse – in osteoblasts during differentiation, which strengthens their survival capacity [12]. Therefore, a reduction in estrogen levels during menopause can cause decreased osteoblast activity, resulting in reduced bone formation and an increased risk of osteoporosis.

Implications of Osteoporosis

Osteoporosis affects millions of postmenopausal women worldwide, yet it remains largely overlooked and undertreated. This is primarily because osteoporosis is a “silent” disease, showing no visible symptoms. As a result, many patients remain unaware of their condition until they experience a fracture. In fact, research reveals that approximately 80% of patients with osteoporosis are not identified or treated [13]. It is critical for osteoporosis to be taken seriously, as it can become irreversibly life-threatening: physically and mentally.

Physical

Fractures can happen unexpectedly when bone is weak. Minimal stress, such as bending forward or coughing, can cause the bone to break [14]. Osteoporotic fractures, particularly in the first year post-injury, carry a 15% mortality rate for women [15]. Recurrent fractures significantly increase mortality risk, with rates rising to 50% after subsequent fractures [16]. Other physical consequences of osteoporosis include osteoarthritis, nerve damage, and kyphosis [17].

Mental

During menopause, estrogen levels significantly drop, subsequently causing serotonin levels to fall [18]. Serotonin helps regulate human emotion, thus, its decline can provoke negative feelings like anxiety and depression. Postmenopausal women with osteoporosis face even greater challenges. Since osteoporosis is incurable, these patients not only endure serotonin-related mood swings, but also live in fear of fractures [19]. Research highlights the prevalence of mental distress among osteoporosis patients including struggles with social reciprocity, loneliness, and social isolation. Additionally, studies indicate that 86.9% of osteoporosis patients suffer from mild to moderate levels of depression, underscoring the need for comprehensive care [20].

Promoting Healthy Aging Through Prevention

Adopting a healthy lifestyle is essential in preventing osteoporosis and promoting overall well-being in postmenopausal women. A balanced diet, particularly one rich in vitamin D, is crucial for calcium absorption and bone strength. Regular exercises,such as walking and jogging, can enhance bone density and build muscle strength, significantly reducing fracture risk [21]. For postmenopausal women, estrogen therapy started early after menopause, can be highly effective in preventing bone loss [22]. Additionally, regular screenings and checkups can also help identify low bone density and risk of osteoporosis, especially for women aged 50 and older. Given that osteoporosis is currently incurable, proactive prevention and consistent management are vital. It is time to secure a future where healthy aging is possible.

Works Cited

1. My Menopause Story: Managing Daily Life With Osteoporosis. (2019). Acog.org. https://www.acog.org/womens-health/experts-and-stories/the-latest/my-menopause-story-managing-daily-life-with-osteoporosis

2. Health Direct. (2018). Osteoporosis. Health Direct; Healthdirect Australia. https://www.healthdirect.gov.au/osteoporosis

3. International Osteoporosis Foundation. (n.d.). Epidemiology | International Osteoporosis Foundation. Www.osteoporosis.foundation. https://www.osteoporosis.foundation/health-professionals/about-osteoporosis/epidemiology

4. National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2022, December). Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/osteoporosis

5. Dipti, Khandelwal, R., Aggarwal, A., & Jaiswal, M. L. (2016). Ayurveda medicinal plants for Asthikshaya (Osteoporosis): A review. Journal of Ayurvedic and Herbal Medicine, 2(6), 229–235. https://doi.org/10.31254/jahm.2016.2608

6. Salari, N., Ghasemi, H., Mohammadi, L., Behzadi, M. hasan, Rabieenia, E., Shohaimi, S., & Mohammadi, M. (2021). The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 16(1). https://doi.org/10.1186/s13018-021-02772-0

7. National Institute on Aging. (2022, November 15). Osteoporosis. National Institute on Aging. https://www.nia.nih.gov/health/osteoporosis/osteoporosis

8. Endocrine Society. (2022). Menopause and Bone Loss. Www.endocrine.org. https://www.endocrine.org/patient-engagement/endocrine-library/menopause-and-bone-los

9. Mayo Clinic. (2024, February 24). Osteoporosis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968

10. Cleveland Clinic. (2023, March 27). Osteoblasts & Osteoclasts: Function, Purpose & Anatomy. Cleveland Clinic. https://my.clevelandclinic.org/health/body/24871-osteoblasts-and-osteoclasts

11. Bradford, P. G., Gerace, K. V., Roland, R. L., & Chrzan, B. G. (2010). Estrogen Regulation of Apoptosis in Osteoblasts. Physiology & Behavior, 99(2), 181–185. https://doi.org/10.1016/j.physbeh.2009.04.025

12. Gavali, S., Gupta, M. K., Daswani, B., Wani, M. R., Sirdeshmukh, R., & Khatkhatay, M. I. (2019). Estrogen enhances human osteoblast survival and function via promotion of autophagy. Biochimica et Biophysica Acta (BBA) - Molecular Cell Research, 1866(9), 1498–1507. https://doi.org/10.1016/j.bbamcr.2019.06.01

13. On world osteoporosis day, experts warn of growing burden of fragility fractures: International Osteoporosis Foundation. IOF International Osteoporosis Foundation. (2024a, October 18). https://www.osteoporosis.foundation/news/world-osteoporosis-day-experts-warn-growing-burden-fragility-fractures-20241018-0503

14. Mayo Foundation for Medical Education and Research. (2024, February 24). Osteoporosis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968

15. U.S. Department of Health and Human Services. (2025, March 18). Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/osteoporosis

16. Zhang, Y., Tan, X., & Tang, C. (2024, June 19). Estrogen-immuno-neuromodulation disorders in Menopausal Depression - Journal of Neuroinflammation. BioMed Central. https://jneuroinflammation.biomedcentral.com/articles/10.1186/s12974-024-03152-1

17. Rizzo, M., Tammaro, G., Guarino, A., Basso, M., Cozzolino, A., & Mariconda, M. (2022, October 13). Quality of life in osteoporotic patients. Orthopedic reviews. https://pmc.ncbi.nlm.nih.gov/articles/PMC9568431/#ref-list1

18. Kashfi, S. S., Abdollahi, G., Hassanzadeh, J., Mokarami, H., & Khani Jeihooni, A. (2022, July 1). The relationship between osteoporosis and Depression. Scientific reports. https://pmc.ncbi.nlm.nih.gov/articles/PMC9249757/

19. Department of Health & Human Services. (1999, October 26). Osteoporosis. Better Health Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/osteoporosis

20. U.S. Department of Health and Human Services. (2025a, March 18). Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/osteoporosis/diagnosis-treatment-and-steps-to-take