Snapped like a Twig
I’m at the dog park. We are ready to leave and I slip the leash onto my dog’s collar. As I turn to unlatch the gate his attention shifts to a dog in his periphery. He sees a ball and makes a lunge for it. My hand is twisted in his leash and I know almost before it happens that something is going to be hurt. It’s caught in the leash and bent backwards. I know almost immediately that my ring finger is broken. Snapped like a twig. I’m 46 and although I was a trauma operating nurse for 6 years, I have never broken a bone.
Fluctuating Estrogen, Rising Cortisol
According to data from the ethnically/racially diverse Study of Women’s Health Across the Nation (SWAN), one of the largest studies of menopause, rapid bone loss is a possibility for many women in a three-year period from the last menstrual period. Bone mineral density loss in the menopause transition is intrinsically tied to fluctuating levels of circulating estrogen, which protects bones. In perimenopause—which begins, on average, four years before a woman’s final menstrual period and extends into the first 12 months of the early postmenopause stage—estrogen levels begin to decline and then fall sharply, potentially slowing production of new bone tissue.
At the same time, cortisol levels, which are important for both bone health and muscle function, rise as part of the aging process. For many women, cortisol also rises as part of the transition to menopause and is a constant presence in women’s lives as a result of midlife stress. A 2019 study based on analysis of data from the largest study to date on menopause, the Women’s Health Initiative, traced the presence of significant social stress, in which cortisol plays a role, to increased risk for osteoporosis and fracture-prone bones in postmenopausal women.
Elevated cortisol levels trigger bone mineral removal and block calcium absorption, which decrease bone cell growth and set the stage for osteoporosis and propensity for fracture.
Perimenopause is a great time to step up activities that help to prevent bone loss and reduce the risk for osteoporosis and fracture. And maybe you already participate in regular strenuous exercise (e.g., intense running, cycling, power yoga). These activities are all important for cardiovascular health. But they can also trigger cortisol bursts and subsequent bone density loss.
Yoga Tools for Balance, Stability, Strength
So, in addition to vigorous yang practices like running, consider engaging in weight-bearing and muscle-strengthening activities that encourage movement against gravity and use resistance (e.g., using resistance bands or weights). Slow, steady forms of yoga practice are also a terrific way to build bone and muscle strength and keep joints fluid and mobile.
A caveat, though, for perimenopausal women with existing low bone density and/or osteoporosis. Certain yoga poses can exaggerate spinal compression and rotation such as forward bends, plough and deep twists (e.g., half lord of the fishes). The National Osteoporosis Foundation suggests avoiding these movements or moving in and out of them with caution. Instead, focus on standing balance and spinal postures to build bone density, muscle tone, and flexibility.