• Tamar Rothenberg, MS, RD

Use these nutrition tips for bone health at the onset of menopause

Menopause is when your menstrual cycle PAUSEs—for good. But for breast cancer survivors, menopause can feel like a hard stop and anything but a 'pause' after breast cancer treatments.


Once menopause officially begins, your risk for both heart disease and osteoporosis rises. Why does this even happen? Some of the reasons behind all these changes include your changing hormones, genetics, metabolism, stress levels, and lifestyle.


Women spend one-third of their life in menopause, starting at an average age of 51. It's important to note that menopause is not a disease to be treated, but rather a normal stage of life.


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Women spend 1/3 of their life in menopause
Women spend 1/3 of their life in menopause

Many women diagnosed with breast cancer are already in menopause. Yet among 240,000 women diagnosed with breast cancer, 25% were premenopausal, and only 30% resumed their menstrual cycles after chemotherapy. This means they will spend more time in menopause and need to protect their bones.


Women will typically have osteoporosis-linked fractures in their 50's in their wrist or upper arm. Hip fractures generally occur at a much later age.


Because your body goes through all these changes, its nutritional needs also change. Here are some expert nutrition and lifestyle tips to promote bone health and prevent bone breakage.


Avoid alcohol


You know that alcohol isn’t the best drink for breast cancer—especially too much. Alcohol will increase your risk of getting or worsening many health conditions. Not to mention it can even lead to loss of muscle mass, balance problems, falls, and accidents. We lose bone faster than building it after menopause, and alcohol contributes to even more bone loss. Breast cancer survivors have a 31% higher risk of fractures. So try my recipe for a fun mocktail instead.


Hibiscus Tea Sangria Mocktail
Hibiscus Tea Sangria Mocktail

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Add in movement you enjoy


Movement lowers risk of recurrence, improves functioning and quality of life for thrivers, helps lift mild depression, and well, just makes life easier. What does it do for our bones?


After menopause, lower estrogen levels also reduces muscle mass and protection from bone breakage. A diagnosis of osteopenia means lower bone density; while osteoporosis also makes bone brittle. Adding in movement strengthens the muscles surrounding the bones, cushioning falls and preventing breakage and fractures.


For women on aromatase inhibitor therapy, combining aerobics in moderate to vigorous exercise showed a lower risk of major fractures. This was compared to those who never exercised or exercised under the recommended 150 minutes per week. These women had a much higher risk of osteoporosis too.


Do the talk/sing test while exercising to check in with your level of exercise. If you can talk but it's uncomfortable to sing, that's the level you're aiming for daily.


Eat higher quality foods


Quality foods lessen the severity of bone loss. Aromatase inhibitors impair bone metabolism. It’s really important to eat quality foods with a lot of nutrients (i.e., nutrient-dense foods). These include a variety of plant foods: fruits, vegetables, and whole grains.


When it comes to protein for your muscles and bones, eat legumes, nuts, and seeds. Protein also helps you absorb dietary calcium. By eating more nutrient-dense foods like these ones you’ll get more vitamins, minerals, fiber—all of which are very important to maintain your health at and beyond menopause.


What about vegetarians? A protein-rich vegetarian diet may prevent fractures. Vegetarian women in peri- and postmenopause who ate vegetable protein more than once a day had a 68% reduction in fracture risk, compared to vegetarian women who ate it less than 3 times per week. Include those plant-based meat proteins too! These foods were found to be protective.


Pro Tip/Fun Fact: Your bones love calcium plus vitamin D. Some of the richest plant food sources are foods fortified with these nutrients, such as 8 oz fortified plant milk, 8 oz fortified orange juice, and a fortified energy bar (check your labels). These contain 300 mg of calcium in each serving and some also include vitamin D. You may still need calcium and vitamin D supplements to reach healthy levels in the blood; otherwise, daily supplementation may not be necessary.


Another strategy is to follow a Mediterranean diet. A Brazilian study of 103 women found these foods are a nonmedical way to prevent osteoporosis and fractures in postmenopausal women. Researchers believe protein can build muscle mass and the antioxidants in plant foods are beneficial for bone health. The foods included vegetables and fruits, beans, and olive oil, and some animal protein. A higher intake of Mediterranean foods was associated with more muscle mass.


Try a mineral-rich menu


What does a calcium-rich meal look like? All it takes is 2-3 servings of foods high in calcium daily. The recommended intake for calcium above the age of 51 is 1,200 mg every day. But only a third of women get enough calcium in their diet.


My clients also ask me for a dairy-free menu, as lactose intolerance can accompany breast cancer treatments. Here's a sample menu.


5 figs contain 75 mg of calcium
5 figs contain 75 mg of calcium

Menu for a dairy-free, calcium-rich day, 1,200 mg:


  • Breakfast:

½ sesame seed bagel (80mg) with 2 Tbsp almond butter (80mg)

1 navel orange (80mg)

8 oz calcium-fortified almond milk (450mg)


  • Lunch:

2 slices whole wheat bread (100mg), ¼ cup hummus (15mg), 2 slices tomato (5mg) and ¼ cup sliced cucumber (5mg), edamame, ½ cup (100 mg)

3 dried figs (55 mg)


  • Snack

Apple (10mg) with 2 Tbsp peanut butter (20mg)


  • Dinner

Stir fried vegetables with 1 cup cooked bok choy (100mg), ½ cup tempeh (90mg), ½ cup broccoli (30mg), ½ cup carrots (20mg)

1 Tbsp Tahini dressing sesame seeds (65mg)

1 cup brown rice (5mg)


Snack

1 cup sliced peaches (10mg)


Speak to your medical team about medications to prevent further bone loss. A dietitian can help you meet your specific health needs with your preferred cultural foods and lifestyle changes after menopause.


When it comes to nutrition for menopause a few simple changes can help you optimize your bone health. Be sure to avoid alcohol; add daily movement you enjoy ; eat higher-quality foods rich in minerals; and speak to your doctor about pharmaceutical options.


If you're concerned about your bone health, book a free 15-minute nutrition consult with me to see if my services can help you.


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