Musculoskeletal health

Menopause can be associated with musculoskeletal conditions, including osteoporosis, joint aches and pains, arthritis and sarcopenia.

Osteoporosis

Oestrogen acts to decrease bone resorption and promote bone formation.1 Early menopause (before the age of 45) and the loss of oestrogen is a clinical risk factor for osteoporosis.1 Half of all post-menopausal women will have an osteoporosis-related fracture during their lifetime.2,3

Bone loss with aging and menopause also increases the risk of osteoporotic vertebral compression fractures, which cause severe pain, impede respiratory function, lower quality of life and increase the risk of new fractures and deaths.4

Consider an individual patient’s risk for osteoporosis and use tools to understand their risk profile. This can guide options for prevention and treatment of osteoporosis and arthritis during the menopause transition including regular physical activity, exercise, hormone replacement therapy and other pharmacotherapy as indicated. The Endocrine Society and the Australasian Menopause Society recommend shared decision making between the patient and the healthcare team when deciding on pharmacoptherapy.3,5

Menopausal hormone therapy (MHT) in women with premature menopause mitigates the increase in bone resorption and preserves bone mass, reducing the risk of osteoporosis.1

Arthritis

When people who have pre-existing arthritis present with an exacerbation of symptoms during the menopause transition, this can further affect their ability to exercise and perform daily activities, as well as their sleep. This increases the complexity of their presentation and management.

Resources

Clinician resources

Osteoporosis management and fracture prevention in post-menopausal women and men over 50 years of age
Evidence-based guideline for health professionals to support clinical care, updated in 2024. Includes a flowchart, summary of recommendations, full recommendations, practical tips and precautions and special conditions including breast cancer.
Source: Royal Australian College of General Practitioners

Fracture risk assessment tool (FRAX)
Tool to evaluate fracture risk, based on individualised models that integrate the risks associated with clinical risk factors as well as bone mineral density at the femoral neck.
Source: FRAX, University of Sheffield

Bone fracture risk calculator
Tool to help doctors and health professionals estimate fracture risk.
Source: Garvan Institute of Medical Research

Musculoskeletal service directory
NSW Health service contacts for Osteoporosis Refracture Prevention and the Osteoarthritis Chronic Care Program services. Allows users to filter by program type and geographical area.
Source: Agency for Clinical Innovation

Menopause - managing bone health (PDF 213.0 KB)
Evidence check covering primary considerations and evidence for the assessment and management of bone health including osteoporosis in menopause.
Source: Agency for Clinical Innovation

Healthy Bones Australia
Includes resources for clinicians and consumers, including translations into several languages.
Source: Healthy Bones Australia

Consumer resources

Navigating change: Exploring the menopause and arthritis connection
Resources for consumers about arthritis in menopause.
Source: Arthritis NSW

Know your bones tool
Online self-assessment and risk tool for consumers, developed with the Garvan Institute of Medical Research.
Source: Healthy Bones Australia

How to keep your bones healthy and avoid fractures (PDF 3.5 MB)
An osteoporotic refracture prevention services guide for consumers who have had a minimal trauma fracture with information on reducing risks of another broken bone, a fall and general care for optimal bone health.
Source: Agency for Clinical Innovation

References

  1. The Royal Australian College of General Practitioners. Osteoporosis prevention, diagnosis and management postmenopausal women and men over 50 years of age. 3rd edn. East Melbourne: RACGP; updated March 2024.
  2. Crandall CJ. Risk assessment tools for osteoporosis screening in postmenopausal women: A systematic review. Curr Osteoporos Rep. 2015;13(5):287-301. DOI: 10.1007/s11914-015-0282-z
  3. Australasian Menopause Society. Osteoporosis. VIC: Australasian Menopause Society; updated July 2023 [cited August 2024].
  4. Jin YZ, Lee JH, Xu B, et al. Effect of medications on prevention of secondary osteoporotic vertebral compression fracture, non-vertebral fracture, and discontinuation due to adverse events: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2019;20(1):399. DOI: 10.1186/s12891-019-2769-8
  5. Endocrine Society. Menopause and bone loss. Washington DC: Endocrine Society; January 2022 [cited August 2024].
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