Falls and Fractures – Two Potential Hazards During Menopause

Perimenopausal and menopausal women oftentimes face symptoms such as hot flashes, vaginal dryness and mood swings that can range from merely annoying, to downright disruptive. But there is another, lesser talked about concern for many women over 40, and it has the potential to be quite serious: an increased risk of falling and sustained injuries. Here we explore more about why perimenopausal and menopausal women may be at a greater risk of falling and injury as well as what they can do to potentially reduce their risk.

The Facts About Falling During Menopause

Falling has been shown to be the most common cause of non-fatal injuries for perimenopausal and menopausal women. One 2005 study, published by Injury Prevention, demonstrated that out of over 1.6 million adults over 65 years of age, 71% who received emergency care for falls were women. Men in this same age group didn’t fall nearly as often, which is likely due to their higher testosterone levels, that help to keep bone and muscle mass strong for several more years.¹

Because the risk of falling and getting hurt is a serious health concern, women approaching menopause should be aware of the changes that are occurring in their bodies, and understand why exactly they are more likely to fall and sustain an injury during this time.

“Women over 40 may be more susceptible to falls for several reasons,” says Dr. Rebecca Levy-Gantt, Doctor of Osteopathic Medicine. “First, if they have not kept up with a regular exercise schedule, they may have weakened muscles or a weakened core, and have a harder time on hilly or uneven terrain. Also, over [age] 40 is a time where weight gain for some women, and increased weight—especially in the mid-section—can cause a change in the center of gravity and result in balance issues.”

Dr. Levy-Gantt encourages both perimenopausal and menopausal women over 40 to stay in shape and continue to exercise, noting that if they do so, “[they] should be no more likely to fall than younger women, at least until they reach the age of frailty, which is over 75 or 80.”

Bone Changes Experienced During Menopause

As women near menopause, their bodies begin to produce less estrogen. Estrogen levels continue to decline even more sharply once menopause occurs. Because estrogen has a direct effect on osteoblast cell production (the cells that work to build new bone), this decrease means that bones are more vulnerable to breaking due to weakness.²

All women suffer some bone loss, but extreme bone density loss—known as osteoporosis—affects one in two women over age 50, according to the National Osteoporosis Foundation.³ Menopausal women with this condition are at an even higher risk of injury from falls due to bone breakage, as bone mass is often severely affected.

Dr. Levy-Gantt notes that the areas most affected in menopausal women are the wrist, hip, and spine. She says the type of injury sustained is directly related to the type of fall and to the amount of bone mass found in particular areas; for example: “The wrist can break as a person may trip or fall forward and use their outstretched arm and hand to 'break the fall'. If the radius, the larger wrist bone, is thin, it may snap.” Another example is a femur or hip fracture that may occur if the neck of the bone has thinned—and due to this weakness, a fall doesn’t have to be dramatic or hard to result in a hip fracture in women during menopause.

Risk Factors for Falls

Accidents happen to everyone, and people of all ages trip and fall. But for women before or during menopause—especially for postmenopausal women—the chances of falling are elevated. Some factors that may increase fall risk include⁴:

• Medications – dizziness can be a side effect of some medications, which may affect balance. 
• Osteoarthritis – postmenopausal women with osteoarthritis have a 20% increased risk of fracture and experience 25% more falls.
• Poor physical health – women with a high body-mass index (BMI) and those who don’t exercise regularly have a higher fall risk.
• Poor general health – diabetes, COPD, dementia, Parkinson’s disease, and stroke are all conditions that may result in imbalance, and thus increase the chance of falling.
• Vascular diseases – according to Dr. Levy-Gantt, low estrogen levels experienced during menopause may make blood vessels less elastic, causing irregular blood flow to the brain, potentially resulting in dizziness that can increase fall risk.

Outcomes of Falling During Menopause

Menopausal women who fall and sustain injuries may experience negative physical and emotional consequences. Possible outcomes that can result from a fall include⁵:

• Fractures – broken bones may range from minor (an arm) to severe (hip replacement).
• Head injuries – adults using blood-thinning medications may suffer a brain bleed if they hit their head during a fall. Some women not on blood thinners can also suffer from a similar injury.
• Depression/social isolation – not being able to engage in normal activities or visit loved ones regularly (due to limited mobility from a fall injury) can take a toll on emotional wellbeing.

Fall Prevention

Falls don’t necessarily have to be in your future as there are several things perimenopausal and menopausal women can do to help keep their bodies in good physical shape. Consider incorporating the following tips into your daily routine, starting now:

• Exercise – activities that improve balance and flexibility are helpful, like tai chi, yoga and walking.⁶ Dr. Levy-Gantt also recommends maintaining a regular exercise program that includes cardiovascular exercise, resistance training, and core strengthening.
• Diet – a well-balanced, healthy diet with animal or plant-based proteins (i.e. fruits, vegetables, and nuts) is important to maintain—and remember to stay hydrated. Adequate calcium and vitamin D intake is also important to help support bone health.⁷
• Sleep – according to Dr. Levy-Gantt, getting a good night’s sleep can be a challenge during menopause, thanks to night sweats and hot flashes, however, a lack of sleep can result in fatigue, headaches, and poor immune function, all of which may contribute to fall risk.
• Safeguard your home – consider removing throw rugs, cords and clutter from your floors and watch out for sleeping pets around the house. Also, be sure you have a well-lit path in your home if you get up during the night to use the bathroom.

As you approach menopause, remember to put some effort into keeping your body strong and healthy. A little awareness can allow you to continue to enjoy the things you love to do for a long time. And as always, ask your healthcare provider if you have questions or concerns about menopause and the effects it may have on your health.

Resources

1. http://c-hit.org/2017/02/13/menopause-puts-women-at-higher-risk-of-fall-related-injuries/
2. https://www.endocrineweb.com/conditions/osteoporosis/estrogen-replacement-therapy-osteoporosis
3. https://www.nof.org/preventing-fractures/general-facts/what-women-need-to-know/
4. https://drmagaziner.com/age-management-medicine-new-jersey/why-are-post-menopausal-women-prone-to-falls/
5. https://www.sciencedaily.com/releases/2018/08/180821112024.htm  
6. https://www.health.harvard.edu/staying-healthy/easy-ways-to-improve-your-balance
7. https://www.nof.org/patients/treatment/nutrition/