Menopause It is a stage of profound hormonal changes in a woman's life, and it has long been associated with the need to pay special attention to bone health and calcium metabolism. For years, menopausal women have been prescribed [a specific supplement] almost routinely. calcium supplements y vitamin D with the aim of preventing osteoporosis and fractures. However, more recent studies qualify this idea and show that the relationship between vitamin D, menopausal symptoms, and bone risk is more complex than previously thought.
A large-scale clinical trial, conducted within the framework of the Women's Health Initiative and published in the journal Maturitas, evaluated more than 34.000 women between 50 and 79 years old. In this study, more than 20 were monitored. menopause symptoms, As the hot flushes, the Fatigue, emotional imbalances and trouble sleepingThe aim was to determine if there was a relationship between these symptoms and vitamin D levels. The analysis did not find a significant relationship between low blood levels of vitamin D and the presence or severity of these symptoms.
It was a long-term clinical trial: the women were followed for an average of almost six years, a period during which half of them took daily calcium and vitamin D supplements The other half received placebo pills. The aim was to analyze not only bone health and fracture risk, but also whether supplementation could influence menopausal symptoms.
The result was that the average number of menopausal symptoms in both groups was virtually the same (just over six). The women who underwent treatment with calcium and vitamin D They presented the same trouble sleeping, the same level of Fatigue or with a emotional well very similar to that of the women who took a placebo. This suggests that, at least in this studied population, supplementation did not have a significant impact on typical menopausal symptoms.
However, one of those in charge of the trial wanted to leave a window open to the possible effectiveness of the Calcium and vitamin D to alleviate certain menopausal symptoms. She proposed conducting further studies in younger women (for example, with an average age of around 51), given that in the trial in question the average age was 64, and it is at this age that these symptoms generally occur. more intense symptoms and the more abrupt hormonal variations. The hypothesis is that, in earlier stages of menopause, the influence of vitamin D on estrogens, serotonin, or insulin could manifest itself differently.
What is vitamin D and why is it so important during menopause?
La vitamin D, also called calciferol, is a fat soluble vitamin essential for maintaining a proper bone and teeth formation and to ensure an adequate calcium absorption in the intestine. Furthermore, it plays an essential role in the movement of the muscles, In nerve transmission between the brain and the rest of the body and in the proper functioning of immune systemwhich needs it to fight viruses and bacteria.
In the stage of the menopause and postmenopausethe decrease in the female sex hormones, especially estrogens, accelerates the loss of bone mass and makes bones more fragile. This increases the risk of osteoporosis and fracturesSufficient vitamin D helps optimize intestinal calcium absorption and maintain a mineral metabolism more stable, thus reducing some of the impact of the drop in estrogen on the skeleton.
But vitamin D doesn't only act on bone. It has been observed to participate in the regulation of immune response, In cardiovascular function, in the glucose metabolism and in processes of cell proliferation and differentiationwhich links its deficit to a higher risk of autoimmune diseases, oncological processes, Metabolic diseases and possible alterations of the fertility.
Menopause, bones, and the role of vitamin D and calcium
El bone It is a very active structure. A process called bone remodeling, in which the resorption (osteoclast activity) and the bone formation (osteoblast activity). Both cell types originate from progenitors of the bone marrow and are modulated by multiple cytokines and for the sex hormones.
The amount of bone mass At any given moment, it reflects the balance between the forces that form and destroy bone, and this balance is influenced by numerous stimulatory and inhibitory factors. With the aging and estrogen deficiency During the climacteric period, there is a marked increase in osteoclastic activityTherefore, bone is lost faster than it is formed.
When the supply or absorption of Calcium, the concentration of ionized calcium in blood It decreases. This triggers the secretion of parathyroid hormone (PTH)which mobilizes calcium from bone by directly stimulating osteoclast activity. At the same time, the increase in PTH promotes the active vitamin D productionwhich increases intestinal calcium absorption to try to compensate for the deficiency. In women with estrogen deficiency, bone also becomes more sensitive to the action of PTH.
La osteoporosis It is defined by a reduction in bone mass and a deterioration of the microarchitecture of bone tissuewhich increases bone fragility and the risk of fractures from minimal traumaIn the skeleton we distinguish the bone corticalwhich represents about 80% of the total and forms the peripheral skeleton, and bone trabecularThis bone is present in the spine, pelvis, and proximal femur. The latter, with its honeycomb structure, is especially vulnerable to the rapid bone loss associated with menopause.
The risk of fractures in menopausal women depends largely on the bone mass achieved in youth and the rate of bone loss after the cessation of ovarian function. Peak bone mass is conditioned by the The heritage and factors endocrine, but also by the lifestyleDiet, physical exercise, sun exposure, and unhealthy habits all play a role. Adequate intake of calcium and vitamin D from an early age, combined with regular physical activity, contributes to achieving a healthy weight. peak bone mass higher that acts as a “reserve” against subsequent loss.
Relationship between vitamin D, menopausal symptoms and associated diseases
In addition to its role on the skeleton and muscles, the vitamin D appears to be related to several menopause symptoms and with various chronic diseases more frequent at this stage. It has been proposed that a prolonged deficiency could contribute to worsening symptoms such as Fatigue, certain muscle and joint pain or even some mood disorders, by influencing the metabolism of Serotonin and other neurotransmitters.
In menopausal women, a low level of vitamin D has been consistently associated with a increased bone fragilityan increased risk of fractures, sarcopenia (loss of muscle mass and strength) and greater probability of fallsFurthermore, its relationship with an increased risk of obesity, metabolic syndrome, diabetes type 2, Cardiovascular disease (coronary and cerebrovascular) and certain hormone-dependent cancers such as breast or colon cancer.
Although the evidence on the direct influence of vitamin D supplementation on the hot flushes, insomnia to humor changes While the evidence is still inconclusive, it does seem clear that maintaining adequate levels contributes to reducing the global morbidity and mortality associated with menopause thanks to its effects on bone, muscle, the immune system and metabolism.
Therefore, many scientific societies recommend that women with postmenopausal osteoporosis under antiresorptive treatment maintain optimal levels of vitamin D all with optimize bone mineral density and improve the response to treatments, always within the framework of a comprehensive intervention that includes healthy nutrition y regular physical exercise.
Taken together, the evidence suggests that, although the vitamin D It is not a magic bullet for menopausal symptoms; its role in the bone health, muscular, metabolic e immunological It makes its control a key aspect of comprehensive care for women during menopause.
All of this places the vitamin D and Calcium as important allies within a broader health strategy that includes a balanced diet, prudent sun exposure, control of risk factors and physical activity, without forgetting that supplementation should always be included individualized and supervised by a healthcare professional.