Menopause and just after menopause is a time when osteoporosis commonly presents itself, so it is important to be aware of the facts! Osteoporosis is the most common kind of bone disease. And while having a family history of osteoporosis can increase your chances of developing it, there are other risk factors, including:.
Estrogen protects your bones. When you reach menopause, your estrogen levels drop. In some cases, this decrease in estrogen can lead to bone loss, according to the National Osteoporosis Foundation NOF.
Another reason that menopausal women are at a higher risk for osteoporosis has to do with not getting enough minerals that help your body maintain healthy bones. Your body also needs vitamin D to absorb calcium. Osteoporosis can even cause vertebra in the back to collapse secondary to weakened bones.
Symptoms of this can include:. There are lots of ways for women in menopause to decrease their chances of developing osteoporosis by protecting and strengthening their bones. At menopause the normal bone turnover cycle is impaired by estrogen deficiency. This may be due to the presence of estrogen receptors in osteoclast progenitor cells and multi-nucleated osteoclasts. The osteoclastic resorption activity increases while the osteoblastic activity decreases. As a result, the amount of bone resorbed exceeds the amount deposited, which leads to a net loss of bone.
The increase of overall bone resorption is due to a weakened inhibition effect due to the reduction of available estrogen on both osteoclastogenesis and osteoclast activity. The stimulatory effect of estrogen on bone formation is less-well-understood, but may be mediated by estrogen-receptor-responsive elements on promoters for genes involved in bone matrix biosynthesis, including type I collagen, or cytokines believed to be important for coupling of bone resorption and bone formation.
There are two phases of bone loss in women: The first occurs predominantly in trabecular bone and starting at menopause.
It results from estrogen deficiency, and leads to a disproportionate increase in bone resorption as compared with formation. This phase could be defined as menopause related bone loss.
After 4—8 years, the second phase exhibits a persistent, slower loss of both trabecular and cortical bone, and is mainly attributed to reduced bone formation. The aging population is expanding at an unprecedented rate. This explosion in population will lead to a greater number of individuals with osteoporosis. The major health threat of osteoporosis is osteoporotic fractures, which occur at a site associated with low BMD most commonly in the spine, the hip, or the wrist, sometimes the humerus or ribs are also involved , and it increases in incidence after the age of 50 years.
Osteoporotic fractures take place in temporal sequence, with the first sign being fractures of the lower end of radius starting at age 50 years, followed by vertebral fractures at age 60—75 years and hip fractures beginning in the late 70s. The prevalence of osteoporosis and related fractures are higher in postmenopausal women than in older men since estrogen plays a key role in maintaining bone health. This far exceeds the estimated number of men with osteoporosis, 2.
In , there were nearly 1. Worldwide, the frequency of osteoporosis and osteoporotic fractures is also influenced by race and ethnicity. Generally speaking, Caucasian and Asian women are more susceptible to osteoporosis than black women. Additionally, it seems that hip fractures occur at an earlier age in developing countries compared with western countries since the peak age for hip fractures in India is in the 60s compared to 80s in western countries.
The prevalence of osteoporosis increases in both men and women with aging, while it increases gradually in males it increases significantly in females over 50 years old. As early as s, Albright and Reifenstein found that estrogen could prevent osteoporosis. In the 's, the association between menopause and osteoporosis was first identified and then estrogen treatment was adopted to prevent bone loss. Nowadays, a large number of studies have proven that estrogen is effective in the prevention of osteoporosis and hormone therapy can still be considered a first line choice for postmenopausal women.
In a meta-analysis of 57 trials both prevention and treatment trials which included about 10, women, the combined results imply that on average the change in bone density is significantly higher in the MHT group both opposed and unopposed estrogen at all measurement sites. After one year the MHT group showed an average increase of bone mineral density at the lumbar spine of 5.
After two years of treatment, the percentage change in favor of MHT increased by about 1. The HOPE trial recruited healthy postmenopausal women 40—65 years old who were randomized to either daily conjugated equine estrogen treatment with 0. A calcium supplement of mg was given to all of the participants including the placebo group. MHT is also effective in preventing osteoporotic fractures. Meanwhile, 10, women were randomized to estrogen ET or placebo.
After three years on ET and after two years on HT, the fracture risk started to decrease. In the HT arm after 5. In the ET trial of 10, women that were followed up for 7. In a randomized trial investigating the effects of tibolone on fractures, 25 women who are at risk for fractures were assigned to a tibolone or placebo group. It is worth mentioning that withdrawal of estrogen results in rapid bone loss and within one year most of the previous increased BMD accumulated over 3—4 years has disappeared.
There is ceaseless debate about MHT since it may relate to breast cancer, coronary heart disease CHD , strokes and thromboembolism. The window of opportunity hypothesis emerges as an answer and has become accepted among specialists from various countries today.
Cumulated data from studies concerning MHT demonstrate two populations of postmenopausal women who response differently to MHT. The diversified response to MHT is based on age or years postmenopausal. The hypothesis is further validated by data published recently from the DOPS study, 28 which suggests that MHT can reduce cardiovascular endpoints in women if started shortly after menopause, which happens to be the period of fast bone loss.
Thus, the timing hypothesis should be kept in mind when we are prescribing hormones to prevent postmenopausal osteoporosis. As we discussed in previous paragraphs, bone resorption has been proven to be fastest in the first 3—4 years after menopause, and it is reasonable to start hormone therapy early after menopause. During this period of time, the response to treatment can be the highest since stopping resorption leads to instant filling in of the resorption or remodeling space and increases bone formation and results in a greater increase in BMD.
The North American Menopause Society guidelines suggest that as long as the lowest effective dose of MHT is used, extending treatment for an individual woman's treatment goals are acceptable when the benefits of menopause symptom relief outweigh potential risks and for further prevention of osteoporotic fracture or preservation of bone mass in women with an established reduction in bone mass other therapies are not suitable.
The Chinese menopause guidelines suggest that menopause hormone therapy is recommended for women who are at risk of osteoporotic fractures and who are younger than 60 years old; while for those who are older than 60 years, menopause hormone therapy is not recommended if it is intended only for the prevention of osteoporotic fractures.
To prevent osteoporosis, the lowest effective dose of MHT should be used and there are fewer side effects in transdermal preparations than with oral medicines. Bone loss will recur after stopping hormone therapy. For those who are at risk of osteoporotic fractures, other protective drugs should be taken. Other pharmacological interventions including bisphosphonates, selected estrogen receptor modulators SERM , recombinant human parathyroid hormone, and denosumab are also effective.
Calcium and vitamin D should be taken as basic nutritional supplements. Adjustment of lifestyle such as regular exercise, quitting smoking and alcohol, and strategies for prevention of falls can also play a vital role. Being a systemic skeletal disease, osteoporosis becomes an important public health and financial issue that is associated with increased mortality and morbidity.
Postmenopausal women are susceptible to primary osteoporosis since osteoporosis is closely related to estrogen deficiency. During the menopausal transition period, the drop of estrogen leads to more bone resorption than formation, resulting in osteoporosis. The major health threat of osteoporosis is osteoporotic fractures. The prevalence of osteoporosis and related fractures are higher in postmenopausal women than in older men and is influenced by ethnicity.
They reduce vertebral, hip and other fractures Possible side effects of treatment include gastrointestinal upset and in particular, gastroesophageal reflux heartburn ,and a rare, but important side effect of osteonecrosis death of bone of the jaw. Bisphosphonates may be taken daily, weekly or monthly. The most commonly used bisphosphonates are alendronate Fosamax , risedronate Actonel and a yearly intravenous form of bisphosphonate called zoledronate Aclasta.
Denosumab Prolia is given as a 6 monthly injection. It works in a different way to bisphosphonates but has the same effect of slowing the rate of resorption. It reduces the risk of vertebral, hip and other fractures. It can increase the risk of skin infections. Teriparatide parathyroid hormone is administered daily via an injection just below the skin. It increases bone formation and absorption of calcium from the gut and kidney.
Calcium and vitamin D supplements may be necessary with this medication and must be monitored under the care of a specialist doctor. It reduces fractures in postmenopausal women. Treatment is limited to one 18 month course per lifetime. Its prescription for use is confined to specialists in osteoporosis. Prevention of falls can assist in decreasing the risk of an osteoporotic fracture, particularly of the hip and wrist.
Factors to consider include:. Refer to AMS sheet Prevention of falls and fractures. Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.
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Self Assessment Tools Are you at risk of breast cancer? Are you at risk of cardiovascular disease? Are you at risk of osteoporotic fracture? Some people are unable to obtain adequate Vitamin D through sun exposure and Vitamin D supplements may be required.
Do regular physical activity Ask your doctor to advise what is appropriate Stop smoking Use caffeine in moderation. Drinking tea does not have an adverse effect on bone health. Physical activity Exercising regularly throughout life may reduce the risk of osteoporosis. Weight bearing exercise refers to any exercises performed on your feet. Examples include walking, running, tennis, Tai Chi and dancing.
General recommendations for physical activity: Avoid high impact activities or those that require sudden, forceful movements. Do weight bearing exercise such as Tai Chi, dancing and weight training Do aerobic activity anything that increases your heart rate, such as walking, jogging, cycling etc three times a week Undertake strength training twice weekly Include flexibility exercises or stretching Be guided by your healthcare professional when deciding on your exercise program.
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