Understanding Postmenopausal Osteoporosis

Table of Content

Understanding
Postmenopausal Osteoporosis

What is Menopause?

Menopause is the natural and permanent stopping of the monthly female periods.

It's due to ovarian failure to produce an egg every month and thus no production of the hormones oestrogen and progesterone.

You have reached menopause if you have not had a period for one year and this happens at an age of approximately 45-50 years.

The changes in your body that occur due to menopause are primarily due to decreasing levels of oestrogen and can start few years earlier. You may experience:

  • A change in periods:
    They can be shorter or longer, lighter or heavier .earlier or later
  • Hot flushes:
    A feeling of intense heat with sweating and rapid heartbeat, and may typically last from two to thirty minutes for each occurrence
  • Sleeplessness:
    Unable to sleep or getting up early
  • Vaginal dryness:
    Itching, dryness or infection in vagina
  • Mood swings:
    Irritability, tiredness, memory loss, depression and/oranxiety

The long term health problems of oestrogen deficiency are:

  • An increased risk of heart diseases
  • Increased bone loss causing osteoporosis referred to as postmenopausal osteoporosis (PMO)

There is a lot of awareness regarding heart diseases in our society but the same cannot be said about PMO. Here we attempt to create some awareness regarding PMO

Osteoporosis: A Silent Killer

Osteoporosis means a porous bone, your bones become brittle and even a simple fall or bump can cause your bone to break easily.

Thus there is a greater risk of fractures if you suffer from osteoporosis.

The most common site of fractures are backbone, wrist and hip joints. Hip Fractures account for

  • 10-20% deaths within a year of sustaining a fracture
  • 10% patients suffer from another fracture within a year
  • 25% patients require long term nursing home care
  • Only 40% patients gain full recovery

Clinical Features of PMO

Osteoporosis is often called a silent disease because bone loss causes no complaints, some may have non-specific complaints of bone pains, back pain, stooped posture, etc.

You may not know that you have osteoporosis until your bones become so weak that a sudden strain, bump, or fall causes a bone fracture.

These fractures cause pain, deformity, loss in height and long-term disability and thereby have a major impact on your quality of life.

Risk factors for Osteoporosis

Many factors will increase your risk of developing osteoporosis and suffering a fracture.Some of these risk factors can be changed, while others cannot.Recognizing your own risk factors is important so you can take steps to prevent this condition from developing or treat it before it becomes worse.

The risk factors for Osteoporosis are:

    • Gender: Women have less bone tissue and lose bone rapidly than men because of oestrogen deficiency following menopause
    • Age:Bone loss in woman starts in the mid-30s but hastens after 50 years of age
    • Race:Asian or Caucasian females are at an increased risk of osteoporosis
    • Early Menopause:If one achieves menopause before age 45 due to surgical removal of ovaries
    • Family history:There is a history of osteoporosis or osteoporosis related fracture in a parent or sibling
    • Medications or chronic diseases:Medicines, like steroids or diseases like Rheumatoid arthritis,Hyperthyroidism increases risk of osteoporosis.Consult your doctor for the same
    • Body weight:Underweight or thin females, due to a small bone structure are at an increased risk of osteoporosis
    • Lifestyle:
      • Smoking
      • Alcoholism
      • Low intake of calcium or Vit D in your diet or no exposure to sunlight which is very important for your body to synthesize Vit D
      • Exercise: An inactive lifestyle or you do not exercise regular

    Diagnosis of Osteoporosis

    Osteoporosis can be diagnosed by measuring Bone Mineral Density(BMD)that reflects the strength of the bone.BMD can be measured by doing:

    • USG of heel and forearm (Screening test for osteoporosis)
    • Dual Energy X-ray Absortiometry (DEXA)

    DEXA is the Gold Standard for diagnosing osteoporosis

    When Should you have a Bone Density Test?

    The decision to have a bone density test is based on your risk factors,Your physician may advise you to have a bone density test:

      • If you are under the age of 65,and have one or more additional risk factors for osteoporosis(besides menopause)
      • If you are aged 65 or older,regardless of additional risk factors
      • If you just sustained a fracture
      • If your doctor is considering treatment for osteoporosis
      • If you are on hormone therapy for a long time

      How to Prevent Osteoporosis?

      Osteoporosis is largely preventable or most people.

      A healthy lifestyle can be critically important for keeping bones strong.

        • Lifestyle:
          • Avoid excess alcohol intake:This is related to both poor nutrition,increased risk of falling and poor bone formation
          • Avoid smoking:Women who smoke often go through menopause earlier,which hastens the development of osteoporosis because bone density decreases more rapidly after menopause
        • Exercise:
          • Engage in weight bearing exercises like walking,dancing,jogging,stair-climbing,racquet sports and hiking.Be sure to check with your doctor before beginning any exercise.Here are some simple tips that you can follow:
            • You can climb stairs instead of using a lift
            • You can get down one bus stop earlier and go walking to your final destination
            • Park your vehicle further away from the entrance
        • Diet:
          • Make sure you are getting enough calcium in your diet,
            • Adults under age 50yrs need 1,000mg of calcium daily
            • Adults age 50yrs and over need 1,200mg of calcium daily
            • Meat,fish,poultry,dairy products like milk,curds,beans,ragi,almonds,oranges are all rich sources of calcium
          • Make sure you are getting enough vitamin D
            • Adults under age 50yrs need 400-800IU of vitamin D 3 daily
            • Adults age 50yrs and over need 800-1,000IU of vitamin D 3 daily
            • Fish,liver,and egg yolk are the only foods that naturally contain vitamin D
            • Sunlight is very important for your body to synthesize Vitamin D
        Others:
        • Treatment of underlying medical conditions that can cause osteoporosis by seeking medical advice e.g. Rheumatoid Arthritis, Gout etc.
        • Do not stop taking any medication without consulting your doctor first

        Prevention of Falls

        In osteoporosis as the bones become brittle even a simple fall or bump can cause your bone to break easily.Here are some important tips to prevent falls:

        • Keep all rooms neat and tidy and especially keep things off the floors.
        • Floor surfaces should be smooth and level but not slippery.
        • Avoid walking around in socks,stockings,or floppy slippers to avoid tripping or slipping.
        • Make sure all carpets and rugs are stuck to the floor or have skid-proof backing so they cannot slide around when someone steps on them.
        • Keep electrical cords and telephone lines out of the way.
        • Make sure stairs have plenty of light and that there are handrails on both sides.
        • For safety in the bathroom,install bars to grab onto bathroom walls.
        • Keep a flashlight with fresh batteries beside the bed in case of a power failure.
        • Make sure the lights in a room can be turned on at the entrance
        • A cordless phone helps prevent a fall caused by rushing to answer the phone,and can be used to call for help if an accident occurs.
        • Consider using hip protectors which will help prevent a hip fracture if you fall.Consult your doctor for the same

        Osteoporosis Treatment

        There have been some great advances in the treatment of osteoporosis over the past ten years.In addition to supplementing diet with adequate amounts of Calcium and Vitamin D and weight-bearing exercise,there are several drug treatments available to people with osteoporosis.These include Bisphosphanates,Calcitonin, Parathyroid Hormone etc.Consult your doctor for the right treatment as your personal medical history and lifestyle will decide which treatments are appropriate for you.

         

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