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Osteoporosis

Osteoporosis is a bone disorder that causes bone density to decrease and results in thinner bones that are more likely to break. Sometimes referred to as a “silent disease,” it is often undetected until a woman experiences a bone fracture. Any bone breakage is a serious issue, particularly as a woman’s healing processes are slowing due to natural aging. It is important to prevent bone injuries, as compounding medical  issues and a reduced quality of life often follow a break.‍

Women are four times more likely to develop Osteoporosis than men

Bone density will start to gradually decline in a woman’s mid thirties, with a more sharp decline in her forties coinciding with peri-menopause for many. During post menopause osteoporosis can become more severe. It is important to take preventative measures to counteract the effects of weakened bone mass, even during peri-menopause. Excellent treatment options are available to slow bone deterioration and to build up bone strength. Bone health is an important, often overlooked, disease that women are at a MUCH higher risk for and that you should discuss with your healthcare provider when your hormones start to change during peri-menopause.

The Lowdown on Osteoporosis

Why it happens and the science behind it, how it may impact your life, how you and your doctor can diagnose it and common triggers or risk factors.

Although it is widely known that osteoporosis is associated with aging, the close connection between this condition and menopause has been less understood by many women.  The reason for osteoporosis’s connection to menopause is simple; the hormone estrogen is used by your body to protect your bones. During menopause, estrogen levels decline and bone density suffers. “Osteoporosis” refers to bone loss and the less serious form of the disease, “osteopenia,” refers to low bone density.‍

When you suffer from (severe) osteoporosis, bones can fracture doing normal activities such as coughing, bending or playing sports. The parts of your body that are most at risk are your wrists, hips, ribs, and spine. It is important to protect your vulnerable skeletal structure well before you experience the too-common result of post-menopausal bone hygiene neglect through an accidental hip fracture, broken wrist from a fall, painful cracked ribs, or spinal damage. Osteoporosis is a disease that affects women significantly more often than men. Women are four times more likely to develop the disease in their lifetime. Half of the women currently aged 50 will experience a bone fracture due to osteoporosis at some point in their lives.

Half of the women currently aged 50 will experience a bone fracture due to osteoporosis at some point in their lives.

Preventative measures against bone breakage and the onset of osteoporosis should be incorporated throughout your peri- and post-menopausal medical treatment discussions. Various pharmacological and lifestyle treatment options are available to increase bone mineral density and to avoid bone fractures.

Osteoporosis is directly related to estrogen’s function in our bodies. Estrogen deficiency is the main cause of bone density loss after menopause. It is important to proactively initiate a discussion with your healthcare provider in order to receive an osteoporosis risk assessment and appropriate preventative treatment resources.

Bone density is assessed based on testing and dual energy x-ray absorptiometry (DEXA scans).  Using a low dose of ionizing radiation, x-rays of your lower spine (lumbar), neck, and hips are taken to measure the rate of bone loss. DEXA scans are quick and non-invasive, and they require no advance preparation.

The “Frax model” is used by healthcare providers to predict the 10-year risk of a hip or major bone fracture. It is used for women who have normal or low levels of bone loss, in order to provide appropriate preventative treatments that fit with the woman’s assessed risk. Based on self-reported answers to questions regarding lifestyle habits, your doctor will be able to assess your Frax score and your risk of osteoporosis-related bone injury later in life.

  • Poor nutrition during childhood contributes to low bone density later in life. Sustained low-calcium intake at an early age is an indicator of the likelihood of an osteoporosis diagnosis later in life.
  • Similarly, eating disorders which disrupt normal body weight and result in prolonged times of less than recommended body weight are also associated with reduced bone density.
  • Smoking is positively correlated with the early onset of osteoporosis and women who suffer a bone fracture and are smokers have a longer recovery time. For a variety of health risk reasons including osteoporosis, women are encouraged to discuss smoke cessation treatment options with their healthcare providers.
  • Osteoporosis is hereditary and women with a family history of low bone density or late-in-life bone injuries are at higher risk.
  • Gender Women are at a much higher risk of developing osteoporosis than men, further indicating the close relationship between the cause of osteoporosis and hormone activity.
  • Early Menopause - if you go through Menopause before the age of 45, but especially before the age of 40
  • Race: if you are caucasian or Asian there is an increased tisk

Physical health

Should I ask my doctor about this?

Absolutely. The recommendation is to have a bone density scan performed using DEXA technology for women over the age of 30 every five years. If one or multiple of the risk factors outlined above apply to you, you should proactively speak to your doctor and insist on getting the scan done.

To underline the importance take this recent study conducted in India by Nanavati Max Hospital: it reported that 60% of women in Mumbai over the age of 40 years suffer from osteopenia and one in four are diganosed with osteoporosis.  

Prevention and Treatment

Learn more about your options for prevention, management and treatment of Osteoporosis. This is not an exhaustive list of the treatment options available, but a good start.

The treatment options available for clinical osteoporosis have improved greatly over the last ten years. The medical community has moved beyond just slowing bone loss to include proactive treatment methods that stimulate the formation of new bone mass. Diagnostics and risk assessments have emerged which provide excellent preventative options early. 

It is important to realize that osteoporosis will not announce itself. Until a woman suffers a bone injury, she may be unaware of her compromised bone density and her vulnerability. It is essential to receive an accurate risk assessment and diagnosis early in your menopausal transition to protect your bone strength throughout your lifetime.

Although initial bone density is affected by prenatal and early childhood nutrition and genetic factors, increasing your bone mass later in life is possible if you focus on a bone-building diet. In addition to calcium and vitamin D supplements, attention should be given to the guidelines of the Mediterranean diet. Research has found that women focusing on this diet’s food variety (whole grains, beans, fruit, vegetables, fish, and nuts) exhibited positive bone density scores.

Exercise is an important menopause health habit. Ideally, moderate aerobic exercise will be included in your weekly routine at least three times. Walking, dancing, low-impact aerobics, elliptical training machines, and stair climbing are all examples of exercises that benefit your bone health. They also help with your cardiovascular strength and have mental health benefits.

If you are focusing your exercise plan on osteoporosis prevention, look for weight-bearing exercises, core strengthening, and activities that promote balance. There is a positive correlation between physical exercise and a reduction in your risk of bone injury later in life.

If you are unsure what exercises to choose for bone health, there are excellent videos online (for example) for osteoporosis prevention.

A Calcium deficiency is very common with studies indicating that up to 60% of postmenopausal women don’t meet the required daily dietary calcium intake of 1000-1300mg. Calcium intake is important as its the main mineral in the human skeleton and essentially helps keep your bones strong.  Your doctor may prescribe you Calcium supplements if you have a deficiency in combination with Vitamin D, which will help in getting the calcium absorbed into the bones. 

There are no effective OTC products available to treat Osteoporosis

  • Raloxifine and Bazedoxifene - both are Selective estrogen receptor modulators (SERMs) that help prevent bone loss and improve Bone Mineral Density (BMD)
  • Bisphosphonates - reduces the resorption rate of bone.
  • Denosumab (Prolia) - is a monoclonal antibody injection that needs to be administered every 6 months. It works in a different way to bisphosphonates but has the same outcome of slowing the rate of resorption. Both Bisphosphonates and Denosumab reduce the risk of vertebral, hip and other fractures
  • Teriparatide - administered through a daily injection.  It increases bone formation and absorption of calcium from the gut and kidney.
  • Hormone replacement therapy (HRT) is an intensive treatment process that may be prescribed for women suffering from multiple menopausal symptoms. If osteoporosis is the only symptom a menopausal woman is suffering from, other treatment alternatives will likely be recommended rather than HRT. Having said that, if HRT is started soon after menopause (before a woman turns 60) studies have shown that it can increase bone density by roughly 5% in two years and, on average, can reduce the risk of hip and spinal fractures by 40%.
  • Tibolone - studies have shown that Tibolone (a type of HRT) can have a beneficial effect on bone health; it can lead to an increased bone density and fracture prevention.

For women who undergo HRT treatment during menopause, there is additional concern regarding osteoporosis once HRT ceases. Once HRT stops and estrogen levels drop, a woman will experience a more rapid rate of bone loss than normal for the first 4-5 years after stopping MHT. If her Bone Mineral Density (BMD) was below the normal threshold while on HRT it is recommended to start treatment with a different medicine before ceasing HRT. 

FAQs

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