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What women don't know about life after menopause: The perils of Osteoporosis

Updated: Jul 8



Osteoporosis, measured by bone mineral density (BMD), is the most common preventable bone disease in the United States and is due to abnormal growth, internal deterioration, or excess loss of bone tissue. The bones become progressively fragile, and the disease is often clinically silent until a fracture occurs. By the time a fracture happens, osteoporosis is considered severe. It is more common in elderly females, but after the age of 25, both genders experience bone loss.


Globally, more than 200 million women are suffering from osteoporosis, and most of these women are aged 45 years and older or postmenopausal. Moreover, nearly 8.9 million people suffer from fractures caused by osteoporosis. The good news is that osteoporosis is completely preventable and treatable if caught early.

Osteoporosis falls into two classification types: Type I osteoporosis and Type II osteoporosis. Type I osteoporosis is mostly seen in women who are postmenopausal due to low estrogen, and Type II osteoporosis is mainly observed among men with hypogonadism-or low testosterone.

The World Health Organization (WHO) defines osteoporosis by Bone Mineral Density (BMD). The diagnosis of osteoporosis means that the Bone Mineral Density (BMD) is low and measured with a T-score value. If the result is lower than -2.5, osteoporosis is present. If the T-score value is in between -2.5 and -1.0, it is called osteopenia or low bone mass. If the value is greater than -1.0, the bone mass is normal. A T-score of -2.5 means about 25% of bone density is lost. The spinal column, the hip, and femur—or thigh bone are most at risk. Those are the major bones in your body that deserve your complete attention.

Two-thirds of the spine (vertebral) fractures are painless, but over time and with progression, fractures don’t heal, and chronic pain is the result. So, it is best to be proactive and prevent the bones from getting weak.

The mechanism of fracture is internal, meaning that the bone collapses in on itself because the internal support has weakened. Think of it like taking out the steel girders inside a skyscraper---after too many are gone, the walls of the building fall inward—same with your osteoporotic bones.

That’s why prevention is the best strategy. Signs and symptoms of a painful vertebral fracture may include the following:

  • Acute pain may follow a fall or minor trauma.

  • Pain localized to a specific area of the spine

  • The pain is either sharp, nagging, or dull and movement may increase the pain

  • Patients often remain and stay in bed, motionless for fear of triggering the pain.

  • The pain usually resolves after 4-6 weeks, but in the case of multiple fractures, the pain may become chronic.

Patients who have a hip fracture might experience the following:

  • Pain in the groin, buttock, thigh, knee during weight-bearing

  • Diminished hip range of motion (ROM)

  • While resting, the hip/leg might rotate outwardly

The best defense against osteoporosis is to enter menopause with the highest bone density you can, and that is largely due to genetics, exercise, diet, and hormone status.


The current clinical guidelines that have strong research to support them are:

  • In postmenopausal women, estrogen or estrogen plus progestogen or raloxifene should not be used for the treatment of osteoporosis but may serve as a useful prevention strategy, along with weight-bearing exercises such as walking or jogging. Cycling and swimming won’t cut it if you want to prevent further bone loss.

  • Clinicians should offer medication to women with known osteoporosis to reduce the risk for hip and vertebral fractures. Those medications are alendronate, risedronate, zoledronic acid, or denosumab may be used.

Other recommendations are to stop smoking and limit alcohol and caffeine intake. Adequate calcium and vitamin D intake are essential in the years preceding menopause.

References

1. [Guideline] Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014 Oct. 25 (10):2359-81. 

2. [Guideline] Schousboe JT, Shepherd JA, Bilezikian JP, Baim S. Executive summary of the 2013 International Society for Clinical Densitometry Position Development Conference on bone densitometry. J Clin Densitom. 2013 Oct-Dec. 16(4):455-66. 

3. Gosfield E 3rd, Bonner FJ Jr. Evaluating bone mineral density in osteoporosis. Am J Phys Med Rehabil. 2000 May-Jun. 79(3):283-91. 

4. Czerwinski E, Badurski JE, Marcinowska-Suchowierska E, Osieleniec J. Current understanding of osteoporosis according to the position of the World Health Organization (WHO) and International Osteoporosis Foundation. Ortop Traumatol Rehabil. 2007 Jul-Aug. 9(4):337-56. 

5. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994 Nov. 4(6):368-81. 

6. [Guideline] Camacho PM, Petak SM, Binkley N, Clarke BL, Harris ST, Hurley DL, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the diagnosis and Treatment of Postmenopausal Osteoporosis – 2016. Endocr Pract. 2016 Sep 2. 22 (Suppl 4):1-42. 

7. Ahmed SF, Elmantaser M. Secondary osteoporosis. Endocr Dev. 2009. 16:170-90

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