Osteoporosis is a condition in which bones are weakened and may fracture easily. Menopause can increase a woman’s risk of developing osteoporosis. The drop in oestrogen levels that occurs at menopause results in increased bone loss. It is estimated that the average woman loses up to 10 per cent of her bone mass in the first 5 years after menopause.

Osteoporosis in Menopause

Osteoporosis is often called the “silent disease” because initially bone loss occurs without any symptoms. A woman may not know that she has osteoporosis until weakened bones cause painful fractures usually in the back or hips. consequently, once a woman has a broken bone due to osteoporosis, she is at high risk of having another. These fractures can be debilitating. Fortunately, there are steps she can take to prevent osteoporosis from ever occurring. And treatments can slow the rate of bone loss if she already has osteoporosis.

Osteoporosis is best diagnosed using a specialised x-ray technique (DEXA). A DEXA measures the severity of bone mineral loss (loss of bone mineral density) and presents the result as a T-score. The T-score compares the bone density of the woman with that of a young woman (when peak bone mass is at its best).

The various T-scores used in diagnosis are:

• Normal bone density – the T-score measures between 0 and -1.
• Osteopaenia – the T-scores are between -1 and -2.5. This means there is some bone loss, but it’s not severe enough to be called osteoporosis.
• Osteoporosis – the T-score measures -2.5 or less.

Physical activity is very important

Exercise can’t stop bone loss, but the activity, especially walking, can slow down the pace of osteoporosis. in addition, exercise keeps muscles toned and strong, making falls less damaging. just 30 minutes of brisk walking several days a week is all you need to increase strength and overall fitness.

Two types of physical activities that are most beneficial to bones are weight bearing and resistance training exercises.in addition to reducing bone loss, physical activity will improve muscle strength, balance and fitness and also reduce the incidence of falls and fractures.

When you start an exercise program, you’d better consult with your doctor, physiotherapist or health care professional.

Weight Bearing Exercise

Weight bearing exercise refers to any exercises performed on feet. Examples include walking, running, tennis and dancing. Studies to evaluate the effects of exercises such as walking have not shown a drastic improvement in bone mass unless this activity is performed as a high intensity activity (walking at a fast pace, jogging and etc.).

Resistance Training Exercises

Resistance training exercises are also known as strength training exercises. Strength training uses weights of some kind (machines, dumbbells, ankle or wrist weights) to create resistance. This helps build muscle mass and places a load (force) on the involved limb bones. in addition, it includes exercises that use one’s own body weight as the load, such as push-ups where the load is placed through the arms and shoulders.

It’s good to note that you should only perform these exercises under the supervision of an accredited trainer, exercise physiologist or physiotherapist to avoid unnecessary injury.

There are a number of medical treatments available for management of osteoporosis including bisphosphonates, selective oestrogen receptor modulators (SERMs), hormone replacement therapy (HRT), vitamin D derivatives and calcium supplements and strontium ranelate. Potential therapies include tibolone and parathyroid hormone.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) relieves menopausal symptoms such as vaginal dryness, hot flushes and night sweats. when taken at the beginning of menopause, HRT can also prevent bone loss and should be started soon after menopause for maximum benefit. This treatment is sometimes called hormone therapy (HT).

HRT should be considered ‘first line’ treatment for osteoporosis in young women and those in their 50s for up to 5 years. Some studies conduct that HRT can increase bone density by around 5 % in 2 years. HRT reduces the risk of spinal fractures by 40 per cent. Bone loss will resume once HRT is stopped.

For those women who cannot take hormone therapy for health reasons or choose not to because of personal reasons, there are some other alternatives.

Calcimar, Miacalcin

These drugs are made up of a naturally occurring hormone, called calcitonin, involved in calcium regulation and bone metabolism. Calcitonin helps slow bone loss and increase spinal bone density. These drugs are used to treat osteoporosis. This drugs may ease pain associated with bone fractures.

Evista

This drug is a selective estrogen receptor modulator (SERM) that has many estrogen-like properties. It is approved for prevention and treatment of osteoporosis and can prevent bone loss at the spine, hip, and other areas of the body. Studies have shown that it can decrease the rate of vertebral fractures by 30%-50%. It may increase the risk of blood clots like estrogen.

Forteo

This is a type of hormone used to treat osteoporosis. It helps rebuild bone and increases bone mineral density. It is given by injection and is used as a treatment for osteoporosis.

Prolia

This is a so-called monoclonal antibody — a fully human, lab-produced antibody that inactivates the body’s bone-breakdown mechanism. This drug is used to treat women at high risk of fracture when other osteoporosis medicines have not worked.

Bisphosphonates

This group of medications includes the drugs Actonel, Fosamax, Reclast, and Boniva. Bisphosphonates are used to prevent and/or treat osteoporosis. they have been shown to slow bone loss, increase bone density and reduce the risk of spine fractures. Actonel and Fosamax have also been shown to reduce risk of non-spine fractures. possible side effects of treatment with bisphosphonates include gastrointestinal upsets.

The female body contains oestrogen receptors, which are located on many body tissues including bone. These receptors respond to the hormone oestrogen. Selective oestrogen receptor modulators (SERMs) are medications that work by blocking the oestrogen effect at some receptor sites, while prompting an oestrogen effect at others. in bone they work like oestrogen and lead to an increase in bone mass (density), mainly in the spine (less in the hips).

You should keep in mind that potential side effects of SERMs include hot flushes and a slightly increased risk of deep vein thrombosis (DVT).

Vitamin D and Calcium Supplements

A woman experiencing menopause may be prescribed a vitamin D derivative by a doctor and calcium supplements. These supplements may reduce the incidence of bone fractures by 30 %. five to 15 minutes of sunlight exposure every day can also boost vitamin D production and contribute to bone health. Vitamin D is activated by the liver and kidneys to boost calcium absorption.

Women age 51-70 require 400 units of vitamin D per day, and women over the age of 70 need 600 units. Vitamin D-fortified milk is one of the best food sources for this nutrient – one 8 oz. glass provides 100 units, or 25% of the daily requirement.

Excellent sources of calcium are milk and dairy products, canned fish with bones like salmon and sardines, dark green leafy vegetables, such as kale, collards and broccoli, calcium-fortified orange juice, and breads made with calcium-fortified flour.

Strontium Ranelate

Strontium is a trace element that is naturally found within soft tissues, blood, teeth and bone. although it is unclear how it works, it seems to reduce bone loss and may enhance bone formation. Studies with this medication in postmenopausal women have shown a reduction in both vertebral (spinal), hip and other fractures.

Like other osteoporosis therapies, you may also require additional vitamin D and calcium supplements if your vitamin D levels are low or dietary calcium intake is insufficient.

Potential Therapies – Tibolone

There is evidence that tibolone has beneficial effects on bone and leads to an increase in bone mineral density and reduction in fracture and risk.

Tibolone may not have the same stimulatory effects on the breast as standard forms of hormone therapy; studies have shown no increase in breast cancer for up to five years of use. Note: tibolone should not be used in women with breast cancer.

Potential Therapies – Parathyroid Hormone

This hormone is administered daily through an injection just below the skin (subcutaneous injection). It increases bone formation and absorption of calcium from the gut and kidney. It’s good to note, Calcium and vitamin D supplements may be necessary with this medication and must be monitored under the care of a specialist physician or endocrinologist.

There are some other recommendations for women who have osteoporosis:Avoid certain medications. Steroids, some breast cancer treatments (such as aromatase inhibitors), drugs used to treat seizures (anticonvulsants), blood thinners (anticoagulants), and thyroid medications increase the rate of bone loss if not used as directed. If you are taking any of these medications, you should talk to your doctor about how to reduce your risk of bone loss through diet, lifestyle changes and, possibly, additional medication.

Other preventive steps. You’d better limit alcohol consumption and do not smoke. Smoking causes your body to make less estrogen, which protects the bones. Too much alcohol can damage your bones and increase your risk of falling and breaking a bone.

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