Osteoporosis and menopause: what every woman needs to know?

According to statistics, osteoporosis most often affects older and middle-aged women. And the main risk here is hormonal changes after menopause. Fortunately, it can be reduced.

Osteoporosis literally translated from ancient Greek means "porous bone" - and this fully reflects the essence of the disease. The limbs, gradually lose bone density, become fragile and brittle. This makes people susceptible to fractures literally out of the blue. Cases of spontaneous fractures are also known. In addition, the patient develops unbearable joint pains.
In many cases, osteoporosis is not detected until the person has had their first serious injury. According to statistics, older people most often suffer from fractures of the hip or lumbar vertebrae.

Short information about osteoporosis

Why do bones become brittle in old age?

The precise cause of osteoporosis is not known to medicine. But it is known how bones renew and what interferes with this process.

Our bones are made from living, constantly renewable tissue. The external layer of the bone (cortical bone) is dense and hard. It hides trabecular tissue underneath, which, on the contrary, looks like a sponge. The main "building material" of bone is hydroxyapatite (a calcium-based mineral compound). In osteoporosis, the “holes” in this “sponge” become bigger which leads to the thinning of the inner layer of the bone.

Before the age of 30 years, the human body renews bone tissue faster than loses it. Osteoblasts (cells that renew bones) are made faster than osteoclasts (cells that “kill” bones). But with age, it becomes more difficult for them to maintain this pace. When bone-building material deficit gets to a certain point, an individual develops osteoporosis.

Why osteoporosis occurs in menopause?

During perimenopause (extinction of ovarian function) and the menopause itself, the female body begins to slow down the production of female hormones - estrogens (estradiol, estrone, and estriol). All three play key roles in metabolism and women's health. Early menopause (before reaching 45) or any long periods when estrogens are low and menstruation stops, resulting in bone loss. The link is simple: estrogens belong to the category of calcium metabolism hormones. And with their deficit, calcium crucial for bones is poorly absorbed. Eventually, bone tissue begins to regenerate more slowly.

What are the symptoms of osteoporosis?

Osteoporosis, like ovarian cancer, is often referred to as a "silent disease." Bone loss goes on without any manifestations for a long time until a sudden strain, shock, or fall causes a fracture.

The disease can be suspected only by changes in posture, pinching of the spinal nerves - by this time the disease has already gone far enough to deform the spine.

Major risk factors

- Age. As we have said, normal bone density is maintained until 30 years, and then it starts to gradually decrease. After menopause (especially if it was early menopause), this process is rapidly accelerated;
- Sex. Women, and especially women over 50 – they are 4 times susceptible to the disease than men. Physiology is partly to blame (women have thinner and lighter bones), partly - hormonal changes in the body;
- Ethnicity.  European and Asian women are more susceptible to the disease than African women. According to statistics from American physicians, hip fractures occur twice as much in white Americans as in African-American women;
- Bone structure. Women of short stature and asthenic constitution have a higher risk of osteoporosis, which is easily explained. Weak constitution results in faster bone loss. Likewise, naturally thin and short men are also at greater risk in old age;
- Heredity. According to statistics, if the parents or one of the grandmothers suffered from osteoporosis (hip fracture, injuries, and deformity of the spine), a woman is much more likely to receive a similar diagnosis;
- History of bone fractures (especially spinal fracture);
- Long-term use of potent medicines. Steroid medications (such as prednisone) raise the risk of osteoporosis;
- Accompanying illnesses. A number of diagnoses, including cancer or stroke, are also potential contributors to osteoporosis.

How to recognize early osteoporosis?

Unfortunately, the first signs of the disease can only be detected in a clinical setting. A bone mineral density test, or densitometry, is an X-ray or ultrasound examination. Undergoing densitometry at least once a year is advised primarily for women over 65, either with concomitant diseases or after early menopause.

Hormone therapy for osteoporosis - is it worth it?

Hormones believed to be extremely helpful in the prophylaxis and treatment of bone loss. But doctors recommend taking hormonal drugs only with diagnosed osteoporosis. Otherwise, potential health damage is possible. If you do decide to drink hormones for prophylaxis, then be sure to consult with your doctor. Perhaps less risky methods will suffice.

After menopause, you should not give up hormonal drugs completely, however, they should be taken with extreme caution.

What is the alternative for hormone therapy?

There are also more harmless drugs that help well in the prophylaxis of osteoporosis:

- Bisphosphonates. They inhibit bone destruction by destroying osteoclasts.
- Evista. The medication is a selective estrogen receptor modulator. It is effective for the prophylaxis and therapy of osteoporosis. When taken regularly, the risk of spinal fractures is reduced by almost half. But the medication elevates the risk of thrombosis so you must be sure that you have no tendency for this disease.
- Teriparatide is a hormone but not a female sex hormone. It helps repair bones and enhances bone density. It is administered by injection.
- Denosumab is a medication with so-called monoclonal antibodies. These are laboratory-grown human antibodies that deactivate the process of bone fragility. It is prescribed when other treatments were not effective.

Prophylaxis of osteoporosis

It is quite possible not to bring the situation to taking medications if you lead a healthy lifestyle. It is trite but true.

-  Exercise and loads. Nature is laid down for a person to constantly move, so a regular training program is needed. For the prophylaxis of osteoporosis, aerobic exercise is best suited (fast walking, jogging, swimming, dancing, etc.). They are all great for maintaining a healthy weight. Besides, exercising coordination and strength can significantly reduce the risk of falls in old age. Choose activities according to age and well-being;
- Foods rich in calcium. The advised daily amount for an adult is about 1000 mg of calcium. For people in the risk group, it should be raised to 1200 mg. Milk and dairy products are perfect sources of calcium, however, try to choose low-fat options. Sea fish, and dark green vegetables (cabbage, broccoli, etc.) are perfect.
- Supplements with calcium. In insufficient calcium from food, doctors usually prescribe vitamin and mineral complexes, however, remember about the daily norm. More than 2000 mg of calcium contributes to the occurrence of kidney stones, especially if you are over 50 years old. In addition, before taking calcium, it is advised that you first pass a complete analysis for trace elements and minerals;
- Vitamin D is crucial for the absorption of calcium by the bones.

It is extremely important to know about high-risk medications that can promote osteoporosis:

- Steroid medications (often used to treat breast cancer);
- Anticonvulsants;
- Anticoagulants;
- Drugs to support the functioning of the thyroid gland.

If you have been taking any of these medications for a long time, be sure to visit your doctor so that he draws up a treatment program to compensate for the loss of calcium. Other preventive measures will be even more commonplace: quit smoking and reduce alcohol consumption.

Where to get calcium from in lactose intolerance?

Lactose allergy can be a serious problem in the prophylaxis of bone disease. To safely eat dairy products, try taking lactase enzyme in parallel (they are sold in pharmacies in the form of drops or tablets). However, you will likely need to switch to lactose-free dairy products and create your diet around other calcium-rich foods.

How to protect yourself from falls with diagnosed osteoporosis?

The primary task is to protect yourself from accidental falls and fractures. Therefore, take precautions:

- Maintain order in the house;
- If possible, remove all loose interior items;
-Mount the handles next to the toilet and bathtub so that you can lean on them;
-Install the right lighting in your home;
- Wear comfortable shoes with good tread;
- Remove any loose rugs and rugs from the interior that you might trip over.

Post by: Jacob Hansen, General healthcare practitioner, National health centre, Stavanger, Norway