Osteoporosis and Menopause
The years preceding menopause are critical for bone health in women. Rapid bone loss may begin a few years before menopause, putting women at risk of developing osteoporosis and suffering painful and serious fractures.
What is Osteoporosis and What Causes It?
Osteoporosis is the thinning of bones caused by bone loss beginning a few years before menopause. Bone loss is particularly rapid in the 5 to 10 years around the menopause because of loss of oestrogen.
Osteoporosis is a risk factor for all fractures except those of the hands, feet and face. Many medical conditions such as coeliac disease and medications such as aromatase inhibitors (used for breast cancer) and prednisone may contribute to bone loss and osteoporosis. The diagnosis of postmenopausal osteoporosis is made in women who have had a spine or hip fracture or by a bone density test.
Should You be Tested?
Fracture risk assessment and bone density testing should be performed in all women with risk factor for osteoporosis. This includes:
1. all postmenopausal women who have had a fracture
2. all women aged 65 years or older
3. younger postmenopausal women with other risk factors including smoking, being thin, a family history of osteoporosis, or diseases or medicines that harm the bones.
Can you Prevent Osteoporosis?
Lifestyle measures, including a healthy diet, regular physical activities such as walking, and avoiding unhealthy habits such as smoking can slow bone loss. However, this measures will not prevent bone loss caused by menopause, and neither should be consider as a treatment for osteoporosis.
Calcium?- for women with low dairy intake, supplements of 600 mg calcium daily may be useful.
Vitamin D supplements?of 1000 IU to 2000 IU daily are recommended for women known to have osteoporosis and for those at risk for vitamin D deficiency.
Oestrogen therapy?should be considered to prevent bone loss in younger postmenopausal women, especially in women with menopause symptoms. Bone loss happens quickly when oestrogen is stopped.
Fall Prevention
Most fractures happen after a fall.?Fall risk can be reduce by:
1. improving muscle strength and balance
2. correcting poor vision
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3. identifying and removing hazards at home such as loose mats, pet bowls, or trailing cables.
What are the Treatment Options for Osteoporosis?
For women with osteoporosis, drug therapy, in addition to lifestyle measures, is necessary to strengthen the skeleton and decrease the risk of fracture.
Bisphosphonates?and?denosumab?are the drugs more often used to treat osteoporosis. These drugs increase bone density, strengthen the bones, and significantly decrease the risk of fractures, but they do not rebuild the damaged bone structure.
Bisphosphonates?are available as tablets taken once weekly or monthly or as an intravenous infusion given once yearly or less often.
Side effects of bisphosphonates include mild and temporary stomach upset and muscle pains. The risk of atypical fractures is very low during the first 5 years of bisphosphonate therapy but increases after 8 to 10 years of treatment.
Denosumab?is given as an injection every 6 months and can be used for many years. As with oestrogen, protection from spine fracture is quickly lost and bone density decreases rapidly when denosumab is stopped unless other treatment begin.
Raloxifene?is anti-oestrogen approved for the prevention and treatment of osteoporosis. However, it is less potent than other bone medications, doesn’t prevent hip fracture and increases hot flushes. As raloxifene is approved to prevent breast cancer in high-risk women, it is a valid option for women who are at risk for breast cancer but not for hip fracture.
Bone-building drugs such as abaloparatide, teriparatide and romosozumab?are more effective than bisphosphonates at increasing bone density and reducing fractures. They are recommended for women at very high risk of fracture including those with recent or multiple fractures.?
Summary
Osteoporosis is a common condition that affects nearly 1 in 3 women after menopause. Oestrogen deficiency leads to rapid bone loss which is maximal within the first 2-3 years after menopause and can be prevented by hormone therapy.
Oestrogen therapy can prevent osteoporosis when started at the time of menopause. Lifestyle measures can slow bone loss but not prevent or treat this. For women who developed osteoporosis multiple treatment options are available that safely and quickly reduce the risk of fractures.
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