Osteoporosis, a chronic and progressive ailment, is a significant health concern for postmenopausal women. This article aims to provide an in-depth understanding of osteoporosis in menopause and the importance of proactive prevention measures.
UNDERSTANDING OSTEOPOROSIS
Osteoporosis is a condition that affects the structural integrity of the bones, making them weak and prone to fractures. It is characterised by a reduction in bone mass, resulting in an increased risk of fractures. While it can occur at any stage of life, the onset of menopause significantly accelerates this degenerative process.
THE ROLE OF HORMONES IN BONE HEALTH
Bones are metabolically active, subject to a constant process of remodelling, known as "bone remodelling". This process is regulated by two types of specialised cells:
Osteoclasts, responsible for bone destruction and reabsorption,
Osteoblasts, tasked with bone construction.
Essential to these processes is the role of vitamin D, calcitonin (secreted by parafollicular cells in the thyroid) and parathyroid hormone (secreted by the parathyroid glands).
Vitamin D facilitates the absorption of calcium and phosphorus, calcitonin promotes bone mineralisation, and parathyroid hormone aids in calcium release from the bones by stimulating osteoclast activity.
However, the central role in all these processes is that of oestrogen hormones. Oestrogen promotes calcium reabsorption in the kidneys, facilitates vitamin D conversion, and increases calcitonin synthesis. Nevertheless, a deficiency in oestrogen results in increased osteoclast activity and bone reabsorption.
OSTEOPOROSIS IN MENOPAUSE: THE UNDERLYING CAUSES
The link between oestrogen deficiency during menopause and osteoporosis is well-established. Reduced oestrogen levels during menopause lead to decreased intestinal and renal calcium reabsorption and increased osteoclast activity, resulting in lowered bone mass.
While the decline in oestrogen is a significant cause of osteoporosis in menopause, other contributing factors include:
Genetic predisposition and family history,
Reduced peak bone mass,
Inadequate dietary calcium intake and poor nutrition,
Sedentary lifestyle,
Periods of amenorrhoea,
Use or abuse of certain medications, like corticosteroids and anticonvulsants,
Presence of certain diseases, such as hyperthyroidism, chronic renal diseases, etc.,
Excessive thinness,
Smoking,
Alcohol abuse.
RECOGNISING THE SYMPTOMS OF OSTEOPOROSIS IN MENOPAUSE
In many cases, patients are unaware of their osteoporosis condition until they undergo specific diagnostic tests or experience fractures. However, certain symptoms may point towards the possibility of osteoporosis, such as:
A decrease in height due to vertebral compression or spinal curvature,
Bone pain,
Muscle pain,
Fractures.
DIAGNOSING OSTEOPOROSIS IN MENOPAUSE
The confirmation of osteoporosis is typically through specific diagnostic tests, primarily the computerised bone densitometry (MOC). This diagnostic test measures the levels of calcium and other minerals within the bones, allowing doctors to establish a parameter known as bone mineral density (BDM).
PREVENTING OSTEOPOROSIS IN MENOPAUSE
Despite the availability of pharmacological treatments for osteoporosis, prevention remains the best therapeutic strategy. The primary focus should be on a balanced diet that provides all the necessary nutrients to the body and regular physical activity, tailored to each woman's age and individual capabilities. Gentle gymnastics and Pilates, for instance, can be an excellent training option for older women.
In addition to diet and lifestyle, other preventive measures include:
Avoiding excessive sodium in the diet and ensuring a balanced nutrient intake,
Avoiding smoking and alcohol abuse,
Avoiding prolonged use or abuse of drugs that may cause the disease, such as corticosteroids.
TREATING OSTEOPOROSIS IN MENOPAUSE
The treatment of osteoporosis involves adopting a healthy diet and lifestyle, possibly in conjunction with pharmacological treatment.
The primary drugs used in the treatment of osteoporosis in menopause include:
Oestrogen-based drugs (hormone replacement therapy),
Oestrogen receptor agonists (for example, raloxifene and bazedoxifene),
Bisphosphonates (for example, alendronate and ibandronic acid),
Drugs based on calcium and vitamin D.
Early diagnosis, proactive prevention, and appropriate treatment are the key to managing osteoporosis in menopause. With these measures, women can minimise the impact of osteoporosis on their quality of life and maintain their independence and well-being during their postmenopausal years.