World Menopause Day: Why are postmenopausal women more prone to osteoporosis? – Times of India

Osteoporosis refers to a common bone disease in older adults that causes significant loss of bone mass and quality. The risk of fragility fractures increases as bones weaken. However, this risk is very crucial for menopausal women. It is estimated that over 61 million people suffer from osteoporosis in India, 80% of whom are women, which also highlights the fact that the prevalence of osteoporosis is high in India compared to Western countries.
Risk factors
Women have a multitude of risk factors that put them at increased risk of osteoporosis as they age. menopause. The first and most important risk factor is simply age; as the years increase, the bones also decrease. Estrogen is another vital hormone involved in building and maintaining bones, and its decrease also plays a role. Other contributing factors include body weight, dietary deficiencies – primarily a lack of calcium and vitamin D – and various lifestyle activities such as smoking and remaining inactive. Certain medications, such as corticosteroids and anticonvulsants, can contribute to bone loss.
Pathophysiology
Menopause is a critical transitional stage in a woman’s life that brings significant hormonal changes. A major cause of osteoporosis in women is changing hormone levels during the menopausal transition. Estrogens are important for bone maintenance and their decline is thought to be responsible for approximately 75% of bone loss observed during the first 15 years after menstruation stops. Although the consequences of a diet low in calcium and vitamin D can contribute to premenopause, the decline in estrogen remains the main cause of successful prevention of bone loss.
Symptoms and signs
Manifestations of osteoporosis are usually characterized by certain types of fractures. Some of the common problems include vertebral compression fractures which can lead to extreme cases of pain, loss of height, and altered posture. Other common fractures are Colles fractures, wrist fractures, and femoral neck fractures. Among hip fractures, a significant percentage are osteoporotic. These injuries represent fragility but also serious implications of the disease on the affected quality of life.
Investigations and diagnosis
The diagnosis is established by BMD scanners. Although DEXA scans are the most acceptable standard, they are strongly recommended for women over 65 years of age. In addition to the BMD test, several blood tests can help establish the disease. These include the measurement of parathyroid hormone, calcium, phosphorus, alkaline phosphatase, among others, kidney function as well as vitamin D levels.
Treatments
Osteoporosis, especially during and after menopause, would require multi-pronged approaches to address it. We must emphasize lifestyle changes: regular physical activity, diet enriched with calcium and vitamin D, exposure to the sun.
MHT is another effective treatment that replaces estrogen levels and prevents bone loss. Of course, if these are the same women who are at greater risk of developing breast cancer but still need treatment for osteoporosis, SERMs like raloxifene can be used as alternatives.
Calcium supplements are also necessary, for which a postmenopausal woman needs approximately 1,200 mg of elemental calcium per day. Most diets contain only 500 to 700 mg, so supplements are often essential.
Vitamin D requirements are also just as critical. The stipulated daily intake for postmenopausal women has been estimated at around 600 IU. Finally, medications to prevent bone loss include bisphosphonates, particularly alendronate, which promotes osteoclast apoptosis and, therefore, delays bone resorption.
The increased prevalence of osteoporosis in women during menopause must be attributed to both hormonal changes and diet and lifestyle factors. A comprehensive rehabilitation program can significantly reduce risks and improve lives.
(Author: Dr Hemant Deshpande, Head, Department of Obstetrics and Gynecology at DPU Super Specialty Hospital, Pimpri, Pune)