Osteoporosis
Osteoporosis is a fairly common womens
health problem among the post-menopausal. Because estrogen is
a factor in encouraging proper bone growth, the loss of estrogen
that occurs as a result of menopause often triggers the dramatic
decrease in bone density known as osteoporosis.
The classic osteoporosis case is the stooped-over elderly woman,
hobbling along with the assistance of a cane or cart. Her spine
is deformed by years of painful, recurring fractures, and it seems
the slightest bump or mishap causes another trip to hospital. Special
alarm necklaces are available to make emergency calls, in case such
individuals fall and break a hip, or worse. It's the nightmare of
any healthy young woman to end up in the stooped elder woman's shoes.
Luckily, osteoporosis is now a well-understood disease. While there
are a number of risk factors in the development of most cases of
osteoporosis, the majority of them are preventable. A few that are
not are: a personal or family history of fractures, female sex,
old age, dementia (leading to increased risk of falls) and European
lineage.
However, the list of preventable or modifiable risk factors is
much more substantial:
- Tobacco smoking (cut down or stop)
- Drinking beverages containing phosphoric acid (fizzy drinks/soda)
- Low body weight (below 58kg/127lbs)
- Lack of estrogen (replaceable via hormone supplements)
- Prolonged amenorrhoea (more than one year -- can be caused by
some birth control methods, or extremely low
- body fat/anorexia)
- Low calcium intake (enriched foods and vitamin supplements can
help)
- Alcoholism (can contribute to mineral deficiency -- reduce or
eliminate alcohol consumption)
- Inadequate physical activity (exercise helps increase bone mass)
- Excess/risky physical activity (anything that increases risk
of injury and fracture)
The vast majority of osteoporosis cases are seen in post-menopausal
women, but there are a number of other disorders and diseases associated
with osteoporosis in other age and gender groups. Endocrine disorders
(such as Cushing's disease and adrenal insufficiency) and 'hypo-gonadal'
disorders (such as Turner syndrome or hypothalamic amenorrhoea)
can cause bone density loss by interfering with the hormonal systems
that contribute to healthy bone formation. Nutritional and gastrointestinal
problems (including malabsorption syndromes and malnutrition) can
lead to mineral deficiencies that prevent sufficient bone growth.
Some forms of cancer can lead to osteoporosis as a secondary condition,
and any disease that leads to a severe lack of physical activity
will naturally lead to a loss of bone mineral density (BMD).
Most women, however, need only worry about regular age/estrogen
related osteoporosis, which is highly preventable if proper lifestyle
choices are made during the pre-menopause years, and reasonably
preventable even after menopause with a reasonable regimen of calcium
supplements and regular exercise. If osteoporosis is suspected,
your doctor will likely test you for a variety of possible causes
before recommending specific treatment, to rule out the diseases
mentioned above.
Osteoporosis by itself is not a fatal illness though. While the
hip and spinal fractures associated with advanced cases are certainly
painful, and decrease the patient's mobility and overall quality
of life, osteoporosis itself would rarely become a problem if not
for the accidental falls and injuries that lead to bone fracture.
Dementia and poor physical fitness are significant contributing
risk factors for osteoporosis sufferers, because of the associated
increased risk of injury and accidents. Perhaps the single biggest
long-term preventative measure every woman can take is a regular
exercise routine. Not only does regular physical activity in children
and teens significantly increase bone density in the adult years,
but even for adults, only thirty minutes of weight-bearing exercise
(such as walking, jogging or aerobics) three times a week increases
bone density and improves muscle tone and coordination, helping
to reduce later risk of falls and fractures.
If you're in a known risk group (such as approaching menopause,
severely restricted physical activity, using prescription steroids),
your doctor may prescribe preventative calcium and vitamin D supplementation.
If you're not in a known risk group, you can still help minimize
your risk with the preventable risk factors list given above. A
few minor lifestyle changes can make a big difference in your long-term
health! In addition to adequate calcium intake (which should be
from a variety of sources, not just dairy products), balanced intake
of vitamin D and magnesium is important for proper calcium utilization.
But perhaps you have an older relative who is already suffering
significant bone loss, or you've just found out osteoporosis has
'snuck up' on you before you took preventative measures. There are
a number of medications currently on the market which can help after
the onset of significant bone mass loss. Bisphosphonate drugs such
as Fosamax (sodium alendronate) are often prescribed in daily or
weekly doses, in some cases even before osteoporosis is diagnosed
if you are in a very high risk group. Actonel is also a common bisphosphonate
medication. Evista (raloxifene), another frequently prescribed treatment
is a selective estrogen receptor modulator (SERM) rather than a
bisphosphonate, and may be more suitable for some patients.
Newer osteoporosis medications include Forsteo (teriparatide),
a recombinant parathyroid hormone, which may be prescribed on its
own or with sodium alendronate. One new medication seems to actually
act to increase bone rather than merely preventing further bone
loss: oral strontium ranelate. However, both teriparatide and strontium
are available primarily to patients for whom traditional bisphosphonate
treatment has proven ineffective.
In any case, if you are concerned about osteoporosis, either for
yourself or a loved one, consulting with a physician about options
for high-risk individuals (or current osteoporosis sufferers) is
always a good idea. Your personal physician will be able to offer
advice and treatment/prevention options customized for your lifestyle
and risk level. For young women and low-risk individuals, a regular
habit of muscle- and bone-building exercise, combined with adequate
intake of calcium and other needed minerals may be all the help
you need, but certainly these basic steps would be good for any
health individual to take in the interest of their overall health,
whether osteoporosis is a concern or not.
Osteoporosis Links
UK - Osteoporosis Society Online
US - National Osteoporosis Foundation
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