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Womens Health
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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