How Does Exercise Affect My Chances Of Osteoporosis What If I Already Have Been Diagnosed With Osteoporosis
Exercise is important at every stage of life, and it is never too late to start. Weight bearing exercise such as walking, or lifting a reasonable amount of weight has a positive impact on bone mass. Other types of exercise help keep you flexible and improve your balance, factors that could help you avoid a fall leading to a bone break.
Induced Menopause Following Prophylactic Bilateral Oophorectomy
Approximately 1 in 9 women aged 35â45 years has undergone hysterectomy, with 40 percent undergoing bilateral oophorectomy at the same time, resulting in the abrupt onset of menopause . The practice of prophylactic oophorectomy has increased over time and more than doubled between 1965 and 1990 . Meanwhile, reports now link induced menopause from bilateral oophorectomy with serious health consequences including premature death, cardiovascular and neurologic disease, and osteoporosis, in addition to menopausal symptoms, psychiatric symptoms, and impaired sexual function.
4.2.1. Mortality and cardiovascular disease
The Mayo Clinic Cohort Study of Oophorectomy and Aging involved a population-based sample of 4,780 women and reported increased all-cause mortality in women who underwent prophylactic bilateral oophorectomy before age 45 years . The increased mortality was mainly observed in women who did not take estrogen after the surgery and up until age 45 years . Cardiovascular mortality was also increased in the women who underwent bilateral oophorectomy before age 45 years and did not take estrogen .
In summary, data consistently show an increased risk for cardiovascular disease in women who undergo bilateral oophorectomy inducing premature menopause or early menopause. Estrogen replacement proximate to bilateral oophorectomy appears to be particularly important for reducing premature coronary heart disease and death in this group of women.
4.2.2. Neurologic outcomes
Ask Your Doctor About Prescription Medications And Injectable Bone
A group of drugs called bisphosphonates helps prevent bone loss. Over time, these medicines have been shown to slow bone loss, increase bone density, and reduce the risk of bone fractures.
A 2017 study showed bisphosphonates can reduce the rate of fractures due to osteoporosis up to 60 percent.
Monoclonal antibodies can also be used to help prevent bone loss. These drugs include denosumab and romosozumab .
Selective estrogen receptor modulators, or SERMs, are a group of drugs that have estrogen-like properties. Theyre sometimes used for the prevention and treatment of osteoporosis.
A showed that the most benefit in SERMS is often in reducing the risk of fractures in the spine up to 42 percent.
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What Are Some Of The Best Weight Bearing Exercises That Help Prevent Osteoporosis Or Slow Its Progress
The ideal exercise program for women just before, at, and after menopause should include some weight bearing, some strengthening and some stretching exercises.
Since your bone mass begins to diminish as menopause is reached, weight bearing exercise is especially recommended. As pressure on your bones is applied, the bodys natural defence system wants to spread the load and actually builds more bone. Activities such as brisk walking, low-impact aerobics, and dancing are considered weight bearing exercises.
Stretching exercises keep muscles flexible and toned, and tend to make us relaxed as well. Yoga is a good example of exercise with the stretch built in. Resistance exercises that require lifting or pulling, sometimes known as weight training, should also be part of your exercise program.
- Health Concerns
How Do I Know If I Have Osteoporosis
A painless and accurate test can provide information about bone health and osteoporosis before problems begin. Bone mineral density tests, or bone measurements, are X-rays that use very small amounts of radiation to determine bone strength.
A bone mineral density test is indicated for:
- Women age 65 and older.
- Women with numerous risk factors.
- Menopausal women who have had fractures
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Design Setting And Participants:
Participants were 5573 women in the National Cancer Institute Combined Cohort Study of DES . Data on reproductive history and medical conditions were collected through questionnaires at baseline in 1994 and subsequently in 1997, 2001, and 2006. Age-stratified Cox regression models were used to calculate multivariable incidence rate ratios and 95% confidence intervals . Effect measure modification by prenatal DES exposure was assessed using cubic restricted spline regression models.
The Osteoporosis Risk For Women In Premature Menopause
Women in early menopause whether naturally or surgically face a high risk of rapid bone loss. Heres a quick look at that threat of osteoporosis and the reason why its vital to take care of our bones now, before we lose a great deal of bone density.
A study conducted by researchers at the National Institute of Child Health and Human Development concluded that women with premature ovarian failure face a high risk for bone loss. Their findings:
Two thirds of the women they studied had enough bone loss that they might be at risk for a hip fracture.
77 out of the 89 women they studied had osteopenia below normal bone density and a precursor of osteoporosis. Two of the women had full-fledged osteoporosis.
Only ten of the women in the study had normal bone density for their age.
To make matters even more worrisome, about half of the women in the study had their bone density test within eighteen months of their POF diagnosis and nearly half of this group already had osteopenia. While this particular study only looked at women with POF, the outlook is similar for women who are in premature menopause due to surgery or cancer treatment. The evidence indicates that if you had your ovaries removed, you experience significant bone loss in the first two years after surgery.
Its clear, then: When you have POF or early menopause naturally or surgically, bone loss is a very real threat and one that can occur rapidly.
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Are There Nutritional Or Other Supplements That I Can Take To Prevent Or Delay The Onset Of Osteoporosis
To reduce the risk of osteoporosis you should consume 1000-1200 mg of calcium per day, and 800 IU of vitamin D per day. It is preferable to get your calcium from foods . To determine your calcium intake, you can use Osteoporosis Canadas Calcium Calculator. If you are not able to get your calcium through your diet, a supplement can be taken instead. Choose a slow release formulation, or take smaller divided doses of calcium, rather than one large supplement. You should also engage in weight bearing or resistance training exercise to help maintain strength, balance and flexibility, and not smoke.
Who Gets Premenopausal Osteoporosis
Things that make you more likely to get the condition include:
- a family history of osteoporosis or fractures
- a history of eating disorders, such as anorexia or bulimia
- a history of other diseases, including kidney disease, celiac disease, thyroid disease, and connective tissue disorders
- your periods become irregular over the course of more than 12 months
- long-term lack of exercise or overtraining
- smoking for a long time
- not getting enough calcium
- taking specific drugs, including steroids, antiseizure meds, some chemotherapy drugs, and long-term use of the blood thinnerheparin.
- weighing less than 127 pounds
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How To Understand Your Bone Density Test Results
Bone density tests provide what are called T-scores, which show how your bone density compares to the average bone density of a 30-year-old. The lowest T-score at the spine or hip is used to diagnose osteoporosis.
According to the National Osteoporosis Foundation, heres how to interpret your T-score:
-1.0 or above: normal bone density
-1.0 to -2.5: low bone density
-2.5 or below: osteoporosis
If your T-score is below -2.5 and you have no other risk factors for osteoporosis, or your T-score is below -1.1 and you do have other risk factors, its recommended to consider further evaluation and treatment to prevent fractures.
Acog Releases Guidelines For Clinical Management Of Osteoporosis
Matthew J. Neff
Am Fam Physician. 2004 Mar 15 69:1558-1560.
The American College of Obstetricians and Gynecologists recently issued guidelines for the clinical management of osteoporosis in women, including recommendations for screening, prevention, and treatment of this condition. The guidelines appeared in the January 2004 issue of Obstetrics and Gynecology.
Approximately 13 to 18 percent of women in the United States who are at least 50 years old have osteoporosis and an additional 37 to 50 percent have osteopenia. Risk factors for osteoporotic fractures in this population include a family history of osteoporosis, previous fractures, white race, dementia, poor nutrition, cigarette smoking, alcoholism, low weight and body mass index, estrogen deficiency, early menopause or prolonged premenopausal amenorrhea, long-term low calorie intake, impaired eyesight despite adequate correction, history of falls, and inadequate physical activity. Appropriate screening strategies and significant pharmacologic interventions are available to prevent and treat osteoporosis.
According to ACOG, the preferred method for diagnosing osteoporosis is bone mineral density testing. Dual-energy x-ray absorptiometry is the technical standard for measuring bone mineral density because it measures at important sites of osteoporotic fractures, has high precision and accuracy, is relatively inexpensive, and has modest radiation exposure.
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Experts Weigh In On When How To Prevent Osteoporosis In Midlife Women
CHICAGO — Menopause can have a substantial impact on a woman’s bone density and risk for osteoporosis, but there is no one-size-fits-all strategy for dealing with the issue, specialists told MedPage Today.
“The estrogen drop precipitating the menopause has a profound effect on bone density, especially during the late perimenopause, as opposed to early- or pre-menopause, ” Alexander Comninos, MBBS, PhD, of Imperial College London, explained by way of background. “A woman will lose up to half of her bone mass during her lifetime, with 50% of this occurring in the first 10 years after menopause. This provides a crucial time-limited postmenopausal window that therapeutic intervention can target.”
However, most current clinical guidelines do not recommend osteoporosis screening until age 65 — 14 years after the average age of menopause, he noted. “Hence, screening at age 65 may miss this important postmenopausal window in which to intervene. Furthermore, the rate of drop of bone mineral density is a key independent predictor of fracture risk, and so assessing this early in the postmenopausal period can help identify candidates for therapeutic intervention.”
Judi Chervenak, MD, of Montefiore Health System and Albert Einstein College of Medicine in Hartsdale, N.Y., noted that one of the biggest osteoporosis risk factors for these women is how much bone they have going into the menopause transition.
Who’s a Candidate?
Other Therapy Options
Uspstf Recommends A 15 Year Hiatus Before Repeating Another Bmd
BMD may not be indicated for people with chronic back pain, screening women aged < 65 years unless significant clinical risk factors have been identified. Some believe that there is no point confirming osteoporosis if there is a fragility fracture however without DEXA one is unsure of the severity of the osteoporosis. It has also been suggested that women on hormonal therapy for menopausal symptom relief do not need DEXA screening, however because of rapid bone loss after discontinuing HT /ET it would be helpful to identify those with low BMD.
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Early Menopause Increases Risk Of Osteoporosis
It is well known that estrogen has protective effects on the bone, maintaining bone density, and that loss of estrogen earlier than the average age of the menopause, ie early or premature menopause, leads to an increased risk of osteoporosis if untreated.
Loss of estrogen before the age of 40 has been stated as being of particular significance, but a recent report in the British Journal of Obstetrics and Gynaecology concludes that menopause before the age of 47 is associated with increased mortality risk and increased risk of both having osteoporosis and of sustaining fragility fracture by the age of 77.
The study included 390 north European women and followed them up for 34 years beginning at the age of 48 and divided into two groups according to age at menopause early menopause < 47 years and late menopause > 47 years.
Study limitations include the small ample size and a high dropout rate, but this is thought to be the first such study with a follow-up period of more than three decades. Women who do experience the menopause before the age of 47 years should be aware of later health risks related to the early loss of estrogen and should consider the use of hormone replacement, at least until the average age of the menopause.
What Are The Symptoms Of Osteoporosis
Osteoporosis is often called a “silent disease” because initially bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as stooped posture.
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Other Risk Factors For Osteoporosis:
Inherited Risk Factors
Race Its a simple rule of thumb: In general, Asian women tend to have the lowest bone density, followed by white women. African Americans tend to have higher bone density and slower rate of bone loss.
Small Body Build The smaller and more fine-boned your frame, the higher the possibility of bone loss and fracture since you started out with less bone to lose.
Family history of osteoporosis If your mother, grandmother, aunt or sister has or had osteoporosis, you are at an increased risk of having it yourself. According to recent scientific studies, this may be due to an inherited osteoporosis gene a gene that is supposed to stimulate the production of a protein that assists Vitamin Ds job in bone-building. If this gene is defective, you generally have poor bone density.
Past Risk Factors
Skipped periods for a long amount of time because of excessive weight loss or exercise. If you stopped having periods for an extended amount of time due to excessive exercise, anorexia or bulimia, you stopped ovulating which means that your estrogen level dropped. Low estrogen levels are linked with bone loss and the development of osteoporosis.
Low calcium diet The formative years are important ones for your bones. If you didnt get enough calcium then, your bones may never have reached their optimal mass meaning you may have entered premature menopause with less bone mass than the average woman your age.
Other Risk Factors
Reducing The Risk Of Osteoporosis During Menopause
Around the time of menopause, you can reduce your risk of developing osteoporosis by following a few lifestyle recommendations, such as:
- Aim for 1,300 mg of dietary calcium intake every day. This equals about three to four serves of dairy food. A wide range of non-dairy foods also contain calcium, such as calcium-fortified soy or almond drinks, firm tofu, almonds, brazil nuts, unhulled tahini, dark green leafy vegetables and fish with edible bones, such as sardines or tinned salmon.
These lifestyle habits are best started younger in life to get the most benefit.
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Induced Premature Menopause Or Early Menopause
Induced menopause may result from premenopausal bilateral oophorectomy or from cancer treatments including chemotherapy and radiation. Premature menopause from these causes has increased over time because of the improved success in the treatment of cancer in children, adolescents, and reproductive-age women. Similarly, the practice of prophylactic bilateral oophorectomy at the time of hysterectomy has increased over time . However, evidence for the long-term risks and adverse health outcomes following induced menopause is starting to accumulate.
Tools To Help Evaluate Your Risk For Bone Fracture And Osteoporosis
The American Bone Health Fracture Risk Calculator can be used to assess risk for postmenopausal women. By inputting your answers to questions regarding your age, lifestyle habits, medical and fracture history, the calculator aims to tell you your risk for bone fracture in the next ten years. Give it a shot here.
A more hands-on way to understand your osteoporosis risk is to have your bone mineral density measured. These are simple X-rays taken to examine the density and strength of your bones. If you have osteoporosis, this can also tell you how severe it is.
Its recommended that the following postmenopausal women have a BMD test done:
Those who experience a fragility fracture. A fragility fracture is a fracture you can get after exposure to a low trauma, or sustaining a fracture that normal people would not have. Low traumas are those occurring from a fall from a standing height or less, without major trauma like being in a car accident.
Those under the age of 65 who have at least one risk factor for osteoporosis.
Those over the age of 65, regardless of additional risk factors.
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Who Develops Osteoporosis
Age and ethnicityOther medical risk factors
Other medical conditions include: endocrine disease, kidney disease, liver disease and obstructive lung disease. Myeloma is a cancer that is frequently associated with a rapid destruction of bone, leading to osteoporosis.Several frequently used medications have also been associated with increased fracture risk’ anti epileptic drugs, breast cancer treatments such as aromatase inhibitors, SSRIs – selective serotonin receptor uptake inhibitors , thiazide diuretics and possibly proton pump inhibitors .
Dont Forget Vitamin D
Your body uses vitamin D to absorb calcium. Being out in the sun for at least 20 minutes a day can help your body to produce enough vitamin D. You can also get vitamin D from your diet. Foods that are rich in vitamin D include eggs, fatty fish, cereals, and milk fortified with vitamin D.
Older adults ages 50 to 70 should aim for at least 600 IUs and no more than 4,000 IUs of vitamin D per day. Check with your healthcare provider before taking vitamin D supplements. They can test your vitamin D levels to determine if supplements are necessary.
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