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Why Does Osteoporosis Occur After Menopause

Bone Health Throughout Our Lives

Hormonal Medication Options for Preventing and Treating Osteoporosis – 222 | Menopause Taylor

When we think of bones, many people imagine a sturdy, structural skeleton. But bones are actually living growing tissues.2 Bones are mostly made of collagen and calcium phosphate, which is a great combination for keeping our bones both flexible and strong.2

Throughout our lives, new bone is being added to our skeleton, and old bone is being removed.2 When were younger, this is a rather fast process. New bone is made before the old bone is discarded, which leads to denser, larger, and heavier bones.2 Around our late 20s, we hit whats referred to as peak bone mass.2 After which point, the production of new bone slows down.2 Old bone is removed before new bone is produced to replace it, leaving us with smaller, less dense bones.2 Osteoporosis can develop either when bone loss occurs too quickly or when new bone formation happens too slowly.2

What Do Women Worry About

A recent survey on bone health in women over 45 very much reflects what my patients tell me about their own concerns. More than 2 in 5 women worries about getting frail or weak as they get older and the same number think they should take better care of their health. Half feel they should take their health more seriously, but arent doing anything about it. Nearly the same number find it hard to stay physically active.

A whopping 86% worry about losing their independence as they get older. But protecting yourself against osteoporosis could very much stack the odds in your favour.

How Much Calcium Do Women Need Each Day

How much calcium you need depends on your age:16

  • 918 years: 1,300 mg per day
  • 1950 years: 1,000 mg per day
  • 51 and older: 1,200 mg per day

Pregnant or nursing women need the same amount of calcium as other women of the same age.

You can get the calcium you need each day from food and/or calcium supplements.

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How Does This Happen

We all know bones are the hardest bits of our bodies, and that they make up our skeleton the framework the rest of our bodies are built around. But did you know that bone doesnt just sit there? Its constantly being reabsorbed by the body and rebuilt. Once youre 40, your bone starts to become less dense as the rate bone is made is exceeded by the rate its reabsorbed.

Should I Take A Calcium Supplement

Preventing Osteoporosis After Menopause

The answer depends on how much calcium you need each day and how much calcium you get from the foods you eat.

It’s best to get the calcium your body needs from food. But if you don’t get enough calcium from the foods you eat, you may want to consider taking a calcium supplement.

You can get calcium supplements at the grocery store or drug store. Talk with your doctor or nurse before taking calcium supplements to see which kind is best for you and how much you need to take.

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Preventing Osteoporosis And Falls

Preventing falls in older people is an important way to prevent fractures. Adults who have good balance and muscle strength are often able to save themselves when they trip. Exercises that improve balance and help maintain muscle mass are beneficial.

Preventing osteoporosis involves regular weight-bearing and resistance exercise, adequate calcium in the diet and an adequate level of vitamin D in the bloodstream.

Sunlight exposure on the skin is the primary source of vitamin D, but we need to practise safe sun exposure to reduce the risk of skin cancer. The recommendations vary by skin type, latitude and season. For people with moderately fair skin, six to seven minutes before 11am or after 3pm during summertime is considered sufficient.

During wintertime, the daily recommended sun exposure increases to between seven and 40 minutes depending on where you live in Australia.

While lifestyle factors such as nutrition and exercise can make an important difference to bone health over time, if an older adult has several risk factors for fracture their doctor may discuss the benefits of bone active medication. These medications slow the rate bone breaks down as we age. In general these medications halve the risk of fracture and are much more effective than lifestyle measures alone.

Read other articles in the series here.

How Does Menopause Change Bone Structure

Menopause speeds up the normal process of bone loss and reduces bone mineral density, which makes your bones thinner and weaker. In the years before menopause , a woman slowly loses bone mass. In the two or three years leading up to menopause and for several years after, bone loss occurs more quickly because the body is producing less and less estrogen.

After menopause, women lose bone tissue more rapidly for approximately 4 to 8 years. This more rapid bone loss is because the ovaries stop producing the female hormone estrogen. Estrogen is directly related to bone health. With the elimination of estrogen, bone loss in women after menopause increases.

There is a direct relationship between the lack of estrogen after menopause and the development of osteoporosis. When estrogen levels start to drop so does the body’s ability to preserve bone mass. Estrogen plays a role in bone development. The following supplements, combined with a healthy diet, may help prevent the onset of this condition.

Calcium: If you think you need to take a supplement to get enough calcium, check with your doctor first. A study published in June 2012 in the journal Heart suggests that taking calcium supplements may increase risk for heart attacks in some people however, the study showed that increasing calcium in the diet through food sources did not seem to increase the risk.

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Combination Therapy With Estrogen Therapy/hormone Therapy

There have been several studies where estrogen was combined with other agents. Combination therapy has been more effective in increasing BMD than either agent alone in some but not in all studies. One study showed that adding calcium supplementation to ET increased spine BMD by 2% and femoral neck BMD by 1.5% compared to ET/HT alone . Alendronate combined with estradiol/norethisterone acetate showed no increase in total hip BMD over those taking either medication separately . Alendronate , risedronate , and calcitriol are other agents that have been combined with 0.625 mg CEE. In all studies the combination of two agents produced spine BMD that was 2% higher than the single agent and a 1â2% higher total hip BMD. The biochemical markers of bone resorption continued to suppress on combination therapy indicating that single therapy does not fully suppress resorption. However, not enough data is available on further fracture reduction.

New Hormone preparations

Since the decline in the use of HT and ET and concerns about the adverse effects of the progestin there has been development of other HT based preparations. The development of Tissue Selective Estrogen Complex that pairs conjugated estrogens with Bazodoxifene which is a selective estrogen receptor modulator .

Effect of tissue selective estrogen complex on lumbar spine and total hip BMD.

Discontinuation of estrogen

Risk-benefit ratio in young and elderly postmenopausal women

BISPHOSPHONATES

What Can I Do To Protect Myself From Fractures If I Have Osteoporosis

Premature Menopause and Osteoporosis – 209 | Menopause Taylor

If you have osteoporosis, it is important to protect yourself against accidental falls, which may result in fractures. Take the following precautions to make your home safe:

  • Remove loose household items, keeping your home free of clutter.
  • Install grab bars on tub and shower walls and beside toilets.
  • Install proper lighting.
  • Apply treads to floors and remove throw rugs.

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How Can I Keep My Bones Strong Preventing Osteoporosis

There are things you should do at any age to prevent weakened bones. Eating foods that are rich in calcium and vitamin D is important. So is regular weight-bearing exercise, such as weight training, walking, hiking, jogging, climbing stairs, tennis, and dancing.

If you have osteoporosis, avoid activities that involve twisting your spine or bending forward from the waist, such as conventional sit-ups, toe touches, or swinging a golf club.

Those are the best ways to keep your bones strong and healthy. Learn more about keeping your bones strong to prevent falls.

Pathophysiology Of Bone Loss

Bone remodeling is the process by which old bone is replaced by new bone. The normal bone remodeling process consists of five phases: the resting phase activation, resorption, reversal, and formation.

  • ⢠In the activation phase of remodeling, osteoclasts are recruited to the surface of the bone.

  • ⢠In the resorption phase, osteoclasts generate an acidic microenvironment between the cell and the surface of the bone, dissolving or resorbing the mineral content of the bone.

  • ⢠In the reversal phase osteoclasts undergo apoptosis and osteoblasts are recruited to the bone surface.

  • ⢠In the formation phase, osteoblasts then deposit collagen this is mineralized to form new bone.

Cellular changes that occur with estrogen changes. + E depicts effects in presence of estrogen -E depicts effects in absence of estrogen. IL-1 is Interleukin 1, TNF-Tumor Necrosis Factor, OPG-Osteoprotegerin. Estrogen decreases osteoclastogenesis and increases osteoclast apoptosis. Estrogen reduces osteoclastogenesis by suppressing IL-1 and TNF and increasing the sensitivity of stromal cells/preosteoblasts to IL-1, thus suppressing MCSF, RANKL, and perhaps most notably, IL-6. In addition, estrogen stimulates the production of OPG, the potent inhibitor of osteoclastogenesis. Estrogen also reduces the responsiveness of osteoclast precursors to RANKL. Estrogen also promotes osteoclastic apoptosis, thereby reducing osteoclast lifespan. This effect appears to be mediated by TGFβ.

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Do I Need To Be Tested For Osteoporosis

Your doctor may suggest a bone density test for osteoporosis if:15

  • You are 65 or older
  • You are younger than 65 and have risk factors for osteoporosis. Bone density testing is recommended for older women whose risk of breaking a bone is the same or greater than that of a 65yearold white woman with no risk factors other than age. Ask your doctor or nurse whether you need a bone density test before age 65.

Why Does It Occur

Menopause: Everything You Need To Know

Bone is a living and growing tissue. Throughout life, bone is constantly being renewed in a process called remodeling. The remodeling process is complex but includes two main types of cells, osteoclasts and osteoblasts.

Osteoclasts are bone chewing cells that remove old bone and get the bone ready for renewal. Osteoclasts release enzymes and acids that carve bones. In this process calcium, phosphorus, and other components of the bone are released into the blood for use by the body. After the osteoclasts carve the bone, it is prepared for action by the osteoblasts. The osteoblasts are the building cells that form bone. Bone building occurs when more bone is formed than removed.

  • Bone mass is maintained when bone formation equals bone removal.
  • Bone loss occurs when more bone is removed than formed.

Think of your bones as a bank account in which you deposit and withdraw calcium throughout life. Calcium is a mineral that makes bone dense and strong. During childhood, the teen years, and early adulthood you build your bone bank. The skeleton grows and bones become larger, denser, and stronger especially when you practice bone healthy actions.

Bone grows fastest between the ages of 9 and 18 years of age. Peak bone mass, defined as the maximum bone density you will ever have, is largely determined by your family history. People who attain higher peak bone mass have larger and heavier bones and are less likely to get osteoporosis later in life.

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Physical Activity Reduces Osteoporosis Risk

Exercising regularly throughout life can reduce the risk of osteoporosis. Doing some type of physical activity on most days of the week for between 30 and 40 minutes is recommended.

Two types of physical activities that are most beneficial to bones are weight-bearing and resistance-training exercises. In addition to reducing bone loss, physical activity will improve muscle strength, balance and fitness, and also reduce the incidence of falls and fractures.

Is There A Safe Alternative To Hormone Therapy

Alternatives to hormone therapy include:

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What If Dairy Foods Make Me Sick Or I Don’t Like To Eat Them How Can I Get Enough Calcium

If you have problems eating foods with dairy or don’t like to eat them, try the following tips to make sure you get enough calcium:

  • Try lactose-reduced or lactose-free products, such as milk or yogurt.
  • Take a lactose supplement before eating dairy foods to help you digest them.
  • Choose other food sources of calcium. Other good sources of calcium include tofu or orange juice with calcium added, and vegetables such as bok choy, kale, collard greens, mustard greens, and broccoli.
  • Ask your doctor or nurse if you need to take calcium supplements.

How Does Osteoporosis Develop

2 health risks women can face during or after menopause

The exact cause of osteoporosis is unknown. However, we do know how the disease develops and what it does to your bones.

Think of your bones as living, growing, and ever-changing entities of your body. Imagine the outer part of your bone as a case. Inside the case is a more delicate bone with little holes in it, similar to a sponge.

If you develop osteoporosis and your bones begin to weaken, the holes in the inner part of your bone grow larger and more numerous. This causes the internal structure of your bone to weaken and become abnormal.

If you fall when your bones are in this state, they may not be strong enough to sustain the fall, and theyll fracture. If osteoporosis is severe, fractures can occur even without a fall or other trauma.

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Why Do We Fall Over When We Get Older

There are many reasons older adults are susceptible to falls. These include side effects of some medications, vision impairments and less ability to prevent tripping over as balance, muscle mass and strength decline with age.

The risk of fracture due to poor bones increases with age, and this is further enhanced by osteoporosis.

Genetics also plays a role in an individuals risk of fracture. Those of us with parents who had a hip fracture have an increased risk of fracture. The most common sites of fracture in older adults are the hip, vertebrae or spine, wrist or the humerus .

About 30% of older adults fall at least once a year. The less often you fall, the less likely you are to break a bone.

People aged 70 and over accounted for 70% of the total acute hospital inpatient costs in 2012. Hip fractures impose the highest burden both in terms of cost and decline in health-related quality of life.

Results from a recent study show most fracture patients have not fully recovered their previous level of quality of life by 18 months after the fracture.

Prevalence Of Osteoporotic Fractures

The prevalence of osteoporotic fractures rises from 4% in women at age 50 – 59 to 52% of women age > 80 years . There is a temporal sequence in osteoporotic fractures, the first sign being fractures of the lower end of radius starting at age 50 years, followed by vertebral fractures at age 60-75 years and hip fractures starting in the late 70âs. For a white American woman at age 50, the risk of suffering an osteoporotic fracture in her remaining lifetime has been estimated at 40%, with two thirds of the fractures occurring after age 75.

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How Menopause Influences Osteoporosis

Women reach peak bone mass around the age of 25 to 30 years, when the skeleton has stopped growing and bones are at their strongest and thickest.

The female hormone, oestrogen, plays an important role in maintaining bone strength. Oestrogen levels drop around the time of menopause, which occurs on average at the age of 50 years, resulting in increased bone loss. If your peak bone mass before menopause is less than ideal, any bone loss that occurs around menopause may result in osteoporosis.

Research suggests that about one in two women over the age of 60 years will experience at least one fracture due to osteoporosis.

Why Does Osteoporosis Accelerate After Menopause And Other Bone Health Questions Answered

Osteoporosis

Bone health isnt something we think about often. Our bones that make up our skeleton seem to simply exist, keeping everything together, until one day, we trip or fall and realize just how necessary strong bones are to our daily lives. However, as women begin to lose estrogen and enter into menopause, osteoporosis becomes a major concern and rightfully so. Some low estrogen side effects include things like bone loss, which is a major risk factor for osteoporosis. The numbers show that nearly 1 out of 2 women over age 50 will break a bone because of osteoporosis.1 Thankfully, osteoporosis is not an inevitable part of aging. There are steps we can take throughout our lifetime to help support our overall bone health and help maintain healthy bones as we age.

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