Osteoporosis is a condition characterised by low bone mass and gradual loss of bone tissue. This makes the bone brittle, fragile and highly prone to fractures. The condition progresses silently without any major signs and symptoms and in most cases is diagnosed only when a fracture occurs. Globally osteoporosis can be accounted for 1 fracture every 3 seconds. Spine and hip fractures are the most serious complications of osteoporosis and are associated with an increased risk of death and disability. In many cases, the bones become so fragile that fractures can occur even without falling, resulting in disabling pain and reduced quality of life. In this article, Dr. Thomas Joseph Kishen, Consultant- Spine Surgery, Spine Care, Manipal Hospitals Old Airport Road shares detailed information on prevalence of osteoporosis in women after menopause.
Osteoporosis in Women
In general, women are 3 times at higher risk of developing osteoporosis as compared to their male counterparts, the risk is even greater after menopause. Elaborating on the topic, Dr Thomas Joseph Kishen said, “Osteoporosis is a significant cause of morbidity and mortality in postmenopausal women. More than 50% of women above 50 years of age are at risk of fragility fractures and about 20% of those aged more than 60 years die within 1 year of having a hip fracture. Various studies report the prevalence of postmenopausal osteoporosis in women to be between 25%-62% in different parts of India.”
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Causes of osteoporosis in old age
The hormone oestrogen plays an important role in maintaining strong bones in women. Post-menopause, the level of oestrogen production reduces significantly in women. This accelerates bone loss and rapid reduction in bone mass density. “Oestrogen deficiency coupled with a diet low in calcium, vitamin D deficiency, sedentary lifestyle, early menopause, progressing age and lack of general awareness about the conditions are some of the key contributing factors driving the increasing prevalence of postmenopausal osteoporosis in India” added Dr Thomas Joseph Kishen.
Also Read: How To Manage Joint Pain During Osteoporosis Through Diet
Prevention and management of osteoporosis in the elderly
The goal of management should be to improve bone health and reduce the risk of fractures. Lifestyle plays an important role in preventing osteoporosis and related complications including:
- Inclusion of lean protein, calcium, magnesium, vitamin C and D in the diet for optimal bone nutrition
- Exposure to sunlight for vitamin D
- Regular weight-bearing and muscle-strengthening exercises are recommended to maintain bone strength
- Smoking cessation
- Limiting alcohol intake
- Obesity management to maintain ideal weight
Elderly women with polypharmacy and comorbid conditions should be assessed for higher risk of falls and take necessary care at home to avoid falls. For example, many medications including those prescribed for hypertension and depression can cause dizziness and should therefore be used with caution.
“Women who fail to maintain optimal blood calcium and Vitamin D levels through diet should take daily calcium (1200 mg/day) and weekly once vitamin D (800 IU) supplements. However, in moderate to high-risk women, medications are required to prevent further bone loss and fractures. There are two broad categories of drugs used for managing osteoporosis, namely anti-resorptive agents and anabolic drugs. Anti-resorptive drugs increase bone mass by slowing down bone resorption (breakdown) and includes bisphosphonates, hormone replacement therapy, oestrogen agonists and calcitonin. Anabolic drugs such as Parathyroid hormone extract acts by directly stimulating bone formation and inhibiting the action of osteoclast which is responsible for breaking down bone tissues.” said Dr Thomas Joseph Kishen.
Also Read: Osteoporosis Patients Can Find Relief With Pilates, Learn Best Exercises for Osteoporosis
Treatment of Osteoporosis
Bisphosphonates are the first-line therapy in most patients and are highly effective in reducing the risk of spine and hip fractures up to 40-70% reported in many studies, including in patients with prior fractures. Hormone replacement therapy is generally reserved for high-risk patients. It may also be considered in peri-menopausal women to additionally help deal with menopausal symptoms. Oestrogen replacement therapy has been shown to increase spine and femoral bone mass significantly in many studies. However, hormone replacement therapy should be used in the lowest effective dose and for a short duration of time to achieve treatment goals due to the possible risk of cancer and heart diseases. Oestrogen agonists and calcitonin are highly effective in preventing spine fractures.
Anabolics should be used in severe osteoporosis or as a 2nd line therapy in patients who are intolerant to anti-resorptive drugs. Intermittent parathyroid therapy increases bone mass density by improving bone tissue microarchitecture and is thought to be more effective in preventing fractures as compared to anti-resorptive therapies. A study in Indian postmenopausal women showed significant improvement in spine bone mass with no serious adverse events. Denosumab is a human monoclonal antibody that primarily acts by preventing osteoclast activity. Inhibition of osteoclast activity decreases bone resorption and improved bone mass density.
Serious fragility fractures involving the hip, spine wrist often requires surgery. The type of surgery depends on the location and the severity of the fracture.
Conclusion
Fragility fractures in post-menopausal women are associated with pain, disability, reduced quality of life and increased risk of death. Women are recommended to undergo regular bone health check-ups including, measurement of bone mass density, height along with maintaining a healthy lifestyle to enable early management of osteoporosis and prevention of associated complications.
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