Information and resources from MaxorPlus® for Menopause and Osteoporosis
What is Menopause?
Menopause is a medical condition in women that occurs as estrogen production levels decline in the ovaries and the reproductive system gradually becomes inactive. The various symptoms related to menopause such as hot flashes, palpitations, psychological symptoms including increased anxiety, depression, irritability, mood swings and lack of concentration, as well as other symptoms such as vaginal dryness and urgency of urination are caused by the body’s attempt to adapt to the changing levels of natural hormones. Women may experience increasingly erratic and waning menstrual periods.
The average age for the onset of menopause has been determined to be at 50.5 years of age, but some women can enter menopause at an earlier age, especially if they have suffered from cancer or other serious illnesses and have undergone chemotherapy in the past.
Following menopause, androgens can be converted into estrogen by fatty tissue. Thus, post-menopausal women who have adrenal glands and still have ovaries (if a hysterectomy has been performed) do continue to produce low levels of estrogen and androgens, but these levels will continue to become relatively lower in their bodies throughout the rest of their lives. Recent studies show that post-menopausal women, especially Caucasian women of European descent, are at an increased risk for developing osteoporosis.
What is Osteoporosis?
Osteoporosis is a condition that features loss of the normal density of bone and fragile bone. Osteoporosis leads to abnormally porous bone that is more compressible like a sponge, rather than dense like a brick. This disorder of the skeletal bone leads to weaker bone and an increase in the risk of bone fractures. Normal bone is composed of protein, collagen, and calcium. Bones that are affected by osteoporosis can fracture with only a minor fall or injury that normally would not cause a bone fracture. The fracture can be in the form of a crack, such as a hip fracture or collapsing, such as a compression fracture of the vertebrae of the spine. The spine, hips and wrists are common areas of osteoporosis-related bone fractures, although osteoporosis-related fractures can occur in almost any skeletal bone area.
Osteoporosis is a silent condition, because symptoms of osteoporosis are non-existent unless a bone fractures. Some osteoporosis fractures may occur and escape detection until years later. Fractures of the vertebrae of the spine can cause severe “band-like” pain that radiates around from the back to the side of the body. Over the years, repeated spine fractures can cause chronic lower back pain as well as loss of height or curving of the spine, which gives individuals a hunched back appearance often referred to as ‘dowager hump.” A fracture that occurs during the course of normal activity is called a minimal trauma fracture; some patients with osteoporosis may develop stress fractures of the feet while walking or stepping off of a curb. Hip fractures typically occur as a result of a fall. With osteoporosis, hip fractures can occur as a result of a minimal or trivial accident. Hip fractures may also be difficult to heal after surgical repair because of poor bone quality.
In the U.S., 44 million people have low bone density, either osteoporosis or osteopenia. This amounts to 55% of the population 50 years old and older. Statistics show that one in two white women will experience a bone fracture due to osteoporosis in her lifetime. Only one-third of hip fracture patients will regain their pre-fracture level of function and one-third of hip fracture patients will end up in a nursing home following a hip fracture injury. It is also estimated that 20% of those who experience a hip fracture will die in the year following the fracture.
Bone mass or density is the amount of bone present in the skeletal structure. The higher the density is the stronger are the bones. Normally, bone density accumulates during childhood and reaches a peak by around age 25. Bone density is then maintained for about 10 years. After age 35, both men and women will normally lose 0.3 to 0.5% of their bone density per year as part of the aging process.
Estrogen is important in maintaining bone density in women. When estrogen levels drop after menopause, bone loss accelerates. During the first several years (up to 10 years) after menopause, women can suffer up to two to four percent loss of bone density per year. This can result in the loss of up to 25 to 30% of their bone density during that time period. Accelerated bone loss after menopause is a major cause of osteoporosis in women.
The goal of osteoporosis treatment is the prevention of bone fractures by stopping bone loss and by increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially decrease the risk of future fracture, none of the available treatments for osteoporosis are complete cures. It is difficult to completely rebuild bone that has been weakened by osteoporosis. Therefore, prevention of osteoporosis is as important as treatment.
- Treatment and Prevention measures include:
- Life style changes – quit smoking, curtail alcohol intake, exercise regularly and consume a balanced diet with adequate calcium and vitamin D intake.
- Use of medications that stop bone loss and increase bone strength, such as Actonel® (risedronate), Boniva® (ibandronate) and Fosamax® (alendronate).
- Use of medications that increase bone formation such as the injectable medication Forteo® (teriparatide).
Note – smoking just one pack of cigarettes per day throughout an adult’s life can lead to a loss of 5% to 10% of bone mass
Building strong and healthy bones requires an adequate dietary intake of calcium and exercise beginning in childhood and adolescence for both sexes. A high dietary calcium intake or taking calcium supplements alone is not sufficient in treating osteoporosis. In the first several years after menopause, rapid bone loss can occur even if calcium supplements are taken.
The following calcium intake has been recommended be the National Institutes of Health for all people, with or without osteoporosis:
- 800mg/day for children 1 to 10 years of age
- 1000mg/day for men, premenopausal women, and postmenopausal women taking estrogen
- 1200mg/day for teenagers and young adults 11 to 24 years of age
- 1500mg/day for post menopausal women not taking estrogen
- 1200mg to 1500mg/day for pregnant and nursing mothers
- the total daily intake of calcium should not exceed 2000mg
An adequate calcium intake and adequate body stores of vitamin D are important foundations for maintaining bone density and strength. Vitamin D is important in several respects. Vitamin D helps the absorption of calcium from the intestines. A lack of vitamin D causes calcium-depleted bone, which further weakens the bone and increases the risk of fracture and vitamin D, along with adequate calcium has been shown in some studies to increase bone density and decrease fractures in older post menopausal women.
Vitamin D comes from the diet and the skin. Vitamin D production by the skin is dependent on exposure to sunlight. Active people living in sunny regions can produce most of the vitamin D they need from their skin.
The Food and Nutrition Board of the Institute of Medicine has recommended the following as an adequate vitamin D intake:
- 200 IU daily for men and women 19 to 50 years of age
- 400 IU daily for men and women 51 to 70 years of age
- 600 IU daily for men and women 71 years of age and older
If a person already has osteoporosis, it is advisable to ensure that 400 IU twice per day is the usual daily intake. Most average multiple vitamin tablets contain 400 IU of vitamin D. Vitamin D can also be obtained in a combination with calcium in tablet forms. Adequate calcium and vitamin D are critical for bone health.
Osteoporosis at a glance:
- Osteoporosis is a condition of increased susceptibility to fracture due to fragile bone
- Osteoporosis weakens bone, and increases the risk of bone fractures
- Bone mass or bone density decreases after age 35 and decreases more rapidly in women after menopause
- Key risk factors for osteoporosis include genetic factors, lack of exercise, lack of calcium and vitamin D, cigarette smoking, excessive alcohol consumption, low body weight and family history of osteoporosis
- Patients with osteoporosis have no symptoms until bone fractures occur
- Treatments for osteoporosis, in addition to prescription osteoporosis medications, include stopping the use of alcohol and cigarettes and proper diet, adequate exercise and the use of calcium and vitamin D supplements.