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What is Postmenopausal Osteoporosis?

Osteoporosis is a disorder wherein the bones become weak and brittle, making them prone to fractures. Menopause occurs in women usually at around the age of 45-52 years and is associated with many hormonal changes. Hormonal changes, in turn, lead to a number of physiological effects, including calcium absorption in the bones. Postmenopause, women are prone to osteoporosis due to loss of the protective function of oestrogen on bones.

What are its main signs and symptoms?

The disease remains largely hidden unless it manifests itself as a fracture or as a finding on an X-ray or body scan conducted for some other purpose. Worse still, some hairline fractures may go unnoticed. A classic example is a vertebral fracture, which may present as nothing more than a dull pain in the back that exacerbates on movement. Fractures do occur under milder forces as well. These are called fragility fractures. At later stages, patients may experience reduced height due to multiple such vertebral fractures. Also, the widow’s hump or kyphosis is seen in women due to weakened posture owing to weaker bones.

What are its main causes?

The hormones produced by ovaries before menopause help maintain the balance of bone formation and resorption but ovarian function and hormones declines with age. Low levels of ovarian hormones increase the rate of bone resorption in the body while bone deposition is relatively slower leading to weaker bones. The bone fragility thus increases and bone strength decreases significantly in the first few years after menopause.

The risk of fracture is high in patients who are prone to more falls due to difficulty in maintaining posture and balance. Lack of physical activity also adds to the risk of bone fragility. Alcohol consumption and smoking are additional risk factors.

How is it diagnosed and treated?

Osteoporosis may result from altered blood levels of calcium and magnesium, anaemia, thyroid dysfunction, vitamin D deficiency and effects of alcohol abuse on liver. Thus, blood tests to assess thyroid function test, and serum levels of calcium, vitamin D and magnesium might be done. X-rays are mandatory in patients where a fracture is suspected. A height loss of more than 1.5 inches also warrants an X-ray imaging test.

An imaging study called as bone density scan or DEXA scan helps identify the various bones that may have osteoporosis and its severity.
Treatment includes the prescription of certain drugs to help strengthen bones- calcium and vitamin D supplements and drugs to slow down bone resorption. Hormone replacement is, however, not advised. Bone mineral density has to be monitored continuously, and the patient is advised to be careful in routine life to avoid falls and injuries, to prevent fractures.

  1. Medicines for Post Menopausal Osteoporosis

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References

  1. J Christopher Gallagher, Sri Harsha Tella. Prevention and treatment of postmenopausal osteoporosis . J Steroid Biochem Mol Biol. 2014 Jul; 142: 155–170. PMID: 24176761
  2. Meng-Xia Ji, Qi Yu. Primary osteoporosis in postmenopausal women . Chronic Dis Transl Med. 2015 Mar; 1(1): 9–13. PMID: 29062981
  3. National Institute of Arthritis and Musculoskeletal and Skin Diseases [Internet]. NIH Osteoporosis and related Bone diseases; National research center: National Institute of Health; Osteoporosis Overview.
  4. Watts NB. Postmenopausal Osteoporosis: A Clinical Review. . J Womens Health (Larchmt). 2018 Sep;27(9):1093-1096. PMID: 29583083
  5. Office on Women's Health [Internet] U.S. Department of Health and Human Services; Osteoporosis.
  6. U. S Food and Drug Association. [Internet]. FDA approves new treatment for osteoporosis in postmenopausal women at high risk of fracture
  7. Better health channel. Department of Health and Human Services [internet]. State government of Victoria; Menopause and osteoporosis
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