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Aging affects us all in different ways. Today, many women are celebrating good health in midlife and beyond. It’s important to be aware of the many components of aging, including physical, hormonal and emotional changes.
Osteoporosis, or porous bone, is a disease in which there is a loss of bone mass and destruction of bone tissue. This process causes weakening of the bones and makes them more likely to break. The bones most often affected are the hips, spine, and wrists.
Osteoporosis affects over 10 million Americans over the age of 50, with women four times more likely to develop osteoporosis than men.
Another 34 million Americans over the age of 50 have low bone mass (osteopenia) and therefore have an increased risk for osteoporosis. Estrogen deficiency is one of the main causes of bone loss in women during and after menopause. Women may lose up to 20 percent of their bone mass in the five to seven years following menopause.
Although the exact medical cause for osteoporosis is unknown, a number of factors contribute to osteoporosis, including the following:
Aging. Bones become less dense and weaker with age.
Race. White and Asian women are most at risk, although all races may develop the disease.
Body weight. Obesity is associated with a higher bone mass, therefore people who weigh less and have less muscle are more at risk for developing osteoporosis.
Lifestyle factors. The following lifestyle factors may increase a person's risk of osteoporosis:
Excessive alcohol use
Dietary calcium and vitamin D deficiency
Family history of bone disease
In 2006, the North American Menopause Society (NAMS) reviewed and updated its guidelines on the diagnosis, prevention, and treatment of postmenopausal osteoporosis. Among its updated recommendations, NAMS suggests that women's lifestyle practices should be reviewed regularly by their doctors, and that practices that help to reduce the risk for osteoporosis should be encouraged. Also, NAMS recommends that a woman's risk for falls should be evaluated at least once a year after menopause has occurred. An additional recommendation is that a woman's height and weight should be measured annually, and she should be assessed for kyphoses--development of a rounded humped spines--and back pain.
Osteoporosis is often called the silent disease because people with osteoporosis may not develop any symptoms. Some may have pain in their bones and muscles, particularly in their back. Occasionally, a collapsed vertebra may cause severe pain, decrease in height, or deformity in the spine.
The symptoms of osteoporosis may resemble other bone disorders or medical problems. Always consult your doctor for a diagnosis.
In addition to a complete personal and family medical history and physical examination, diagnostic procedures for osteoporosis may include the following:
X-rays (skeletal). A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Bone density test (also called bone densitometry). Measurement of the mass of bone in relation to its volume to determine the risk of developing osteoporosis.
Blood tests. These tests are done to measure serum calcium and potassium levels.
FRAX score. A score given to estimate the risk of a fracture within 10 years. The score uses the results of a bone densitometry test as well as other individual factors.
The effects of this disease can best be managed with early diagnosis and treatment.
Bone densitometry testing is primarily performed to identify people with osteoporosis and osteopenia (decreased bone mass that has not yet reached the level of osteoporosis) so that the appropriate medical therapy and treatment can be implemented. Early treatment helps to prevent future bone fractures. It may also be recommended for people who have already fractured a bone and are considered at risk for osteoporosis.
The bone densitometry test determines the bone mineral density (BMD). Your BMD is compared to two norms--healthy young adults (your T-score) and age-matched adults (your Z-score).
First, your BMD result is compared with the BMD results from healthy 25- to 35-year-old adults of your same sex and ethnicity. The standard deviation (SD) is the difference between your BMD and that of the healthy young adults. This result is your T-score. Positive T-scores indicate the bone is stronger than a healthy young adult; negative T-scores indicate the bone is weaker.
According to the World Health Organization, osteoporosis is defined based on the following bone density levels:
A T-score within 1 SD (+1 or -1) of the young adult mean indicates normal bone density.
A T-score of 1 to 2.5 SD below the young adult mean (-1 to - 2.5 SD) indicates low bone mass.
A T-score of 2.5 SD or more below the young adult mean (> - 2.5 SD) indicates the presence of osteoporosis.
In general, the risk for bone fracture doubles with every SD below normal. Thus, a person with a BMD of 1 SD below normal (T-score of -1) has twice the risk for bone fracture as a person with a normal BMD. A person with a T-score of -2 has four times the risk for bone fracture as a person with a normal BMD. When this information is known, people with a high risk for bone fracture can be treated with the goal of preventing future fractures.
Secondly, your BMD is compared to an age-matched norm. This is called your Z-score. Z-scores are calculated in the same way, but the comparisons are made to someone of your age, sex, race, height, and weight.
Specific treatment for osteoporosis will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
The goals of managing osteoporosis are to decrease pain, prevent fractures, and minimize further bone loss. Some of the methods used to treat osteoporosis are also the methods to help prevent it from developing, including the following:
Maintain an appropriate body weight.
Increase walking and other weight-bearing exercises.
Minimize caffeine and alcohol consumption.
Maintain an adequate intake of calcium through diet and supplements. Vitamin D is also necessary because it facilitates the absorption of calcium.
Prevent falls in the elderly to prevent fractures (for example, install hand railings, or assistive devices in the bathroom or shower).
Consult your doctor regarding a medication regimen.
For postmenopausal osteoporosis in women, the FDA has approved the following medications to maintain bone health:
Estrogen replacement therapy (ERT) and hormone replacement therapy (HRT). ERT has proven to reduce bone loss, increase bone density, and reduce the risk of hip and spinal fractures in postmenopausal women. However, a woman considering ERT should consult her doctor, as the research conducted by the National Heart, Lung, and Blood Institute of the National Institutes of Health found several important health risks associated with this therapy. For many women, the risks of ERT outweigh the benefits.
Alendronate sodium (Fosamax). This medication, from a group of medications called bisphosphonates, reduces bone loss, increases bone density, and reduces the risk of fractures.
Risedronate sodium (Actonel). This medication is also from the bisphosphonate family and has similar effects as alendronate.
Ibandronate sodium (Boniva). This medication is a type of bisphosphonate that is taken once a month. It works by slowing the loss of bone, which may increase bone mass.
Raloxifene (Evista). This medication is from a new group of medications called selective estrogen receptor modulators (SERMs) that help to prevent bone loss.
Parathyroid hormone (Fortéo). This medication is a form of parathyroid hormone, teriparatide, and is approved to treat postmenopausal women and men who are at high risk for fractures. It helps form bone.
Denosumab (Prolia, Xgeva). This medication is a monoclonal antibody given by injection under the skin and is approved for women with osteoporosis at high risk for fractures, as well as for women who are being treated with cancer medications that can weaken bones.
An osteoporosis rehabilitation program is designed to meet the needs of the individual patient, depending on the type and severity of the disease. Active involvement of the patient and family is vital to the success of the program.
The goal of rehabilitation is to help the patient to return to the highest level of function and independence possible, while improving the overall quality of life--physically, emotionally, and socially. The focus of rehabilitation is to decrease pain, help prevent fractures, and minimize further bone loss.
In order to help reach these goals, osteoporosis rehabilitation programs may include the following:
Exercise programs and conditioning to increase weight bearing and physical fitness
Pain management techniques
Nutritional counseling to improve calcium and vitamin D intake and decrease caffeine and alcohol intake
Use of assistive devices to improve safety at home patient and family education, especially prevention of falls
Osteoporosis rehabilitation programs can be conducted on an inpatient or outpatient basis. Many skilled professionals are part of the osteoporosis rehabilitation team, including any or all of the following:
Osteoporosis is the most common type of bone disease, affecting an estimated one out of five American women over age 50.
When a woman permanently stops having menstrual periods, she has reached the stage of life called menopause. Often called the change of life, this stage signals the end of a woman's ability to have children. Many health care providers actually use the term menopause to refer to the period of time when a woman's hormone levels begin to change. Menopause is said to be complete when menstrual periods have ceased for one continuous year.
The transition phase before menopause is medically referred to as perimenopause or climacteric. During this transition time before menopause, the supply of mature eggs in a woman's ovaries diminishes and ovulation becomes irregular. At the same time, the production of estrogen and progesterone decreases. It is the enormous drop in estrogen levels that causes most of the symptoms commonly associated with menopause.
While the average age of menopause is 51, menopause can actually occur any time from the 30s to the mid-50s or later. Women who smoke and are underweight tend to experience an earlier menopause, while women who are overweight often experience a later menopause. Generally, a woman tends to experience menopause at about the same age as her mother did.
Menopause can also occur for reasons other than natural reasons. These include, but are not limited to, the following:
Premature menopause. Premature menopause may occur when there is ovarian failure before the age of 40, and may be associated with smoking, radiation exposure, chemotherapeutic drugs, or surgery that impairs the ovarian blood supply. Premature ovarian failure is also called primary ovarian insufficiency.
Surgical menopause. Surgical menopause may follow an oophorectomy (removal of an ovary or both ovaries), or radiation of the pelvis, including the ovaries, in premenopausal women. This results in an abrupt menopause, with women often experiencing more severe menopausal symptoms than if they were to experience menopause naturally.
The following are the most common symptoms of menopause. However, each woman may experience symptoms differently—with some having few and less severe symptoms, while others have more frequent and stressful ones. The signs and symptoms of menopause may include:
Hot flashes or flushes are, by far, the most common symptom of menopause, with about 75 percent of all women experiencing sudden, brief, periodic increases in their body temperature. Usually hot flashes start before a woman's last period. For 80 percent of women, hot flashes occur for two years or less. A small percentage of women experience hot flashes for more than two years. These flashes seem to be directly related to decreasing levels of estrogen. Hot flashes vary in frequency and intensity for each woman.
In addition to the increase in the temperature of the skin, a hot flash may cause an increase in a woman's heart rate. This causes sudden perspiration as the body tries to reduce its temperature. This symptom may also be accompanied by heart palpitations and dizziness.
Hot flashes that occur at night are called night sweats. A woman may wake up drenched in sweat and have to change her night clothes and sheets.
Vaginal atrophy involves the drying and thinning of the tissues of the vagina and urethra. This can lead to dyspareunia (pain during sexual intercourse), as well as vaginitis, cystitis, and urinary tract infections.
Relaxation of the pelvic muscles
Relaxation of the pelvic muscles can lead to urinary incontinence and also increase the risk of the uterus, bladder, urethra, or rectum protruding into the vagina.
Intermittent dizziness, paresthesias (an abnormal sensation, such as numbness, prickling, tingling, and/or heightened sensitivity), cardiac palpitations, and tachycardia may occur as symptoms of menopause.
Changing hormones can cause some women to experience an increase in facial hair and/or a thinning of the hair on the scalp.
While it is commonly thought that mental health may be negatively affected by menopause, several studies have indicated that menopausal women suffer no more anxiety, depression, anger, nervousness, or feelings of stress than women of the same age who are still menstruating. Psychological and emotional symptoms of fatigue, irritability, insomnia, and nervousness may be related to both the lack of estrogen, the stress of aging, and a woman's changing roles.
Q: "I am 49 years old and have started exhibiting signs of menopause, with the most bothersome being hot flashes. I wondered if there is anything I can do to cope with these?"
A: Hot flashes appear as a result of decreasing estrogen levels. In response to this, your glands release higher amounts of other hormones that affect the brain's thermostat, causing your body temperature to fluctuate. Hormone therapy has shown to relieve some of the discomfort of hot flashes for many women. However, the decision to start the supplementation of these hormones should be made only after you and your health care provider have evaluated the risk versus benefit ratio based on your individual medical history.
To learn more about women's health, and specifically hormone therapy, the National Heart, Lung, and Blood Institute of the National Institutes of Health launched the Women's Health Initiative (WHI) in 1991. The hormone trial had two studies: the estrogen-plus-progestin study of women with a uterus and the estrogen-alone study of women without a uterus. Both studies were concluded early when the research showed that hormone therapy did not help prevent heart disease and it increased risk for some medical problems. Follow-up studies found an increased risk of heart disease in women who took estrogen-plus-progestin therapy, especially those who started hormone therapy more than 10 years after menopause.
The WHI recommends that women follow the FDA advice on hormone (estrogen-alone or estrogen-plus-progestin) therapy. It states that hormone therapy should not be taken to prevent heart disease.
These products are approved therapies for relief from moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy. Although hormone therapy may be effective for the prevention of postmenopausal osteoporosis, it should only be considered for women at significant risk of osteoporosis who cannot take non-estrogen medications. The FDA recommends that hormone therapy be used at the lowest doses for the shortest duration needed to achieve treatment goals. Postmenopausal women who use or are considering using hormone therapy should discuss the possible benefits and risks to them with their health care providers.
Practical suggestions for coping with hot flashes include:
Dress in layers, so that you can remove clothing when a hot flash begins.
Avoid foods and beverages that may cause hot flashes, such as spicy foods, alcohol, coffee, tea, and other hot beverages.
Drink a glass of cold water or fruit juice when a hot flash begins.
Reduce your stress level, which may aggravate hot flashes.
Keep a thermos of ice water or an ice pack next to your bed during the night.
Use cotton sheets, lingerie, and clothing that allow your skin to breathe.
Keep a diary or record of your symptoms to determine what might trigger your hot flashes.
Specific treatment for menopausal symptoms will be determined by your health care provider based on:
Several therapies that help to manage the symptoms often associated with menopause include the following:
Hormone therapy (HT)
Hormone therapy (HT) involves the administration of a combination of the female hormones estrogen and progesterone during perimenopause and menopause. HT is most commonly prescribed in pill form. However, estrogen can also be administered by using transdermal skin patches and vaginal creams.
The decision to start the supplementation of these hormones should be made only after you and your health care provider have evaluated the risks and benefits based on your individual medical history.
Estrogen therapy (ET)
Estrogen therapy (ET) involves the administration of estrogen alone, which is no longer being produced by the body. ET is often prescribed for women who have had a hysterectomy. Estrogen is prescribed in the following forms: pills, transdermal skin patches (where the estrogen is absorbed through the skin), and vaginal creams.
The decision to start the supplementation of this hormone should be made only after you and your health care provider have evaluated the risks and benefits based on your individual medical history.
This type of treatment often involves the use of over-the-counter creams that do not contain estrogen to relieve some of the symptoms associated with menopause.
Estrogen alternatives are the so-called "synthetic estrogens," such as raloxifene, which may offer the bone-building benefits of estrogen without many of the possible coinciding risks (such as an increased risk of endometrial cancer).
Homeopathy and herbal treatments, often called bioidentical hormones, may offer some relief from some symptoms of menopause. However, there are concerns about potency, safety, purity, and effectiveness.
When approaching menopause, every woman should discuss each option—the potential risks and benefits—with her health care provider. Visit Online Resources of Women's Health for more information.
The symptoms of menopause are caused by changes in estrogen and progesterone levels. As the ovaries become less functional, they produce less of these hormones and the body responds accordingly.
While this change of life called menopause was once a life stage dreaded by many women, today's woman has an abundance of medical knowledge and resources available to her as she experiences menopause. The key to staying youthful and active is good nutrition and regular physical exercise.
As a person ages, nutritional requirements change. A premenopausal woman should consume about 1,000 mg of calcium daily. Women after menopause should consume 1,200 mg of calcium per day, according to the American Academy of Orthopaedic Surgeons.
Vitamin D is also very important for calcium absorption and bone formation. According to a 1992 study, women with postmenopausal osteoporosis who took vitamin D for three years significantly reduced their risk of spinal fractures. This issue is controversial, however, as vitamin D can cause kidney stones, constipation, or abdominal pain, especially in women with kidney problems.
Other nutritional guidelines recommended by the National Research Council of the National Institutes of Health include:
Choose foods low in fat, saturated fat, and cholesterol. Fat intake should be less than 30 percent of daily calorie intake.
Eat fruits, vegetables, and whole grain cereal products, especially those high in vitamin C and beta carotene. People of all ages should consume 20 to 30 grams of fiber daily.
Avoid foods and drinks with processed sugar, as many of these products contain empty calories and promote weight gain.
Avoid salt-cured and smoked foods, such as sausages, smoked fish, ham, bacon, bologna, and hot dogs. These foods are high in sodium, which can lead to high blood pressure, a serious risk for aging women.
Menopausal women often experience weight gain, possibly because of declining estrogen levels. Raising your activity level will help to avoid this weight gain. Exercise becomes particularly important as a woman ages. Regular exercise benefits the heart and bones, helps regulate weight, and can be a mood enhancer, creating a better sense of well-being. Women who are physically inactive are more likely to suffer from coronary heart disease, obesity, high blood pressure, diabetes, and osteoporosis. Sedentary women may also suffer from chronic back pain, insomnia, poor circulation, weak muscles, loss of bone mass, and depression.
Aerobic activities, such as walking, jogging, swimming, biking, and dancing, help prevent some of these problems and also help raise HDL cholesterol levels, commonly referred to as the "good" cholesterol. Weight-bearing exercises, such as walking and running, as well as moderate weight training, help increase bone mass. In postmenopausal women, moderate exercise helps preserve bone mass in the spine and prevents fractures.
Exercise also has a mood-enhancing quality, due to hormones, called endorphins, which are released in the brain. The mood-heightening quality of these endorphins can last for several hours and helps the body fight stress.
Always consult your doctor before starting an exercise program, particularly if you have been sedentary. Your doctor can recommend the appropriate exercise program for you.
Sexual activity may decrease for some women during and after menopause. The symptoms of menopause, such as drier genital tissues and lower estrogen levels, may contribute to a decreased interest in sex. However, estrogen creams and estrogen pills can restore elasticity and secretions in the genital area, and soluble lubricants may also help make sexual intercourse more pleasurable.
It is important to note that women who still experience sporadic menstruation during perimenopause need to continue using some form of birth control. Consult your doctor regarding which form of birth control may be best for you.
The following tips will help to provide healthy living after menopause. Consult your doctor for more information:
If you are considering hormone replacement therapy, the decision to start should be made only after you and your doctor have evaluated the risk versus benefit ratio based on your individual medical history.
Eat a low-fat, high-fiber diet rich in fruits, vegetables, and whole grains. Reduce consumption of saturated fats.
Do not smoke. Smoking is a major risk factor for heart disease.
Exercise regularly. Even moderate exercise, such as walking a half-hour three times a week is beneficial.
Maintain a healthy weight.
Take medication for high blood pressure or to reduce your cholesterol, if prescribed by your doctor. This will help minimize your risk for heart disease.
Good nutrition and regular exercise can help you stay healthy and youthful at this stage of life.
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