Osteoporosis
is
a disease characterized by decreased bone mass and increased risk of fracture. All bones are at risk, but the most common sites of fracture include the vertebral column, the wrist and the hip. Osteoporosis affects both men and women, but occurs more commonly in women. This is partly due to the role menopause plays in bone loss. Bone loss begins to occur at a slow
rate (0.2 to 0.5 percent per year) during one's late 20s or early 30s. For the first five to 10 years after menopause, the rate of bone loss isaccelerated
and may occur at a rate of two to four percent per year. After this, it returns to the previous age-related rate of loss. A woman may lose 30 to 50 percent of her total bone mass during the menopausal years. Risk factors for primary osteoporosis include Caucasian race, tobacco use, chronic alcohol use, a low calcium diet, one's family history and a sedentary lifestyle.
Osteoporosis may
also
occur as a result of other chronic
diseases
or be associated with long-term use of certain medications; this
is known as secondary osteoporosis.
Measurement
of the bone density by a test known as a DEXA scan can identify those women
at risk for osteoporosis and fracture. Bone density testing should be considered
in menopausal women who choose not to use estrogen replacement therapy,
women over 60 who have never been on hormone replacement therapy, women
who have factors related to secondary osteoporosis, women who have lost
two inches in height, women with low bone density on regular X-rays and
post-menopausal women with fractures.
Estrogen
replacement therapy prevents the accelerated bone loss associated with
menopause. It is most effective when started soon after menopause, since
once bone is lost it cannot be replaced. Estrogen replacement maintains
existing bone density for as long as it is taken; bone loss resumes if
estrogen replacement therapy is discontinued. It is never too late to start
estrogen therapy and once started, it should be continued long term. Estrogen
replacement therapy decreases the risk of fracture even in women with osteoporosis;
it is effective therapy in both the prevention and treatment of osteoporosis.
There
are other medications that act similar to estrogen by preventing bone loss
that occurs after menopause. These include Tamoxifen, Evista (raloxifene),
and Didronel and Fosamax (bisphosphanates). Tamoxifen is used in the treatment
of breast cancer and has a bone-sparing effect, but is not used primarily
for that purpose. Evista is a new drug approved for the prevention of osteoporosis.
Evista has not been available long enough to determine its effect on fracture
rate; therefore, it is not yet used routinely in the treatment of osteoporosis.
Other
important interventions to maintain
bone
health before and after the menopause include maintaining an adequate intake
of calcium and vitamin D as well as performing a weight-bearing exercise
program. Calcium can be obtained through dietary intake and supplement
use. Calcium requirements during menopause vary with the use of estrogen.
A total intake of 1000 milligrams is recommended for women while on estrogen
replacement; 1500 milligrams is recommended for women not on replacement
therapy and those diagnosed with osteoporosis. Four hundred international
units (IUs) of vitamin D on a daily basis is the recommended dose. This
is the equivalent of 20 minutes exposure to sunshine every day.
What to Do:
It
is necessary to maintain a diet rich in calcium or supplement as indicated.
It is helpful to develop a regular exercise routine and increase activity
in daily life. People should consider taking a multivitamin that includes
vitamin D. One may want to discuss her risk for osteoporosis with a healthcare
provider. One may also want to discuss indications for a DEXA scan, bone
mineral density testing, with the healthcare provider. Women should
discuss the risks and benefits of estrogen replacement after menopause
with the provider. It may be necessary to consider the use of other medications,
such as Evista and Fosamax, for the prevention and treatment of osteoporosis.
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