Postmenopausal Osteoporosis
Rahana Abd Rahman, Ani Amelia Zainuddin, Ng Beng Kwang
(Jabatan Obstetrik dan Ginekologi, Pusat Perubatan Universiti Kebangsaan Malaysia)

 

The advancement of medical care in Malaysia had reduced the mortality rate in the elderly age group leading to increases in life expectancy. The mean age of menopause in Malaysian women is 50.7  years. Menopause is one of the major risk factors for osteoporosis causing fractures in the elderly age group. Therefore, the burden of osteoporosis is expected to increase. Osteoporosis means thinning of the bones causing fragility making them easier to fracture. In Malaysia, Chinese women have the highest rate of osteoporotic hip fracture. Osteoporosis related fractures have become a major cause of death in the elderly and a major economic burden for Asian countries including Malaysia.

 

What is osteoporosis?

Bones go through changes throughout life namely resorption and formation. Osteoporosis is a result of rapid resorption exceeding the bone formation leading to reduced bone density. Hence the bone becomes fragile and easily fractures.

 

What are the risk factors for osteoporosis?

Non modifiable	Modifiable
Advancing age Oriental and caucasian Female Premature menopause Slender build Family history in first degree relative	Low calcium intake Sedentary lifestyle Smoking Excessive alcohol intake Excessive caffeine intake

 

How to diagnose osteoporosis?

Measurement of bone mineral density at the hip and lumbar spine using DEXA. The results are presented as T-score. The T-score is used to compare the bone density of the person scanned with that of a young woman. T-score of -1 indicates normal density. T-score between -1 and -2.5 indicates low bone density and -2.5 or less means osteoporosis.

 

What are the implications of osteoporosis?

Osteoporosis is a risk factor for fractures which can affect a person’s quality of life and survival rate. In the elderly age group, hip fractures may necessitate surgery and prolonged hospitalization causing loss of independence and emotional stress.

 

How to prevent osteoporosis?

Nutrition	Calcium Women 19-50 years old: 1000mg/day Women 51-65 years old: 1300mg/day   Vitamin D Sunlight exposure >15 min/day Supplement of 800 IU/day   Others Maintain BMI not < 19kg/m2 Maintain adequate protein and energy intake
Healthy lifestyle	Regular physical activity especially weight bearing exercises (walking, running, tai chi, dancing) Stop smoking Use caffeine in moderation
Pharmacology	Hormonal therapy Biphosphonates Selective estrogen receptor modulators
Prevention of fall	Ensuring good health and safe environment at home

 

How to maintain adequate calcium in the body?

Increase your intake of:

• Dairy products such as cheese, yoghurt and milk
• Soybean and tofu
• Dark green vegetables such as broccoli and kale
• Sardines and salmons with bones

Avoid food that cause loss of calcium:

• Excessive animal protein
• Excessive sodium, alcohol and caffeine

 

What are the treatment options for osteoporosis?

Hormonal therapy	Estrogen therapy confers maximal benefits when started at menopause and continued for 10 years   Progestogen is imperative in women with intact uterus
Selective estrogen receptor modulators	Improves and preserve bone density at spine and hip joint
Biphosphonates	Inhibit bone resorption
Calcitonin	Anti-resorptive agent
Calcium	In combination with other treatment
Vitamin D	Supplement of 800IU/day combined with calcium

 

Conclusion

The increasing numbers of women above 50 years old warrants a widespread education on bone health. In order to prevent osteoporosis, a healthy lifestyle and diet are important. There are multiple drug therapies available for the treatment of menopause. Women need to be vigilant in their bone status in order to have appropriate treatment.

 

References

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