OSTEOPOROSIS & THE MENOPAUSE

There can be few women today who have not heard of osteoporosis. This crippling disorder is caused by loss of bone mass which increases the likelihood of fracture later in life. The latest estimates indicate that osteoporosis will affect a third of all women after the menopause, and a half of all women over 75.

Doctors have called it the silent epidemic because, more often than not, a fracture is the first sign that osteoporosis has struck the skeleton.

Some women do lose height, others develop curvature of the spine, but all of them are faced with the grim and irreversible reality that their bones have lost density and strength, putting them at far greater risk of hip, wrist and spine fractures. As people age, their bones lose strength, but women, once they have passed the menopause and no longer produce the hormone oestrogen, lose bone mass at an accelerated rate. That's why prevention of osteoporosis is really a question of dealing with the menopause.

The menopause

The menopause is actually that brief time when a women's reproductive life comes to an end. It's the time when the ovaries stop producing eggs, and when release of the hormone oestrogen comes to end. This change of life is marked by the end of menstrual periods.

The symptoms which many suffer at the menopause are primarily a result of oestrogen deficiency. They may be short term like osteoporosis they may be physical or psychological, general or more localised. But whatever their nature, doctors seem now agreed that such symptoms justify treatment. As far as osteoporosis is concerned, this means preventing a disease which could cripple a woman's later years.

What's going on?

Bone is a living tissue, in a constant process of renewal in which lost bone tissue is replaced by new. Because oestrogen is vital for this process, women after the menopause are at considerable risk. This rapid postmenopausal bone loss is the main reason why women are more likely to develop osteoporosis than men. There are other causes too immobility, poor nutrition, and smoking.

Which women are at risk?

Most are not diagnosed till they are well beyond 50, and most have already suffered a fracture. Because lack of exercise and inadequate nutrition have been linked to osteoporosis, sedentary postmenopausal women with poor diets are at risk. Hi tech bone screening is now available in some specialist centres to measure bone density and the rate of bone loss.

Experts are now agreed that these bone measurements provide the most reliable guide to fracture risk.

Fact box

• One in three women will suffer a fracture because of osteoporosis
• The main cause is oestrogen deficiency as a result of the ovaries shutting down
• Women lose between a quarter and half their bone mass by the age of 80
• Hormone replacement therapy has become an accepted preventive treatment

Fractures

Fractures of the hip and wrist usually occur after fall from tripping or stumbling and are more likely in women with osteoporosis. One in seven women will suffer a hip fracture, and one in seven a fracture of the wrist.

Overall, one in three women will experience a fracture of some kind.

Hip fractures are the most serious one in four victims will never walk again without help.

Prevention action

Prevention of osteoporosis is of great importance because there are no guaranteed methods of successful treatment. This can be helped by lifestyle measures like exercise and following a diet with adequate calcium and or by various therapies designed to prevent bone loss. Because hormone replacement therapy restores the oestrogen which nature has taken away, HRT has become the most accepted preventive treatment. Your family doctor can give you further advice.

Hormone replacement therapy

Because osteoporosis is certainly related to changing hormone levels, hormone replacement therapy which replaces the body's lost oestrogen, has been shown to be useful in preventing the condition and reducing the risk of fracture.

All kinds of HRT tablets, skin patches, and implants might be prescribed. Women who have had a hysterectomy normally need no other hormone but oestrogen, however, women who still have a womb must take a short course of progestogen each month. This will cause a return to monthly bleeding.

Not all women are suitable for HRT, and doctors can offer advice about this.

Long term hormone replacement therapy for at least three years is often recommended for the prevention of osteoporosis after the menopause.

Generally, regular exercise and healthy diet and lifestyle will help keep the skeleton in good shape, and reduce the risk of osteoporosis and of fractures.