What You Should Know About Menopause and Osteoporosis
Have you been told you need to take a drug to manage your osteoporosis risk or menopausal symptoms? Read a full explana

I would like to clarify a few concepts to help people better understand menopause and osteoporosis and take the appropriate steps to improve their health.

Menopause is defined as the end of menstruation, confirmed by 12 consecutive months without a menstrual period. Perimenopause is the time of up to 5 years prior to the time when changes begin through 12 months following the last menses. It should be remembered that menopause can also be caused by medical ( e.g. chemotherapy for cancer ) or surgical interventions that damage or remove the ovaries. Menopause means the end of the supply of eggs. As a result important hormonal changes occur. Estrogen, progesterone and testosterone levels decline.

These occurrences create signs and symptoms such as hot flashes and night sweats, vaginal dryness, insomnia, mood changes, poor concentration or memory loss, less ability to deal with stress, urinary incontinence or infections. The experience of menopause affects each woman in an individual way.  The correct lifestyle changes including appropriate diet, exercise, stress management, supplements, medications if needed and natural hormones can help many women in this stage of their lives.

Osteoporosis is a skeletal disease characterized by severe bone loss, disruption of skeletal architecture and bone quality sufficient to predispose to fractures of the vertebral column, upper femur, distal radius, proximal humerus, ribs and pubis. The predominant sex is female. Incidence/Prevalence in the USA are 30-40%  in women, 5-15% in men. For secondary osteoporosis it is cumulatively 5-10% in both sexes.

Osteoporosis is categorized in:
A) Primary, such as postmenopausal (Type I) which is most common in Caucasian and Asian women. This is due to excessive and prolonged acceleration of bone resorption ( Calcium matrix is taken out of bone)  following menopausal loss of sex hormones ( estrogen, progesterone, testosterone) as described above .
Involutional (Type II) which occurs in both sexes above age 75 and is due to prolonged imbalance between bone resorption and formation.
B) Secondary: this is due to other factors including eating disorders, steroid excess, rheumatoid arthritis, chronic liver/kidney disease, malabsorption syndromes, hyperparathyroidism, hyperthyroidism, overtraining athletes/ballet dancers with low estrogen, chronic anticoagulant use, chronic anti-seizure medication and other.

Unfortunately both primary and secondary osteoporosis often overlap.
The DIAGNOSIS of osteoporosis  is usually made by presentation and physical examination. The most well known test is the bone density test DEXA scan  which measures bone density in lumbar spine and upper femur. There is also a peripheral DEXA which measures  BMD (Bone Mass Density) of the heel, distal tibia, and distal radius. These tests confirm the diagnosis and assesses the severity of bone loss.

TREATMENT options include exercise, supplements, hormones ,various medications and  very importantly DIET. Changing diet if overweight, eating  more raw and fresh vegetable foods, avoiding excess phosphate intake, i.e. avoiding phosphoric-acid-containing beverages and excess animal food intake can have profound effects. Milk is controversial, dairy consumption has been associated with more, not less osteoporosis.

Also important is intake of 2000-30000 IU vitamin D daily from preferably vegetal sources. 

Calcium intake of about 1200-1500 mg/day from vegetal sources should be taken as well.

The medications  most used for osteoporosis include  a class called Bisphosphonates such as  (Fosamax) ,  (Actonel), ( Boniva) , (Evista) a selective estrogen receptor modulator (SERM) which binds to estrogen receptors,  HRT  and Parathyroid hormone ( Forteo) , which can increase bone mass.  Unfortunately as with all medications there are precautions and side effects. For example, for the bisphosphonates esophageal dysfunction, reflux disease and bone pain can occur. The recently discovered occurrence of osteonecrosis of the jaw  and also possible fractures complicate the use of these medications.

Conventional  hormone replacement therapy has dramatically decreased since  the 2002 results of the Women’s Health Initiative. WHI showed that combined artificial estrogen-progestin treatment increased heart attacks by about 29%. Other risks included a 40% increase in stroke, a 100% increase in venous thromboembolism (clots in lungs, legs, pelvis) and a 26% increase in risk of breast cancer. Raloxifene Evista can have problems of  thromboembolism. Parathyroid hormone is usually reserved for special situations.

In the field of natural medicine there is awareness that chemical hormones are not advisable and medications have many side effects. The best approach is felt to be a comprehensive and individualized program for each single person, developed together with their integrative physician. With the correct lifestyle changes including appropriate diet, exercise, stress management, supplements, natural hormones and possibly medications we can improve both menopause and osteoporosis which frequently go together. Such programs can help many women regain a very good quality of life.

About the Author:
Anthony Bazzan - Anthony J. Bazzan, MD-- Integrative Medicine

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