Osteoporosis in menopause: symptoms, treatment and prevention

What Are Osteoporosis In Menopause: Symptoms, Treatment And Prevention

Osteoporosis in menopause is one of the characteristic problems that many women have to face when they are in this stage of life, even more so if predisposing risk factors are present.Osteoporosis is a pathology characterized by a deterioration of the skeletal architecture, with a progressive reduction of the mass of the bone which, consequently, becomes more fragile and exposed to a greater risk of fractures (typical, but not exclusive, is the fracture of the femur ).

To be fair, bone loss can still occur over the course of an individual’s life but, without a doubt, the onset of menopause accelerates this degeneration.

Bone Remodeling

Brief Summary: Bone Remodeling And The Role Of Hormones

Bones are metabolically active and subject to a continuous remodeling process, known as ” bone remodeling “. Approximately 10% of total bone mass is renewed each day through mechanisms of resorption and neo-formation . This process is mainly governed by two types of specialized cells :

  • Osteoclasts , responsible for the destruction and resorption of bone ;
  • Osteoblasts , on the other hand, are responsible for building bone (deposition of different layers of a pre-bone matrix – called osteoid – which is mineralized immediately after its deposition).

In all these processes, the role played by vitamin D and the hormones calcitonin (secreted by the parafollicular cells of the thyroid) and parathormone or parathyroid hormone (secreted by the parathyroid glands ) is also fundamental. Vitamin D, in fact, is involved in the absorption of calcium and phosphorus , calcitonin carries out a promotional action towards bone mineralization (it stimulates the deposit of calcium), counteracting the action of the parathyroid hormone which, on the other hand, favors the release of calcium from the bones, favoring the activity of the osteoclasts.

Role Of Estrogens

Upstream of all the processes described above is the action of the hormone estrogen . These, in fact, play a central role, for example, by promoting the tubular reabsorption of calcium in the kidney ; favoring the conversion of vitamin D and the consequent intestinal absorption of calcium and again, increasing the synthesis of calcitonin which counteracts the effects of the parathyroid hormone.

In addition to this, estrogens act on various local factors by indirectly stimulating bone formation, on which they also have a direct trophic action. Conversely, their deficiency results in an increase in osteoclast activity and bone resorption.


What Are The Causes Of Osteoporosis In Menopause?

The relationship between estrogen deficiency that typically occurs during menopause and osteoporosis has now been widely confirmed. In fact, by decreasing the levels of these hormones during menopause, the activities they perform are reduced, leading to less intestinal and renal calcium reabsorption and greater osteoclast activity, with a consequent decrease in bone mass.

However, the drop in estrogen does not seem to be the only cause of the onset of osteoporosis in menopause; in fact, even if it is believed that the decrease in these hormones contributes to a large extent, there are other factors which, competing with each other, can favor the onset of the disease.

Risk Factors For Osteoporosis In Menopause

Taking into account the fact that the female sex and the menopause itself with its characteristic reduction in estrogen production represent risk factors for menopause, the probability of the onset of the disease is all the higher in the presence of:

  • Familiarity and genetic predisposition (unfortunately, it is not possible to intervene on these factors);
  • Reduced peak bone mass ;
  • Poor dietary calcium intake and incorrect nutrition ;
  • Sedentary lifestyle;
  • Periods of amenorrhea ;
  • Use or abuse of certain types of medications, such as corticosteroids and anticonvulsants ;
  • Presence of certain types of diseases, such as hyperthyroidism , some chronic kidney diseases, etc.;
  • Excessive thinness ;
  • Smoking habit ;
  • Alcohol abuse .


What Are The Symptoms Of Osteoporosis In Menopause?

In many cases, patients do not realize that they have developed osteoporosis in menopause until they undergo specific instrumental investigations or suffer fractures.

However, it has been observed that the height of those experiencing osteoporosis tends to decrease due to compression of the spine or curvature of the back.

Other symptoms you may experience include bone pain , muscle pain and fractures .


How Is Osteoporosis Diagnosed In Menopause?

The diagnosis of osteoporosis is generally confirmed by carrying out specific instrumental investigations and, in particular, by computerized bone mineralometry (MOC). With this diagnostic test, the levels of calcium and other minerals within the bones can be measured, and doctors are able to establish a parameter known as bone mineral density (BDM).

Bone mineralometry, in addition to being a diagnostic means to confirm the existence of osteoporosis, can also be performed regularly for “preventive” purposes, or rather, as a means of early diagnosis in order to promptly identify the onset of the disease to be able to start appropriate treatment as soon as possible.


How Can Osteoporosis In Menopause Be Prevented?

Despite the existence of some pharmacological treatments that can prove useful in the presence of osteoporosis, as occurs with most diseases, prevention appears to be the best “therapeutic strategy”.

One of the main factors on which it is possible to intervene is undoubtedly the diet which must be structured in such a way as to provide the body with all the nutrients it needs, not only during menopause, but throughout the entire life of each patient. Clearly, as age progresses and the menopause approaches , the right calcium intake ( during menopause, the need for this mineral in women increases) and vitamin D is essential. But be careful not to overdo it; these substances, essential for bone health, must indeed be introduced but in the right quantities and without going overboard which could, however, cause further problems.

Another factor on which action can be taken to try to prevent the onset of osteoporosis is lifestyle . In particular, physical activity is very important , of course, proportionate to the age and individual abilities of each woman. For example, gentle gymnastics and Pilates can represent an excellent training possibility even for older women. In addition to being useful in the prevention of osteoporosis in menopause, physical activity also helps prevent cardiovascular disease , helps maintain mental well-being and a better aesthetic shape, allows you to maintain both a balanced body weight  and good tonemuscular .

In addition to what has been said so far, in the context of the prevention of osteoporosis in menopause it is also useful:

  • Avoid excessive sodium in the diet and adopt a balanced diet that provides the right amount of nutrients;
  • Avoid smoking and give up the habit if present;
  • Avoid the abuse of alcohol and caffeine ;
  • Avoid the abuse or prolonged use of drugs that can promote the disease, such as corticosteroids.

For preventive purposes, if deemed necessary, the doctor may decide to prescribe vitamin D and calcium supplementation to the patient.


How can Osteoporosis in Menopause be treated?

The treatment of osteoporosis foresees, if it has not already been done, that the patient adopts a correct diet and a correct lifestyle which can be associated with a pharmacological treatment. In these cases, the doctor will determine, on a case-by-case basis, whether the use of medicines is necessary.

However, among the main drugs used in the treatment of osteoporosis in menopause, we mention:

  • Estrogen -based drugs ( hormone replacement therapy );
  • Estrogen receptor agonists (for example, raloxifene and bazedoxifene );
  • Bisphosphonates (for example, alendronate and ibandronic acid );
  • Calcium and vitamin D drugs .

Some of the above-mentioned drugs are sometimes also administered for preventive purposes. Clearly, each of them must be prescribed by the doctor and requires the presentation of a specific medical prescription to be dispensed.

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