Wednesday, May 25, 2022

(Courtesy of Parkview Pharmacy) Osteoporosis (OP) in post-menopausal women is due to estrogen deficiency that leads to loss of bone density and affects bone architecture. Loss of estrogen also increases calcium excretion and decreases calcium and vitamin D absorption through the gut.

Bone loss begins during peri-menopause and continues up to eight years after menopause and can be as high as 2% per year, with total bone mineral density (BMD) loss about 10%. There is a high morbidity and mortality rate associated with hip and spine fractures in these women.

Postmenopausal women, people over 65 years old, Caucasians and Asians and people with small body frame, are mostly affected. In the United States, the prevalence of osteoporosis in adults over 50, is more than 10 million.

General risk factors are age, female gender, rheumatoid arthritis, diabetes, hyperparathyroidism, smoking, alcohol (more than three drinks/day), low body mass index (BMI), a prior osteoporotic fracture, family history, taking glucocorticoids for more than three months, long-term use of proton pump inhibitors (PPIs), low calcium intake, vitamin D deficiency, excess vitamin A intake, inadequate physical activity and sedatives that increase risk of fall and fracture.

Osteoporosis usually does not show any symptoms until a fracture happens.

The first goal of therapy for OP is prevention. Once osteoporosis develops, the goal is to improve bone mass and strength and prevent fractures. In patients who have already experienced fractures, decreasing pain and deformity, improving functional capacity, quality of life and reducing future falls and fractures are the main goals.

When diagnosis of osteoporosis is confirmed based on BMD measurements and vertebral imaging, treatment can begin.

In postmenopausal women or men under 50 years old, the T-score is used to show the bone density. T-score greater than -1 is normal; T-score -1 to -2.5 is low bone mass or osteopenia, and T-score less than -2.5 is osteoporosis.

Medications indicated for osteoporosis are bisphosphonates (BPs) such as alendronate, ibandronate, risedronate, zoledronic acid; teriparatide; raloxifene; and denosumab.

Non-drug interventions include enough intake of calcium and vitamin D, regular muscle-strengthening and weight-bearing exercise, quit smoking, limit alcohol intake and management of risk factors for falling.

The recommended exercises are weight-bearing exercises such as walking, jogging, Tai Chi, stair climbing, dancing, and tennis and muscle-strengthening exercises such as weight training and other resistive exercises, such as yoga and Pilates.

A balanced diet with calcium-rich foods including low-fat dairy products such as milk, cheese, yogurts and fruits, and vegetables such as broccoli, is ideal. Intake of calcium: 1200 mg/day for women over 51 and men over 71 is suggested if diet is insufficient. In addition to calcium, people over 50 should be advised to take vitamin D, 800-1,000 IU/day; and protein, 1g/kg/day.

If lactose-intolerant, taking lactose-free dairy products, soy or almond milk and eating fruits and dark green, leafy vegetables provide the same amount of calcium and vitamin D.

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