MENOPAUSE AND BONE HEALTH “OSTEOPOROSIS”

18th October is celebrated as “WORLD INTERNATIONAL MENOPAUSE DAY” All the women during reproductive cycle (menstrual cycles) faces a lot of trouble and hurdles. They also experienced abdominal cramps and heaviness during periods. When menopause occurred, women get excited that now all hurdles associated with periods vain off No, it is not like that. After menopause, a new window with new problems have been opened. All these problems of life after menopause have been explained under the heading of “RE-ADJUSTMENT OF WOMAN’S LIFE AFTER MENOPAUSE”

WHAT IS MENOPAUSE…….?                                                     

At the age of 40, 50 years, the sexual cycle become irregular, and ovulation fails to occur during many of the cycles. After a few months to a few years, the cycles cease and female sex hormones diminish to almost none is called menopause.

WHY MENOPAUSE HAPPENED?

The cause of menopause is” burning out ” of the ovaries. Throughout a woman’s reproductive life, about 400 of the primordial follicles grow in to mature follicles and ovulate, and hundreds of thousands of ova degenerate. At the age of 45 years, only a few primordial follicles (immature follicles means they are at early stage and require development) remain to be stimulated by FSH and LH and the production of estrogens by the ovaries decreases as the number of primordial follicles approaches zero. When the estrogen production falls below a critical value, the estrogens can no longer inhibit the production of the gonadotropin FSH and LH. The gonadotropin FSH and LH (mainly FSH) are produced after menopause in and continuous quantities, but as the remaining primordial follicles become atretic (an ovarian follicle that degenerate before coming to maturity), the production of estrogens by the ovaries falls virtually to zero.

RE-ADJUSTMENT OF WOMAN’S LIFE AFTER MENOPAUSE

At the time menopause, a woman must readjust her life from one that has been physiologically stimulated by estrogens and progesterone production to one devoid of these hormones. The loss of the estrogens often causes marked physiologic changes in the function of the body, including,

” Hot flushes ” characterized by extreme flushing of the skin and night sweat.

Psychic sensation of dyspnea

Irritability

Fatigue

Anxiety

Occasionally various psychotic states.

Vaginal dryness which result decrease in sexual desire.

Menopause increase the risk of type 2 diabetic.

Menopause has also impact on heart health and there are increase chances for development of heart related diseases.

Decreased strength and calcification of bones throughout the body. 

WHAT IS OSTEOPOROSIS?

Osteoporosis is the most common of all bone disease in adults in old age especially after menopause. It is different from osteocalcin (softening of bones due to deficiency of Vitamin D which play a key role in calcification of bone (deposition of calcium to make the bone. hard). Before osteoporosis, osteopenia occurred in osteopenia there is low bone mineral density which with the passage of time convert into osteoporosis a progressive condition in which bones become structurally weak and more likely to fracture. In other words, we can say that osteoporosis results from diminished organic bone matrix rather than from poor bone calcification. In osteoporosis, the osteoblastic activity (formation of bone) in the bone is less than normal, and consequently the rate of bone osteoid (unmineralized organic component of the bone) deposition is depressed or there is increase in osteoclastic (a specialized cell which absorb and remove old bone and helps in remodeling).

CAUSES OF OSTEOPOROSIS OTHER THAN MENOPAUSE 

Post menopausal i.e., Lack of estrogen secretion because estrogens have an osteoblast stimulating activity.

Old ag, I which growth hormone and other growth factors diminish greatly, another reason is that many of protein anabolic functions also deteriorate with age, so that bone matrix cannot be deposited satisfactorily. 

Lack of physical stress on the bones because of inactivity

Malnutrition due to which sufficient protein matrix cannot be formed 

Many diseases of protein metabolism like Cushing ‘s syndromes. can cause osteoporosis. 

ROLE OF ESTROGENS IN WOMAN BONE HEALTH

Estrogens cause increased osteoblastic activity (formation of bone) in the bones. After menopause, almost no estrogens are secreted by the ovaries so there will be,

Diminished osteoblastic activity in the bones

Decreased bone matrix because estrogen also has impact on protein metabolism

Decreased deposition of calcium and phosphate

WHAT TYPE OF LIFE STYLE MODIFICATION HELPFUL AFTER MENOPAUSE                              

The following life styles changes will be helpful after menopause, 

EXERCISE AS

we already discussed above inactivity is also responsible for osteoporosis. Exercised will put some physical stress on bone that will prevent from osteoporosis

WEIGHT MANAGEMENT

As we already know that our body skeleton is like a hanger. Putting a lot of weight on the hanger, there will be increase chances of its breaking. In the similar way, increase weight of body increases the chances of fracture.

BALANCED DIET

Balanced diet which is rich in calcium and vitamin D will be helpful in preventing osteoporosis. Orange juice, milk, cereals, beef liver, cheese, egg, fish, spinach, okra, oat meal are the best sources of calcium and vitamin D through diet.

UIT ALCOHOL DRINKING / SMOKING

Alcohol and smoking are two factors for osteoporosis. By avoiding these two habits you can prevent yourself from osteoporosis.

GO OUT SIDE AND MAKE SUN SHINE VITAMIN

As we know that, Vitamin D is also known as SUN SHINE vitamin. It is the only vitamin which synthesized from the cholesterol of your skin after exposing your skin to sun. If your body has a lot of calcium with vitamin D deficiency then body will not be able to utilize this calcium for calcification of bones. Due to this factor, vitamin D is essential requirement for proper calcium utilization.

DRUGS FOR OSTEOPOROTIC FRACTURE

Fracture which occurred after menopause are termed as osteoporosis fracture. Many drugs are available for it which are listed as follow,

BIPHOSPHONATES

These group of drugs includes etidronate, pamidronate, Alendronate and risedronate. They act by increasing bone mass and slow down bone loss.

DENOSUMAB 

Denosumab is an IV medication that prevent bone loss and lowered the risk of fracture.

ABALOPARATIDE

It is self-administered injection for bone formation. It’s given as daily dose under the skin for not more than 2 years.

TERIPARATIDE

It’s a para thyroid hormone which stimulate new bone formation.

ROMOZOZUMAB

It’s a sclerostin blocker which is under the doctor supervision.

CALCITONIN

It’s available as nasal spray for calcium regulation.

CALCIUM AND VITAMIN D 

As we already discussed the importance of calcium and vitamin D in body. They enhance bone formation. 

HORMONE REPLACEMENT THERAPY (HRT) ESTROGEN

Hormone replacement therapy is used to relieve symptoms of menopause. However, this therapy has side effects also.

The purpose of celebrating the world menopause day is to increase awareness about post-menopausal life and how can someone keep herself healthy with this change of life.