World Menopause Day: What are the early signs of osteoporosis in women?

New Delhi: World Menopause Day is observed on October 18 every year. The day aims at spreading awareness about menopause and the complications associated with it. When it comes to this phase in a woman’s life, which marks the end of the reproductive years in a woman’s life, it is accompanied by several symptoms that can cause discomfort, ranging from mood swings to hot flashes to even bone problems such as osteoporosis. Osteoporosis is the most prevalent bone disorder in the elderly, characterised by bone mass and quality loss, thereby predisposing individuals to fragility fractures.

In an interaction with News9Live, Dr Hemant Deshpande, Head of Obstetrics and Gynaecology at DPU Private Super Specialty Hospital, Pune, answered all FAQs about the association between osteoporosis and menopause.

Risk Factors

Doctors say that age, race, absence of estrogen, body weight, dietary disorders (like insufficient calcium and vitamin D, caffeine, and alcohol), medication use (heparin, anticonvulsants, thyroxine, corticosteroids), and lifestyle factors like smoking and sedentary lifestyle.

Pathophysiology of Osteoporosis

Estrogen is essential in both the male and female to maintain skeletal health. The principal reason postmenopausal women suffer from marked bone loss is the fall in estrogen levels, which accounts for 75% or more of the bone loss in the first 15 years post-menopause. Although dietary intake of calcium and vitamin D can be reduced in the premenopausal years, loss of estrogen is the concern that needs to be addressed by bone loss.

Signs and Symptoms of Osteoporosis:

1. Spinal vertebral compression fractures.
2. Spontaneous spinal osteoporosis can lead to collapsing pain, height loss, and postural deformities.
3. Colles' fracture
4. Neck of femur fractures, with 80% of hip fractures associated with osteoporosis.

Investigations:

Bone Mineral Density Measurement: DEXA scans are recommended starting at age 65, as this is the gold standard for assessing bone density.

Diagnostic tests

1. Serum levels of parathyroid hormone, calcium, phosphorus, and alkaline phosphatase (ALP).
2. Renal function tests (RFT).
3. Serum 25-hydroxy vitamin D levels.
4. Thyroid function tests (TFTs) and a complete blood count (haemogram).

Treatment options

1. Lifestyle Change: Encourage lifelong exercise, a vitamin D- and calcium-rich diet, yoga, and morning sun exposure.
2. Menopausal Hormone Therapy (MHT): MHT should be initiated promptly for the treatment of osteoporosis.
3. Selective Estrogen Receptor Modulators (SERM): Raloxifene can be used as a therapeutic alternative to prevent spinal fractures from osteoporosis, especially in women at increased risk for both breast cancer and spinal fractures.
4. Calcium Supplementation: Postmenopausal women will require 1200 mg of elemental calcium per day (from the diet and supplement). Since the average diet supplies only about 500-700 mg, supplementation with a minimum of 500 mg daily is required for patients on estrogen therapy.
5. Vitamin D: The recommended daily allowance for vitamin D in postmenopausal women is 600 IU.
6. Bisphosphonates (Alendronate): These can truly prevent loss of bone through the induction of osteoclast apoptosis and inhibition of bone resorption.