These effects vary from individual to individual depending on genetic, psychological and environmental factors. The development of osteoporosis, a synonym for low bone density, is one of the major health concerns related to menopause. Although menopause is not a disease, osteoporosis is. Osteoporosis involves a wasting or deterioration of bone mass that normally begins slowly at about age 35 but develops much more rapidly with the decrease in estrogen levels associated with menopause.
Currently, it is estimated that one in three post-menopausal women in western countries are afflicted with it. As stated previously, because osteoporosis has no symptoms it has often been called "the silent epidemic. Until recently it could not be diagnosed until a fracture had occurred because there were no tests to determine bone weakness. To date, the US Preventative Task Force suggests annual screening for osteoporosis for women over 65 years of age this is covered by Medicare.
There are currently several options available for screening. One specific technique known as "dual-energy X-ray absorption" or DXA, has made it possible to detect mineral loss within intact bone. This test uses less radiation than a standard chest x-ray, measures mineral loss in the hip and spine and takes about minutes to perform.
The main purpose of this test is to determine the likelihood of fracture risk. The results are measured in Z-scores and T-scores. The Z-score compares the patient's bone density to the normal rate of someone their age. The T-score is used to diagnose the standard deviation SD above or below the mean compared to others of the same sex and ethnicity. An increase or decrease of 1. Because of the accuracy and the low dosage of radiation, the American Academy of Orthopedic Surgeons has labeled DXA as the gold standard bone mineral density today.
Lower cost conventional radiography methods are also used to provide information about bone health. Radiography used independently, or with MRI or CT can be useful in identifying osteopenia - bone thinning. All women under 65 who have sustained a fracture as an adult, who have a family history of the disease, or who smoke should be screened.
Although osteoporosis has no symptoms, if one knows what to look for there may be earlier warning signs that point to a problem developing. These include:. The human body loses calcium daily through renal, gastrointestinal and skin excretion. Decreased levels of serum calcium lead to increased secretion of the parathyroid hormone, which in turn, acts on the kidney to decrease calcium and Vitamin D secretions. The extra Vitamin D in the blood encourages the intestinal tract to increase calcium absorption. If these natural feedback loops are not functioning properly to maintain adequate levels of serum calcium, the parathyroid hormone causes bone to be broken down for its calcium bone reabsorption.
Chronic bone reabsorption leads to bone loss and eventually the disease of osteoporosis. Even under the best of circumstances the body is not very efficient at absorbing calcium - it only absorbs about one-third of the calcium ingested whether that ingestion comes from whole foods or calcium supplements. Calcium intake in American women is far below the levels needed to ensure that serum levels remain high enough to prevent bone reabsorption.
From childhood to adulthood bone is made faster than it is broken down with maximum bone density usually reached at about age By age 50 most American women have lost up to one-third of their peak skeletal calcium without even realizing it. This process accelerates even further with the onset of menopause, resulting in nearly a million fractures a year , of which are hip fractures in elderly American women.
About one in four women will experience some sort of fracture between the ages of 60 and 90 years and nearly 50, a year will die from complications of the disease. Medical costs run in the billions per year. The bone is composed of calcium and protein. Each bone has two components - compact bone and spongy bone. Compact bone sometimes called cortical bone is on the outer part of the bone and it is hard and solid while spongy bone also known as trabecular bone is on the inside and is porous. Type 1 osteoporosis postmenopausal causes a loss of trabecular bone and is mainly due to when the amount of estrogen greatly decreases.
This process leads to an increase in the resorption of bone the bones loses substance. Type 2 osteoporosis senile osteoporosis typically happens after the age of 70 and affects women twice as frequently as men. Type II osteoporosis involves a thinning of both the trabecular bone the spongy bone inside of the hard cortical bone and the hard cortical bone.
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The first signs of osteoporosis are seen in bones with the greatest amount of spongy bone material such as the spine, hips and wrists. With the development of osteoporosis the walls of compact bone become thinner and the holes in the spongy bone become bigger. Tooth loss may also occur as a result of weakened bone structure in the jaws. In the early post-menopausal years the cause of bone loss is primarily due to decreased estrogen levels leading to increased rapid bone loss in the spine and hip.
Calcium and Vitamin D supplementation does not appear to prevent or even decrease spinal reabsorption and may not decrease hip reabsorption either. Calcium supplementation, however, appears to decrease bone loss of the forearms and to increase total body bone density. When this period of rapid bone loss is over, inadequate calcium intake can cause bone loss to continue.
At this point studies show that calcium supplementation can significantly alter the process of bone reabsorption by keeping serum calcium at adequate levels.
The United States Preventative Service Task Force also recommends a noninvasive online tool to screen for osteoporosis. The program estimates a person's year risk of fractures based on clinical information, such as age, parental fracture history, tobacco and alcohol use, body mass index and other previous medical conditions.follow url
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Even after menopause some estrogen is converted from adrenal gland hormones and is stored in the body's adipose tissues. Being normal to slightly plump may be advantageous at this stage of life. The goal of one recently published study was to determine the major risk factors of osteoporosis. The study used DXA technology to measure T-scores of postmenopausal women. Descriptive statistics, such as body mass index, age, weight and height were also measured.
According to the analysis, the rate of bone loss was the quickest just after menopause, but slowed down in the woman aged. The researchers believe that the reduction in female hormones is responsible for the bone loss. High intake of phosphorous e.
The difficulty in assessing the risk of carbonated beverages stems from the fact that most studies of this problem involve teenage girls. While there does appear to be an association between increased intake of carbonated beverages and decreased bone density, experts must admit that the problem may be that carbonated beverages are often substituted for milk in this age group. It is hard to determine whether the problem is the increased carbonation or the decreased milk intake. To further complicate things, most carbonated beverages contain caffeine, which has also been shown to cause calcium excretion.
Once again it is hard to determine whether the culprit is the carbonation or the caffeine.
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Additionally, some carbonated beverages contain minerals that bind to calcium and thus nullify calcium's actions in the body. One study of middle-class women age found no link between carbonated beverage intake and bone loss no matter how frequent or how prolonged the carbonation intake had been. Until further determinations can be made, experts suggest that women take their calcium supplements with plain water, milk, or orange juice which has been shown to increase calcium absorption rather than with seltzer water or other carbonated beverages.
In conclusion, it is safe to say that adequate calcium and Vitamin D3 intake may slow bone loss, decrease bone turnover, enhance the body's response to other therapies such as HRT and play a role in the prevention of osteoporosis. The emphasis in patient teaching should be on prevention through lifestyle changes such as diet, exercise, calcium supplementation and hormone replacement therapy. It is not inevitable that one becomes unhealthy as one ages. Until the time of menopause, women enjoy a certain amount of protection against cardiovascular disease when compared to the risks for men of a similar age.
After menopause women begin to lose this protection and by the age of 75 the risk is similar for both sexes. Studies show that postmenopausal first heart attacks in women are twice as likely to be fatal than are first heart attacks in men. The protection in the pre menopausal years is believed to come from the woman's elevated estrogen levels.
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This results in an increase of atherosclerosis, especially in women who smoke, are obese or who live sedentary lives. As with osteoporosis, this problem is increased further in women who have an early menopause whether naturally or surgically induced. Those who go through menopause before the age of 40 are at increased risk. Worldwide, 8. According to the American Heart Association, an estimated 44 million women in the U. Cardiovascular diseases and stroke cause 1 in 3 women's deaths each year, killing approximately one woman every 80 seconds.
By the age of 55 it is the leading cause of death in women. When women get heart disease they are usually sicker than men are when they finally seek treatment. Women who have MIs are also twice as likely as men to die within the first few weeks after the attack. Women are also less likely to receive certain state of the art treatment protocols. Heart Disease is the leading cause of death for women over 65 years of age. While age is a significant cause of heart disease regardless of gender, current studies have shown that it may be more relevant in women than in men.
During this depletion of estrogen, total cholesterol and triglycerides increase, while HDL cholesterol levels decrease. This lethal combination increases the risk of coronary heart disease two to three times than that of premenopausal women. Historically, HRT replacement was universally prescribed to menopausal women to help reduce negative symptoms, and was also thought to curb heart disease. However, findings from the Women's Health Initiative WHI revealed that HRT does not prevent heart disease, and may actually increase the risk of negative coronary events. Other recent observational and randomized studies have suggested that HRT could have some cardiovascular benefits on early postmenopausal women, and have negative outcomes on women who wait too long to begin the therapy.
Additional studies are needed to explore the age, time of initiation, duration of therapy and dosage variations to help answer questions about HRT. Other risk factors for the development of cardiovascular disease are important to consider as well.
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These include the following:. Chest pain is less likely to signal the development of heart disease in women than in men. This is probably explained by the fact that many other conditions may produce chest pain in women. These conditions include heart spasms, mitral valve prolapse, indigestion, gallstones, esophageal spasms, costochondritis and pleurisy. Angina is just as common in women as it is in men but women may experience more nausea and vomiting, more neck and shoulder pain and more shortness of breath.