Postmenopausal Women And Osteoporosis

Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist, although any bone can be affected.

Types of Osteoporosis
o Primary Osteoporosis
o Secondary Osteoporosis

Primary Osteoporosis :
PMO – Postmenopausal Osteoporosis
Senile (Age related) Osteoporosis
Idiopathic Osteoporosis

o We are in the midst of a global Osteoporosis epidemic. 200 million people worldwide are suffering from this condition.
o National Osteoporosis Foundation (NOF) findings are as follows:
-Osteoporosis related broken bones affect more women than breast cancer, uterine cancer and ovarian cancer combined. One out of two women will have an Osteoporosis related bone fracture in her lifetime.
o Bone health must be considered a top priority for everyone over the age of fifty throughout the world.
o Osteoporosis is 100% preventable. Osteoporosis is 100% treatable, but Osteoporosis cannot be completely cured.

prevention is always the best treatment, so talk to your doctor and get a BONE MINERAL DENSITY (BMD) test now to see what you need to do to keep your bones healthy, strong and beautiful.

o Our body achieves its peak bone mass (Maximum bone density and strength) by the time we are 25 and 30, it does a pretty good job by working out a precise balance between resorption (the removal of old bone) and formation (the addition of new bone).
o When a woman reaches the age of menopause her bone loss accelerates from about 3% up to 7% a year.
o Think of it this way: If you have been diagnosed with low bone mass or density, this means that your bones have less mineral per square inch than they should which is known as Osteopenia – means thinning of bones.
symptoms
o Osteoporosis is often called a "silent disease" because bone loss occurs without symptoms. Women may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebra to collapse. Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis or stooped posture.
Risk Factors
Body – type risk factor
o Tall, thin, fair-skinned women have a high risk of developing Osteoporosis.
Weight risk factor
o Sudden weight loss after menopause (More than 10% of your body weight) can double your chances of developing Osteoporosis.
o If you need to lose weight after menopause, do it slowly and under the care of your doctor.
Risk factors you can change
o DXA testing
o Lack of exercise
o Smoking
o Alcohol
o Caffeine
o Low calcium and Vitamin D
o Low body weight
o Certain medications
Detection
o Specialized tests called bone mineral density (BMD) tests can measure bone density in various sites of the body. A BMD test can:
o Detect osteoporosis before a fracture occurs
o Predict chances of fracturing in the future
o Determine rate of bone loss and/or monitor the effects of treatment if a DXA BMD test is conducted at intervals of one year or more.
Postmenopausal Osteoporosis
o Affects only women associated with the loss of estrogen, that occurs after menopause.
o Affects trabecular (porous, spongy) bones of 1. Wrist 2. Spine
Hormone Replacement Therapy: Yes , No or Maybe.
o Especially estrogen, to postmenopausal women, which decreases dramatically after menopause.
o ERT = Estrogen Replacement Therapy
o When estrogen is combined with progesterone it is generally called Hormone Replacement Therapy (HRT)

Postmenopausal
Age: 50 to 75
Type of bone loss: Trabecular
Site of fracture: Wrist and spine
Rate of bone loss: Accelerated
Calcium absorption: Decreased

OSTEOPOROSIS
o Metabolic bone degeneration (Osteoporosis) affects millions of people and is directly responsible for debilitating hip, vertebral and limb fractures in the elderly.
o The magnitude of the Osteoporosis problem has been realized in recent years; and the value of early detection and therapeutic intervention has become clear.
Why we get Osteoporosis?
o Osteoporosis is a degenerative disease which means porous bone. What happens is that when our body stops getting the CALCIUM that it needs (Which does tend to happen as we get older). It steals the needed calcium from our bones, over a period of time when our bones have lost more calcium than they can replace Osteopenia (Thinning of the bone) develops. If not treated, this turns into full blown Osteoporosis, it is actually the long term negative result of a short term coping mechanism.
o The secret to preventing Osteoporosis is to give your body all the calcium it needs, so that it doesn't have to steal calcium from bones.
o Vitamin D and exercise are also very important.
o Your body cannot survive without adequate levels of

1. Calcium

2. Phosphorous

3. Magnesium

4. Sodium
o These substances are normally stored in your bones. When the levels of these minerals and nutrients get too low in your blood, your bones give them up to restore a healthy balance of them in your bloodstream.
o When your blood mineral levels are restored to normal, your body can go on functioning in a healthy way.
o Bones are givers. The most charitable of all our bones are those that have a high trabecular content, like the jaw, pelvis, wrist and spine. Sometimes the first sign of systemic bone loss is receding gums. The wrist and vertebrae also tend to fracture before the hip, because they are composed largely of trabecular bone.

CONTRIBUTING FACTORS:
o Inadequate nutrition
o Smoking
o Alcohol abuse
o Minimal exercise
o Depression
o Some medications
o Some surgeries
o Irregular periods
o Exposure to toxins in the environment.

THE CALCIUM REVOLUTION
o Researchers are increasingly finding that the humble mineral calcium plays a major role in warding off major illnesses from high blood pressure to colon cancer. You name the disease and calcium is beginning to have a place there, says David M., a nephrologist at Oregon Health Sciences University.
o Americans are in a major calcium deficiency crisis.
o Calcium is essential for bones and teeth.
o It regulates heart rhythm.
o Helps blood clot properly.
o Maintains proper nerve and muscle function.
o May lower blood pressure.
o Eases insomnia.
o Keeps cell membranes healthy.
o Helps us metabolize fat.
o May reduce the risk of breast and colon cancer.

ABSORPTION OF CALCIUM
o Learn how to increase the amount of absorbable calcium in your diet everyday.
o About 98% of the calcium in our body is stored in our bones.
o Approximately 1% of it is in our teeth.
o Other 1% circulates in the bloodstream and other tissues.

CALCIUM
o Dietary Reference Intake (DRI) – 1500 mg/day in divided doses.
o Countries such as USA, whose population consume large quantities of dairy products and calcium, have much higher rates of Osteoporosis than countries which consume little or no dairy products and little calcium.

EXCESS CALCIUM
o Excess calcium in postmenopausal women can cause
o Kidney stone formation
o Hypercalcemia
o Fractures
EXCESSIVE CALCIUM EXCRETION
o Excessive calcium excretion is the cause of bone loss. E.g. amount of calcium ingested is more than what is absorbed or required causing negative balance which is equal to bone loss.
o However if more calcium is consumed than is lost then one is said to be in positive balance.
o Anyone having a disease of the parathyroid gland should not take calcium and consult their health professional.

ANIMAL PROTEIN & CALCIUM LOSS
o Consumption of large quantities of animal protein causes greater loss of calcium.
o Urinary calcium excretion on a high protein diet is about 90-100gms which increases the risk of Osteoporosis in most women.
o SO PLETHORA OF PROTEIN causes PAUSSITY OF BONE.
o Vegetable proteins are safe and do not cause negative calcium balance.
o Calcium is the most important mineral in your body, but most of us are not getting enough of it in an absorbable form.
o Please try to make sure you are getting the following important nutrients in your diet each day:
o Calcium 1000-1500 mg

(In divided doses)
o Phosphorous 500 – 700 mg
o Magnesium 750 mg
o Vitamin D 400 – 800 IU

(When you can't get 15 minutes of sunlight.)
o Vitamin C 1000 mg

(In divided doses)
o Vitamin K 100 – 300 mcg
o Zinc 12 mg
EXAMINATIONS
o DXA – Dual X-ray Absorptiometry

This test is simple, non-invasive to measure bone density, which is a measure of bone strength.
o Serum calcium
o Serum Vitamin D

CALCIUM FACTS
o ALL CALCIUM SUPPLEMENTS WORK THE SAME WAY. THEY CONTAIN DIFFERENT AMOUNTS OF ELEMENTAL CALCIUM.

Calcium Carbonate 40% calcium
Calcium Citrate 20-24% calcium
Calcium Lactate 13% calcium
E.g. For every tablet that contains 1000 mg of Calcium Carbonate, only 400 mg (40%) of the amount is available to us for absorption. The remaining 60% of the tablet is made up of oxygen and carbon.

American Journal of Therapeutic & Journal of Clinical Pharmacology have concluded that Calcium Citrate is better absorbed than Calcium Carbonate, which is a preferred supplement for the elderly.

FOR PROPER ABSORPTION OF CALCIUM

VITAMIN C

DRI = 1000 mg/day

(In divided doses)
Absorption of calcium is proper if there is an acidic medium. If not then calcium will deposit and cause atherosclerosis.
Caution: Do not take Vitamin C if you have kidney stones, gout or iron deficiency disease.
o PHOSPHORUS

DRI = 500 – 700 mg
Phosphorus is very essential for the synthesis of protein, carbohydrates and fats.
Calcium : Phosphorus

2 : 1
Deficiency of phosphorus: Osteoporosis, nervousness, depression, nerve and brain functions are affected.
e.g. walnuts, almonds, ragi etc.
o Excessive consumption of phosphorus (E.g. red meat and carbonated beverages) can decrease and contribute to bone diseases, as there is phosphoric acid in the beverages.

MAGNESIUM

DRI = 320 mg/day
o This trace mineral facilitates bone formation, protein synthesis, muscle function and regulation.
o Magnesium has a role in the production of a bone hormone called parathyroid hormone (PTH).
o Normal levels of PTH results in bone formation.
o High levels of PTH results in calcium loss.
o Low magnesium results in low PTH.

Sources of Magnesium
o Wheat germ
o Almonds
o Flaxseed
o Soya Products
o Fig
o Nuts
o Apples and bananas

VITAMIN D

400 IU/day
o Five to fifteen minutes of sunlight a day guarantees all the essential Vitamin D that you need.
o Fifteen minutes of sunlight a day on fair skin should result in the production of 100-200 units

of Vitamin D3.
o It can increase calcium absorption by up to 65%
o When people on weight loss drugs, which reduces the absorption of fat develop deficiencies of

fat soluble vitamins like Vitamin A, D, E and K.

VITAMIN A

DRI = 700 mgm/day
o Vitamin A is essential in low doses, but in high doses is harmful.
o Recent studies suggest that consuming more than 1.5 mg/day of Vitamin A from a supplement

increases the risk of fracture.
o Vegetarians are at risk of not consuming enough Vitamin A, as found by The Institute of Medical

Panel, U.S.A., as vegetarians have to rely on carrots and sweet potatoes for their Vitamin A

requirements.

VITAMIN K

DRI = 100 -300 mg/day
o Necessary for the body to make the protein Osteocalcin, which plays an important role in binding

calcium crystals in the bone.
o It helps against bone loss in postmenopausal women.
o Vitamin K also appears to play a major role in the healing of fractures.
Food sources:
o Green leafy vegetables
o Whole wheat
o Oats
o Cabbage
o Green Tea
o ZINC

DRI = 12 mg/day
o Low levels of zinc have been associated with Osteoporosis.
o In one study, women with osteoporosis had 30% less zinc in their bloodstream than non-osteoporotic women.
o You must take a varied diet to have all nutrients and minerals instead of supplements.
Food sources:
o Whole grains
o Bran
o Cashew nuts and peanuts
o Pumpkin seeds
o Sesame seeds
o BORON

DRI = 2-3 mcg/day
o Latest studies indicate that trace mineral boron can exercise great influence on Osteoporosis.
o Boron deficiency can hamper calcium metabolism and thereby make the bones brittle. It serves

as a mild form of 'Estrogen Replacement Therapy'.
Food sources:
o Avocado
o Broccoli
o Carrots
o Spinach
o Kidney beans
o Almonds
o Oranges

10 DIET TIPS FOR HEALTHY BONES
o Reduce the animal protein in your diet.
o Reduce the extra salt in your diet. Try to keep it to 2,000 mg/day.
o Reduce food high in saturated fat.
o Reduce caffeine. Switch from regular to decaffeinated coffee.
o Increase vegetables, fruits, legumes, beans, whole grains & green leafy

vegetables.
o Increase calcium-rich foods.
o Increase water intake to 8-10 glasses per day.
o Eat in a relaxed setting. Chew your food slowly and well.
o Stop smoking.
o Reduce alcohol intake.
o Osteoporosis, a condition of decreased bone that increases the likelihood of fracture, places a

significant burden on our society in terms of health cost and morbidity.
o Estrogen deficiency is the most dominant factor in the pathogenesis of postmenopausal

osteoporosis.

Responsible factors:
o Bone loss
o Estrogen deficiency
o Negative calcium balance
o Variety of genetic and environmental factors

The best approach to the management of Osteoporosis is to develop a lifelong strategy that maximizes peak bone mass and minimizes postmenopausal bone loss.

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