Osteoporosis in Women

 

If you are a woman below 50 years of age or have yet to achieve menopause, it is very unlikely that you have even heard about osteoporosis. You may have come across the term without really paying attention to it. You really should. Osteoporosis in women is more common than you think. Menopausal women are not the only ones affected either. Very young women can also develop osteoporosis.

The lack of awareness about osteoporosis makes it scarier. When you don’t know what’s happening to you, your fear and anxiety alone can aggravate your condition tenfold. You owe it to your health to educate yourself about this prevalent condition so that you are better equipped to deal with it, perhaps even avoid it. So without further ado, let’s get right into what osteoporosis in women is.

Does Osteoporosis Only Occur In Women?

No, osteoporosis occurs in both women and men. However, it is true that women are at a higher risk for developing osteoporosis. More than two-thirds of all people afflicted by the disease are women.

The drastic hormonal changes in a woman’s life because of menstruation, pregnancy, breast-feeding and menopause all contribute to decreasing bone density levels in time.

As if that’s not bad enough, women tend to have lower bone density than men to begin with. Not to mention that they lose density with age faster than men do. From the age of 20 to 80 a women will lose about 1/3 of her bone density. Compare this to the ¼ that men will lose and you can see that women seem to be born with a disadvantage when it comes to osteoporosis.

You will thus find more cases of osteoporosis in women than in men. This is why most information about the disease talks about it in relation to women. Osteoporosis in men affects the sex differently and the treatment options and risk factors will vary a bit too. For now, we will only cover osteoporosis in women, the symptoms of the disease, what factors increase your risk of developing it, the treatment options available to you, and what you can do throughout your life to prevent osteoporosis or at least to minimize the level of damage to your bones.

What is Osteoporosis?

Bones are made up mainly of calcium and a very dense form of connective tissue. They are very hard but very lightweight. Healthy bones can withstand immense pressures because they are very, very strong and quite thick. Osteoporosis, simply put, it is a health condition characterized by weakened bones.

If your bones are healthy, they go through a continuous process of breaking down and rebuilding. The process is a slow one which is why you are not aware of it. However, the process gets much faster with age and by the time most women hit menopause, the loss of estrogen causes the breaking down process to accelerate to a point where the body cannot rebuild fast enough. This causes your bones to get weaker since they are effectively losing more mass as each day passes.

This causes the bones to get brittle and almost porous in composition, which in turn leads to quite a few complications that we will cover in a bit.

Contrary to what you might be thinking, osteoporosis does not affect only menopausal women although the prevalence is higher in that age group. The disease can and does hit women right from the age of 20 if they have any of the risk factors.

Complications of Osteoporosis in Women

Osteoporosis in women means that the afflicted patient is more prone to fractures or massive bone injury in case of a fall or accident. For example, even simply tripping and falling down from a very low height can cause a severe break in the bones. In some cases where the bone mass has reached drastically low levels, even just coughing can cause a fracture in the ribs. There have been cases where twisting the ankle from a slight imbalance has led to ankle fractures.

The most serious complication is a fracture of the hip bone or the spine. Firstly, these cause excruciating pain. Secondly, the only way to fix them is obviously through surgery. This in itself is bad enough as post-operative complications can lead to death. If the patient does survive the operation, there is always the chance of lifelong disability. Sounds terrifying, doesn’t it? It gets worse.

There have been cases of osteoporosis in women where the patients developed spinal fractures even though they had not fallen down or been in an accident or involved in any incident that typically causes bone trauma. In these cases, the bones had weakened to such an extent that they just crumple.

Causes of Osteoporosis in Women

As we have already seen, it is rapid acceleration of bone deterioration that leads to osteoporosis in women. The extent to which your bones will deteriorate will greatly depend on your peak bone mass. Now what does that mean?

Early bone development is closely related to bone problems later in life. At 18, women achieve the highest level of bone mass they every will in life. This is known as peak bone mass. After that and until the age of 30, they will still continue to gain bone mass but the amounts are negligible. Post-30, there is no longer any increase in bone mass at all. So as you can deduce, it is better to adapt a lifestyle for healthy bones in childhood itself so that optimal bone mass can be achieved by 18.

Some women develop osteoporosis even if they had satisfactory or high peak bone mass. This is usually the case when other risk factors for the disease are present.

Risk Factors for Osteoporosis in Women

• If your mum or dad or any of your siblings had osteoporosis, it is very likely that you will either have low peak bone mass or develop osteoporosis later in life even if your peak bone mass was normal.
• Are you too thin or have you been relatively underweight your whole life? Then you are at a higher risk of developing osteoporosis.
• Women who smoke are a higher risk of developing osteoporosis than those who do not.
• Women who have irregular periods or start menstruating too early are at higher risk for osteoporosis. Such irregularities in the menstrual cycle indicate a hormonal problem. And hormonal problems can greatly affect bone density. Studies have shown that those who have irregular periods actually have less bone mass as well as weaker bones than those who have normal periods.
• Since changing hormonal levels have a profound impact on your bones, menopausal women are at a very high risk for osteoporosis. In fact, more than 60% of all menopausal women will develop osteoporosis to some extent if they do not take care.
• Any inflammation of the bones, as would be true in the case of rheumatoid arthritis, raises the risk of osteoporosis.
• Your nutrition has a great impact not just on bone density but also on your body’s ability to fight off disease. It stands to reason then that a lack of proper nutrition will definitely increase your chances of developing osteoporosis. Calcium and vitamin D in particular are required for bone strength. It cannot be just one or the other; it has to be both together. Calcium for obvious reasons as your bones are made of calcium and it can thus help to replenish any calcium that is lost during bone deterioration, and vitamin D is required because the body needs it to absorb calcium properly. So if there is a lack of either, it reduces bone strength which in turn increases your risk for osteoporosis.
• Women or young girls who suffer from eating disorders such as bulimia or anorexia are at heightened risk of osteoporosis. Not just are these women getting less or no calcium and vitamin D, their bodies are not getting much of any other nutrition either.
• Lack of exercise or exercising too much can both increase your risk for osteoporosis.
• A sedentary lifestyle increases the risk of osteoporosis.
• Women who suffer from certain medical problems such as depression, hyperthyroidism and digestive issues generally, not always, have lower peak bone mass. So their risk of developing osteoporosis is much higher.
• Thyroid disorders in particular put women at higher risk for osteoporosis since the thyroid glands are responsible for hormonal levels in the body and we have already seen that a hormonal imbalance can greatly affect bone mass.
• Certain medications can also cause osteoporosis in women. Some steroids which are used to treat asthma are known to raise the risk of osteoporosis in women. Other medications that prevent bones from rebuilding include those that are used to treat cancer, seizures, gastric reflux and depression.
• It has been discovered in recent times that some oral contraceptives deplete bone mass. A major example is Depo-Provera – a very popular contraceptive which is widely used by women across the world.
• Very high levels of vitamin A have also been linked to osteoporosis in women. However, it is only osteoporosis from meat sources that have been found to have an impact on bone density. Vitamin A from plant sources is OK.
• The older you get, the higher your chances of developing osteoporosis. This is not only because of menopause but also because bones lose density with age.
• Caucasian and Asian women are at higher risk of osteoporosis than women of other races.
• Women who have petite or small frames are also at higher risk of developing osteoporosis because their small bodies mean that there is less bone mass to begin with.

Symptoms of Osteoporosis in Women

It is not that easy to diagnose osteoporosis in women early as the symptoms show up only when the disease has progressed to quite an extent. Event then, the symptoms can be quite generic and easy to miss.

There are no symptoms in the early stages. Only when the bones have already gotten weak will there be any signs to alert you to the problem.

• Back pain can be a symptom of osteoporosis in women.
• Over time, the person afflicted by osteoporosis may lose height.
• Because of the weakened bones, the patient may develop a stoop or a hunch.
• In most cases, osteoporosis is only suspected after a light fall results in an abnormally serious fracture.

As you can see, these symptoms of osteoporosis in women can be attributed to old age, bad posture or the regular aches and pains that accompany modern lifestyles. This is why it is important to take preventive measures as well as to undergo regular tests to keep track of your bone density, especially if you are at high risk for osteoporosis.

Treatment for Osteoporosis in Women

The treatment for osteoporosis in women will differ from woman to woman depending on the severity of the condition in each. For example, you may be taking the same medication as someone else with osteoporosis but you might be popping a pill once a week while the other person is only required to do so once a month. Do not self-medicate and do not change your dosage without first consulting your doctor.

One of the main medications that are prescribed for treatment of osteoporosis in women is bisphosphonates such as ibandronate, alendronate, zoledronic acid and risedronate. Bisphosphonates are drugs that prevent bones from losing more mass than they already have. They also strengthen bones and help reduce any pain that may develop as a part of the condition.

Remember that breaking down and rebuilding of bones we talked about earlier? And how the breaking down process accelerates when you have osteoporosis?  Bisphosphonates effectively slow down the process again. Another reason that bisphosphonates are prescribed is because they have proven to be very good at preventing fractures in case of a fall. The side effects of bisphosphonates are minimal – just heartburn and, in some cases, stomach trouble. These can be avoided by taking the medicine on an empty stomach as well as staying upright for the next hour so that the medication does not ride back up into your esophagus.

The second main medications that will be prescribed for treatment of osteoporosis in women is hormones. Since the main cause of the accelerated breakdown of bones is the plummeting levels of hormones in the body, the process can be halted to an extent by replacing the lost hormones. Estrogen and raloxifene are two of the main hormones which have been approved by the FDA for the treatment of osteoporosis in women.

Be warned though that estrogen replacement has been linked to increased risk of some types of cancer as well as heart disease. So discuss this in detail with your doctor before going down this road.

With any disease or health condition, medication will only partly help. The other half of the treatment involves a lifestyle change. Nothing radical, just the regular common-sense advice that we all know we should be following.

• Exercise – Physical activity increases the strength of your bones. Weight-bearing exercises in particular are known to help your bones to get stronger as well as improve your balance, the latter as important as the former since it will prevent falls.
• Eat healthy – Get your recommended allowance of calcium and vitamin D from the foods you eat. Maintain a balanced diet and a healthy weight. The heavier you are the more stress there is on your bones. Losing even 5% of your body weight if you are obese can help relieve the stress on your bones.
• Don’t crash diet – Crash dieting will indeed lead to rapid weight loss. However, your body still needs nutrition to survive during the time that you are depriving it of food. It partly leeches this nutrition from the calcium and other minerals stored in your bones, thus reducing bone density and making your bones weaker.
• Quit smoking – Some types of cigarettes increase the rate at which your bone loses density. Smoking has long been a risk factor for many other diseases as well so you will be doing yourself a huge favor in the long run if you quit the nasty habit.
• Drink less alcohol – If you must drink, limit yourself to one drink a day. The less the better.

Prevention of Osteoporosis in Women

You can never start building strong bones too early in life. It’s never too late either. If you have not yet been diagnosed with osteoporosis then you still have a chance to start taking care of your bones.

• Limit your intake of vitamin A to plant sources carrots and sweet potatoes.
• Avoid getting your vitamin A from animal sources such as liver and eggs.
• Increase your intake of calcium-rich foods and vitamin D. A few good examples are green, leafy vegetables, tofu, soy, cereals, dairy and juices. You can get your daily dose of vitamin D by stepping out into the sunlight for about half an hour early in the morning. Or you can ask your doctor to prescribe vitamin D supplements.
• If you have started experiencing the symptoms of menopause, then hormone replacement therapy can help to prevent the development of osteoporosis. It’s a case of putting a brake on the deterioration process before it begins.
• Get routine x-rays as they can help your doctor keep a track of your bone density. This applies to women of all ages.
• If you have hormonal problems, are at high risk for osteoporosis or are nearing menopause, then ask your doctor about prescribing bisphosphonates as these can help to maintain bone mass and slow down the inevitable deterioration of your bones.
• If you are using oral contraceptives, discuss with your doctor whether it is linked to lower bone density.
• Depo-Provera should not be used for more than two years in a row. There are so many other forms of contraception that it is smarter to just go with one of the other options in the first place and avoid Depo-Provera altogether if possible.
• Do weight-bearing exercises regularly to increase bone strength and bone mass.
• Other exercises that elevate bone density levels include running, jumping, walking and swimming.
• Limit your intake of caffeine and alcohol.
• Quit smoking.

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