BONE HEALTH IN AGING

We all know that bone health is one of the most neglected factors in our daily routine life, especially in older individuals. As one grows out of childhood, bones acquire bone mass, which gives strength to the bone. This continues till 30 years of age, after which there is continuous decline in bone strength and mass. In women, post-menopause (cessation of menstruation) there is sudden and rapid decline in bone mass, which lead to increased frequency of osteoporosis in them. However, after 70 years of age, both men and women are at equal risk of developing osteoporosis.

What are the reasons for osteoporosis?

There are few common causes that lead to osteoporosis:

1. Menopause is an important cause of osteoporosis. Due to loss of protective estrogens there is rapid bone loss and women with premature ovarian failure at young age develop it to a greater extent.

2. Inadequate intake of vitamin D and calcium. Studies have shown that vit. D deficiency is rampant in India and that leads to calcium loss and bone demineralization, as calcium is not available through meals

3. Lack of physical activity leads to decrease muscle bulk and increase bone Calcium loss. Hence, regular exercise schedule is must to prevent osteoporosis.

4. Smoking and alcohol intake are detrimental to bone health and lead to increase chances of fracture.

5. Other endocrine disease, bone related diseases and chronic medications like steroids may lead to decrease in bone mass and increase fracture risk.

How can it be diagnosed?

Osteoporosis might stay hidden have till there is a fracture. While vertebral fractures are common, patients may present with complain of backache, forward stooping of back or with more severe hip fracture, which increase risk of death in person and cause movement restriction. Hence, the recommendation that every woman more than 65 years of age and men more than 70 years of age should under go testing for osteoporosis using a DEXA Scan of hip and spine which may detect incidental fractures also.

What are the treatment options available?

Treatment is simple

• Adequate physical activity 
• Nutritious food rich in vitamin D and calcium  
• Lifestyle modification: Quitting smoking and alcohol is of utmost importance.
• Women with early menopause (before 40 years) should be treated with hormone replacement therapy to prevent bone loss in consultation with their treating expert.
• Medication: both oral and injectable forms are available. But drugs have their side effects and should be taken under supervision of endocrinologist.

Is it possible to prevent osteoporosis?

A healthy lifestyle, and regular intake of calcium and vitamin D starting from younger age group helps in achieving a good bone mass and prevention of osteoporosis.   

Dr Vineet Surana

MD, DM Endocrinology

Consultant Endocrinology

Metro Heart Institute and Hospital

Delhi.

GUIDE TO A HEALTHY MENOPAUSE

There are three important hormonal milestones in any woman’s life cycle: 

• Puberty 
• Pregnancy 
• Menopause. 

Puberty and pregnancy are instrumental in defining womanhood. These hormonal events are responsible for continuation of mankind and make women biologically distinct and superior to their male counterparts. This positive hormonal balance continues till age of 45 to 55 years and comes to an end at, what we call, menopause.

Why this discussion about Menopause?

Menopause is an important milestone in any woman’s health cycle. Female hormones viz. estrogens and progesterone are responsible for maintaining cyclical menstrual bleeding and thus fertility in women. These hormones, especially estrogen, have been shown to have a tremendous positive impact on health of other organs like bones, heart and brain. At menopause, secretion of these hormones gets halted. This predisposes the women towards poor health outcome in form of disruption in sex life, osteoporosis (weak bones), heart problems and also increased risk of dementia (decreased thinking power).

How do you identify impending menopause?

Menopause happens usually between 45 and 55 years, but, the average age of menopause is 51 years. In general, you can expect to have menopause at approximately same age as your mother or sister had., Changing hormonal milieu can lead to some of the symptoms of menopause even years before you stop having menstrual periods. The most common symptoms are irregular periods, hot flashes, night sweats, mood changes, sleep problems, and vaginal dryness.

Can we discuss Hot-Flashes in little detail?

Hot flash:

Hot flashes are experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from two to thirty minutes, ending with chills and shiver.  The sensation of heat usually begins in the face or chest and it can spread throughout the whole body. Hot flashes may be associated with a feeling of anxiety or heart palpitations during the hot flash. The hot-flashes may happen few times each week or every few minutes throughout the day. Hot flashes are often more frequent and more intense during hot weather or in an overheated room. When hot flashes happen during sleep, they are called night sweats.

Does every woman with menopause needs treatment?

Menopause is a normal physiological event in any woman’s life. In view of positive impact of female hormones on all body function, there had been a great enthusiasm towards treating every woman with these hormones in past. But, recent studies have suggested that benefit of this treatment is not uniform and great and may even harm woman. But, this does not mean that a woman with menopausal symptoms have to suffer. We have safe and established treatments to alleviate these symptoms and thus improving quality of life during menopausal transition. Even hormonal replacement for short term periods has been shown to be safe. But, individualization of treatment is of paramount importance in management.

Apart from symptomatic management, what are the health issues requiring specific attention?

Heart and Bones. 

Osteoporosis is one issue, importance of which cannot be overemphasized. Every woman should get a DXA scan (bone density test) done ten years post menopause and get it evaluated by their hormone specialist (Endocrinologist). As diabetes is becoming more prevalent in our society, heart problems in post-menopausal age are becoming more and more common. So getting your blood sugars and cholesterol tested would be good idea. Another health issue which should not be overlooked is depression and anxiety. 

All these little things can help you to continue your life as before. 

Happy Menopause to you.

Dr Rajiv Singla

HOD and Consultant, Endocrinology Department

Kalpavriksh Superspeciality Clinic & Saket City Hospital

www.kvsc.in