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Osteoporosis in Women and Current Research

Osteoporosis in Women

Osteoporosis is a disease of the bones, and the most common worldwide. It causes decreased bone mass, the bones become more porous increasingly over time, plus the spaces or cavities inside become fragile, this withstanding less of the blows and easily fracturing. This disease has been defined as the widespread skeletal disorder, characterized by low bone mass and deterioration of bone microarchitecture.

Osteoporosis can be classified as primary (occurs in both sexes and in all ages, although it is more represented in women who have gone through menopause and in older men) and secondary (it is a product of drug treatments, or some intercurrent disease, or alcoholism). Causes of secondary osteoporosis can aggravate and accelerate bone loss. Unfortunately, these fractures mostly occur at an already advanced stage of the disease, because it is a silent disease. When it is quite advanced, bones become brittle, and even with a simple fall or a simple tension, such as bending or coughing, fracture. The most common fractures are those of wrists, vertebral, and hips and the latter are of great importance because of the consequences that it brings with it. The patient has to be hospitalized, surgically intervened, and pass a period of recovery that causes a loss of quality of life for the patient and family members. Even if the recovery is short, not to mention that there are patients who do not fully recover.

Osteoporosis can develop in two ways. You may lose too much bone, or your body may not form enough bone, some people have both problems. This disease affects all races and sexes, although the highest incidences are from the female Caucasians and Asians ethnicity, (women have less bone mass than men, tend to live longer than men, and when estrogen levels fall it accelerates bone mass erosion). Although there may be patients occur off other races, male and female sexes who have not passed the menopause stage, but they a smaller amount.

Hence, a great deal of attention is paid to habits related to raising the quality of life of the bone system, such as calcium intake either by absorbing dairy products, physical exercises, and the elimination of smoking. Proper calcium intake varies by age and gender, for this, medical monitoring is necessary for the proper amounts. Vitamin D is also essential for bone conservation, most people need about 800 international units (IU) of vitamin D every day. This vitamin allows the body to absorb calcium. Vitamin D can be obtained from the sun, food, and supplements and is formed primarily through the skin when it receives sun radiation appropriately.

When the disease is at an advanced stage, you may have several symptoms. The most common being: back pain, which in most cases can cause one or more compressed or fractured vertebrae, gradual loss of height, unexpected bone fracture and hunched posture.  Patients who have taken corticosteroids for several months or who have suffered hip fractures should go to the doctor for checkups. Bone density can be measured with advanced technology called dual-energy radioabsorciometry (DEXA). A scan is performed on the patient’s body, analyzing some bones, usually those of the hip and spine. They test the mineral levels in the bones.

Early interventions, medical treatments, and lifestyle conditions are very important, but there are higher risk factors that are unalterable and you can’t control them; such as:  sex, race, age, family history, (genetic factor, especially if they have suffered hip fractures from the mother or father) and height (small people being shorter their bones have less bone mass to cope with old age).

Treatment of Osteoporosis depends on the results of the bone density test, if the risk of fractures is not high it is not necessary to medical to the patient, but if the risk of bone fractures is high, the treatment focuses on modifying bone loss and avoiding fractures; the most common medicines are Biophosphonate, (Zoledronic Acid, Alendronate, Ibandronate, Risedronate). These medication’s side effects include heartburn-like symptoms, nausea, and abdominal pains, hence the importance of strictly following the dosage recommended by your doctor. If these medicines are incorporated intravenously, the patient does not suffer stomach damage, but the first three days, they can cause headache pains, muscle aches, and fever. Intravenous treatment is scheduled for a quarterly or annual injection as the disease progresses. While orally it is recommended to take a weekly or monthly tablet and may be more expensive. There are other bone-strengthening medicines that are mainly used if there is intolerance to the treatment or if it is not effective, such as Teriparatide (Forteo). This powerful drug is like parathyroid hormone and stimulates bone growth. A daily injection is used under the skin. After two years of treatment with teriparatide, another medicine is indicated to maintain bone growth. Abaloparatide (Tymlos) is another parathyroid hormone-like medicine. You can take it for only two years, after which your doctor will guide you, to other medications, such as, Calcitonin. This is a hormone that slows down bone loss. It is available as an injection or nasal spray. Side effects of the injection may be diarrhea, stomach pain, nausea, and vomiting. Side effects of nasal spray may include headache and irritation of the nasal mucosa. Other option is Raloxifene, helps prevent and treat osteoporosis in women. It also increases bone density. Side effects include suffocations and the risk of blood clotting. Another drug is Teriparatide, which contributes to bone formation. It is a synthetic form of parathyroid hormone, and both men and women can use it. It can be given by injections. It is injected into the thigh or stomach once a day. Common side effects are nausea, stomach pain, headache, muscle weakness, tiredness and loss of appetite. Another option is Romosozumab (Evenity), this medicine is newer. It is given by injection and only in the doctor’s office and it is limited to one year of treatment, and as in the previous cases the results are indicated in another medicine.  All medications to treat osteoporosis have the ability to slow down or even reverse the progression of the disease and help prevent bone fractures.  There is no absolute cure for the disease, but if you can change lifestyle habits especially from the age of 25, consult with your doctor if you have any genetic records, modify your, exercise periodically and avoid falls


Current Studies

“Reasons for not treating women with postmenopausal osteoporosis with prescription medications: physicians’ and patients’ perspectives.” Written by Weaver JP, Olsson K, Sadasivan R, Modi A, Sen S. (2017) is important in the study of osteoporosis.

The background of the study includes: In the United States of America, between one-third and two-thirds of postmenopausal women diagnosed with osteoporosis do not begin treatment with a prescription drug for the disease. The objective of the study was to understand the reasons why they refuse to do so.

In the study, researchers looked at: Online physician and patient surveys were conducted in 2013. The survey included a list of recently diagnosed postmenopausal women who did not have treatment for osteoporosis and data from physicians for the subject in question

The results show: the medical survey was completed by 224 Physicians and 811 patient letters were reviewed, a total of 165 patients completed the patient survey. Among the most common reasons for Physicians not recommending treatment were: Low calcium and/or vitamin D levels, pre-existing gastrointestinal problems, polypharmacy and patients potentially at risk from drug side effects. Patients’ reasons for refusing treatment for this disease after diagnosis were concerns about side effects, considering other over-the-counter options, behavioral modifications, and questioning the potential benefit of receiving medications

The conclusions of the study showed that: patients decided not to receive drug treatment for newly diagnosed osteoporosis in at least 50% of cases, the most common reasons given by Physicians and patients were that they had other alternatives and concern about the risks of consuming prescription drugs.

Another study important to the field is “Physical activity-does it really increase bone density in postmenopausal women? A Review of Articles Published Between 2001-2016.” written by Segev D,Hellersteint D, Dunsky A (2018).

The background of the study includes: Physical activity has many health benefits including the positive effect on bone health over the life cycle. In the first stage of life during childhood the physical stress stimulates bone remodeling and increases density, but due to hormonal changes during adulthood and mainly postmenopause the rate of bone remodeling slows down and is less efficient.

The objective of the study was: Examine the effectiveness of physical activity to improve bone mineral density (BMD) in women after menopause based on literature review

The methods include articles from three databases (PubMed, SPORT Discus with full text, and Science Direct) were reviewed. Only publications with bone mineral density studies clearly affected by the physical activity of women of menopause age were used. Twelve articles met these above criteria.

The results showed that: Physical activity had a positive effect on bone mineral density. Exercise prevented bone loss and, in some cases, contributed to the increase in bone loss.

The conclusions of the study showed that: Physical activity can significantly improve bone mineral density in postmenopausal women, but the exact type of activity, as well as intensity, duration, and frequency are not yet clear. More studies are needed to know which type of training is right for postmenopausal women.


Patient Experience

Family member A, who is currently 76-years-old, and diagnosed at age 56-years-old, had an early menopause at age 38-years-old. From the age of 45 years old approximately, started with back pain. At first doctors told her they were occurring due to age. The pains deepened until it began to increase, at that time not much was known about the disease, one day while having a conversation with a relative she went to rest her hands on the table, and felt a very severe pain; her wrists fractured. She went to the hospital immediately and doctors ordered a densymmetry where the results were low and an X-ray that indicated that. She had suffered a fractured vertebra and was corrected only because the shape of the vertebrae indicated that. Treatment began and the doctors’ first recommendations were to remove all the obstacles from the house that she could trip and fall from. Unfortunately, 10-years-ago she suffered a fall and had a hip fracture.they used prosthetics and rehabilitation for her to be able to walk again. It has been 1 year and currently she can walk only on crutches. She never smokes, she never took drugs, or alcohol, but she used many medications of cortisone for asthma when she was very young.

The other case is a friend of family member, she is a woman, she only has 27 years old , anorexic during adolescence and smoker, was hospitalized twice because of this disease and one of the times she was in the hospital when she was only 17 years old, she had the densymmetry and X-rays and osteoporosis (low bone mass with high probability of fracture), as it was hunched into the back and the mouth began to deform, many cavities and teeth loose. The medications you were prescribed for life are calcium and Vitamin D supplements and the diet with lots of dairy and the meat has to grind it because it causes you to chew it, all your daily activities make them walking because she noticed that they decrease the pain


Reference

 

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