Osteoporosis and Menopause

Happy Thanksgiving! This month is the time that we start to feel a chill in the air in South Carolina. However, it’s usually warm enough that I’ve spent more than several Thanksgivings on the back porch with all my family, having a wonderful meal. The topic this month is, as above, Osteoporosis and Menopause. Most of us have someone in their extended or immediate family who has this illness. Osteoporosis is a disease that weakens bones, increasing the risk of sudden and unexpected fractures. Literally meaning "porous bone," osteoporosis results in an increased loss of bone mass and strength. The disease often progresses without any symptoms or pain in most people. A lot of the time, osteoporosis is not discovered until weakened bones cause painful fractures, usually in the back or hips. Once you have a broken bone due to osteoporosis, you are at high risk of having another. And these fractures can be debilitating. Fortunately, there are steps you can take to help prevent osteoporosis from ever occurring and treatments that can slow the rate of bone loss if you already have osteoporosis.

What Causes Osteoporosis?

Though we do not know the exact cause of osteoporosis, we do know how the disease develops. Your bones are made of living, growing tissue. An outer shell of cortical or dense bone encases trabecular bone, a sponge-like bone. When a bone is weakened by osteoporosis, the "holes" in the "sponge" grow larger and more numerous, weakening the internal structure of the bone.

Until about age 30, a person normally builds more bone than he or she loses. During the aging process, bone breakdown begins to outpace bone buildup, resulting in a gradual loss of bone mass. Once this loss of bone reaches a certain point, a person has osteoporosis.

How Is Osteoporosis Related to Menopause?

There is a direct relationship between the lack of estrogen during perimenopause and menopause and the development of osteoporosis. Early menopause (before age 45) and any prolonged periods in which hormone levels are low and menstrual periods are absent or infrequent can cause loss of bone mass.

What Are the Symptoms of Osteoporosis?

The most common cause of osteoporosis pain is a spinal compression fracture. It can cause:

• Sudden, severe back pain that gets worse when you are standing or walking with some relief when you lie down
• Trouble twisting or bending your body, and pain when you do
• Loss of height
• A curved spine called kyphosis, also known as a “dowager’s hump.”

Bones are fragile in osteoporosis.  Fractures can happen even from simple movements that don't seem dangerous, for example lifting a bag of groceries, twising to get out of a car, or tripping slightly on a rug.

Fractures can take months to heal. The pain should start to go away as the bone begins to repair itself. However, for some people, osteoporosis pain can last longer. Osteoporosis is often called a "silent disease" because initially bone loss occurs without symptoms. People 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 stooped posture.

Who Gets Osteoporosis?

Important risk factors for osteoporosis include:

• Age. After maximum bone density and strength is reached (generally around age 30), bone mass begins to naturally decline with age.
• Gender. Women over the age of 50 have the greatest risk of developing osteoporosis. In fact, women are four times more likely than men to develop osteoporosis. Women's lighter, thinner bones and longer life spans account for some of the reasons why they are at a higher risk for osteoporosis.
• Ethnicity. Research has shown that Caucasian and Asian women are more likely to develop osteoporosis. Additionally, hip fractures are twice as likely to occur in Caucasian women as in African American women. However, women of color who fracture their hips have a higher mortality.
• Bone structure and body weight. Petite and thin women have a greater risk of developing osteoporosis in part because they have less bone to lose than women with more body weight and larger frames. Similarly, small-boned, thin men are at greater risk than men with larger frames and more body weight.
• Family history. Heredity is one of the most important risk factors for osteoporosis. If your parents or grandparents have had any signs of osteoporosis, such as a fractured hip after a minor fall, you may be at greater risk of developing the disease.
• Prior history of fracture/bone breakage.
• Certain medications. The use of some medications, such as the long term use of steroids (like prednisone) can also increase your risk of developing osteoporosis.
• Some medical conditions including cancer and stroke may increase your risk for osteoporosis.

How Do I Know if I Have Osteoporosis?

A painless and accurate test can provide information about bone health and osteoporosis before problems begin. Bone mineral density (BMD) tests, or bone measurements, are X-rays that use very small amounts of radiation to determine bone strength. A bone mineral density test is indicated for:

• Women age 65 and older.
• Women with numerous risk factors.
• Menopausal women who have had fractures.

The best thing to do if you suspect you have osteoporosis is to make an appointment to come in to see us at Palmetto Endocrinology. The pain from this illness is usually more severe than the aches many people feel as they get older. But you don’t have to just grin and bear it. You and your providers here at Palmetto have a range of options to choose from to help you find relief.

Author

Joseph Mathews, MD, FACP, FACE, ECNU, CCD Joseph W. Mathews M.D., a board certified Endocrinologist and Medical Director of Palmetto Endocrinology, was born and raised in South Carolina. He earned his Bachelor of Science in Biology from the College of Charleston, Cum Laude. He then achieved his M.D. at the Medical University of South Carolina where he also completed his residency in Internal Medicine and a Fellowship in Endocrinology, Diabetes, and Metabolism. Dr. Mathews is also a Fellow of both the American College of Endocrinology and the American College of Physicians, holds an Endocrine Certification in Neck Ultrasound (ECNU) and is a Certified Clinical Densitometrist (CCD). He has extensive experience performing ultrasound guided fine needle aspiration biopsies. His practice includes a range of specializations including prescribing and fitting patients with insulin pumps. Dr. Mathews' practice has drawn patients from out of state to benefit from his expertise in thyroid disorders, diabetes, cortisol problems and their Endocrine disorders.