What is it?
A disease in which bones become fragile and more likely to break.
Breaks usually occur in the hip, spine and wrist

What causes osteoporosis?
Scientist have not yet learned all the reasons this occurs.
When you are young your body makes new bone faster than it breaks down old bones.
As you get older, this process slows down and you start losing bone density.
The risk for osteoporosis depends on how much bone mass you attained between ages 25 and 35 and how fast you lose it.

Risk Factors
Anorexia nervosa or bulimia
Diet low in calcium
Use of certain medications
Low testosterone levels in men
An inactive lifestyle
Cigarette smoking
Excessive use of alcohol
Being Asian or Caucasian

Bone Health
Bones are living tissue, they provide structural support, protect vital organs and store calcium.
Until age 30, we store and build bone effectively.
As part of the aging process, bones begin to break down faster than they are formed.
Accelerates after menopause. Estrogen is the hormone that protects against bone loss.

Bone Mass Density
The National Osteoporosis Foundation
Recommends you have a BDT if:
You use medications that cause osteoporosis
You have type I diabetes, liver disease, kidney disease or a family history
You experience early menopause
You’re postmenopausal over 50 and have at least one risk factor.
You’re postmenopausal over 65 and never had a test.

Calcium
Is needed for heart muscles, and nerves to function properly.
Inadequate amounts contribute to osteoporosis.
Appropriate calcium intake falls between 1000 and 1300 mg a day

How to get enough Calcium every day!
Follow the Food Guide Pyramid
for Dietary Calcium Sources
Dairy- low fat yogurt, skim milk, cheese, chocolate pudding, ice milk, ice cream or frozen yogurt.
Protein- tofu, sardines, salmon
Vegetables- turnip greens, Bok Choy, Broccoli, collard greens
Other foods: vegetable lasagna, cheese enchilada, cheese pizza, calcium fortified orange juice.

Exercise
Exercising regularly in childhood and adolescence can ensure that you will reach peak bone density.
Need to participate in weight bearing exercise. For example, walking, dancing, jogging, stair climbing, racquet sports and hiking.

Medications
There is no cure, but several medications have been approved.
Each stops or slows bone loss, increases bone density, and reduces fracture risk.
Estrogen Replacement,
Alendronate,raloxitene and risedronate are prescribed to prevent and treat the disease.

Bone-Building Checklist
Maintain a calcium rich diet.
Get plenty of vitamin D
Engage in weight-bearing exercise
Don’t smoke and limit alcohol intake
Consider Hormone Replacement or other medications if you are at risk.

• Menoupause is the final menstruation marking the termination of menses (defined as 6 months of amenorrhea)
• Menopause is preceded by the climacteric or perimenioausal period the multiyear transition from optimal menstrual condition to menoupause
• The postmenopause period is the time after menopause

Factors affecting age of onset

Genetics

• Smoking (decreases age by 3 years)
• Chemo / radiation therapy

Physioology during the perimenopausal period

Oocytes die

Women’s immature eggs, or oocytes, begin to die precipitously and become resistant to follicle-stimulating hormone (FSH),  the pituitary hormone that causes their marturation

• FSH levels rise for two reasons :
  1. Decreased inhibin (inhibin inhibits FSH secretion; it is produced smaller amounts by the fewer oocytes)
  2. Resistant oocytes require more FSH to successfully mature, triggering greater FSH release

Ovulation becomes less frequent

Women ovulate less frequently, initially one to two fewer times per year and eventually just before menopause, perhaps once every 3 to 4 months. This is due to shortened follicular phase. The luteal phase does not change.

Estrogen levels fall

Estrogen levels begin to decline, resulting in hot flashes (may also be due to increased luteinizing hormone) Hot flashes usually occur on the face, neck and upper chest and last a few minutes followed by intense diaphoresis.

Physiology during the menopausal period

Levels of androstenedione fall, a hormone that is primarily produced by the follicle.

• Ovaries increase production of testosterone which may result in hirsutism and virilism
• Decrease in estradiol level and decrease in estrone level
• FSH and LH levels rise secondary to absenece of negative feedback.

Treatment of the adverse effects of menopause

Hormone replacement therapy or estrogen replacement therapy has been shown to counteract the complications of estradiol loss.

Estrogen replacement therapy

Indicated in women status post hysterectomy.

Hormone replacement therapy

The progesterone component is needed to protect the endometrium for constant stimulation and resultant increase in endometrial cancer. It is indicated for women who still have their uterus.

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