Osteoporosis and Osteopenia
Menopause is recognized for a number of changes in health, including More bone loss. Research shows that some women experience a more rapid thinning of bones when the body stops making estrogen. The risk to your bones does not really increase until you are IN menopause.
Entering menopause is marked by the periods stopping. Some women begin getting (or getting worse) hot flashes. Others have symptoms of menopause during the transition into menopause. We can do a blood test to prove if you are in menopause, or not. Your FSH level (follicle-stimulating hormone) goes UP in menopause. Sometimes we test for low estrogen too. The FSH is a more reliable test than an estrogen level.
Women with risk factors are considered at higher chance of getting thin bones. Risk factors include:
- Thin bones today
- Mother or sister with thin bones that broke
- Low body mass index (being skinny)
- Lack of exercise
- Smokers and heavy drinkers of alcohol
- Being Caucasian or Asian
- Reaching menopause before age 45
Bone Mineral Density Testing
There is a test to measure how thin the bones are. This DEXA scan measures the bones of the hip and lower spine. Your score is a comparison to the bones of an average 25 – 30 year old woman.
- A “T score” of -1.0 to -2.5 is indicative of osteopenia, thin bones but NOT osteoporosis.
- A “T score” below -2.5 is diagnostic of osteoporosis.
- The risk of breaking a bone because it is too thin goes UP as the T score gets lower into the negative.
- Treatment is usually recommended for women with T scores more negative than -1.5 to –2.0 WITH risk factors, and more negative than -2.0 to -2.5 for women WITHOUT risk factors.
If bone density is NOT in the treatment range, testing can be repeated every 3-5 years. Medicare does not allow BMD (bone mineral density) testing sooner than 2 years. Everyone agrees that women OVER 65 should have DEXA scans. Most agree that menopausal women WITH risk factors should be tested in menopause and before age 65. The government, as explained in the USPSTF (US Preventive Services Task Force) guidelines does NOT suggest BMD testing before age 60, even with risk factors.
Postmenopausal women working for bone health should:
- Take 1200 mg of elemental calcium each day, and NOT MORE than 2500 mg each day
- Take 400 to 800 IU of vitamin D each day, and NOT MORE than 2000 IU each day
- STOP smoking
- Drink alcohol in moderation
Medications to Prevent (and treat) osteoporosis:
- Fosamax (alendronate) 5 mg daily, or 35 mg weekly (10 and 70 for treatment)
- Actonel (risedronarte) 5 mg daily, or 35 mg weekly
- Evista (raloxifene) 60 mg daily
- Boniva (ibandronate) 2.5 mg daily (approved by FDA, but not sold, yet)
- Estrogen* (must be used with caution)
Learn more at these web sites:
- National Osteoporosis Foundation – http://nof.org/
- North American Menopause Society – http://www.menopause.org/
- CDC.gov – http://www.cdc.gov/nutrition/everyone/basics/vitamins/calcium.html
Hormone Replacement Therapy
Menopause is the natural change in ovarian function. One of the most obvious symptoms of the menopause is hot flashes. Hormone replacement therapy (HRT) in menopause can treat hot flashes AND keep bones healthy and strong.…[read more]
What you should know about keeping your heart healthy during this transition in life…[read more]
When you desire a solution for your libido, there are options…[read more]
Estrogens and Progestins
Once the decision is made to treat your hot flashes with estrogen, the question is which one? Estrogens may differ in how you take them, but your body does not really know the difference in terms of treating the hot flashes…[read more]