Osteoporosis in Women

Dr.Anupama Sonees

Osteoporosis is a disease of bones that causes bones to become weak & break easily. It is most common in older women, but younger women too can get osteoporosis.

Why osteoporosis is common in women? 

 Risk factor of OPS (osteoporosis):-
1.Women have less bone mass than men. Women who have small, thin body are at high risk.

2.Nutritional factors - Women who do not get enough calcium and Vit D are at risk of OPS ,calcium and Vit D work together to build & maintain strong bone. Women who are having eating disorder especially anorexia nervosa can weaken their bone.

3.Sunlight exposure - Sunlight is most important source of vitamin D and stimulates the production of vitamin D3 in the skin. Women who do not expose to sunlight are at high risk of osteoporosis.

4.Mobility or exercise - Women who do not get enough physical activity are at high risk. Women of all ages need to get regular weight bearing physical activity such as walking, dancing, playing tennis to help build and maintain bone density.

5.Hormonal imbalance - post menopausal women are at high risk. After menopause ovaries makes very little of the hormone Estrogen. Estrogen helps to protect bone density. Some women lose upto 25% of bone mass in first 10 years after menopause.

Female who have not got menstrual period for 3 months in a row (called Amenorrhea) means your ovaries have stopped making estrogen. 

6.Medical illness - In Rheumatic diseases like rheumatoid arthritis as well as Rheumatic condition such as Ankylosing Spondylitis (AS), SLE there is increased risk of osteoporosis. In these diseases disease activity, immobility and treatment are factors that increase the risk of osteoporosis and fractures.

- Women who are having health problem that raises risk of OPS like diabetes, IBD, depression, premature ovarian failure.

- Women who take certain medicines to treat long term health problems such as arthritis, asthma, lupus or thyroid, are at risk.

7.Smoking - Women who smoke or chew tobacco have lower bone density and often go through menopause earlier than non smokers.

8.Alcohol - Drinking too much alcohol also causes osteoporosis.

9.Women who have family history of osteoporosis are at high risk. 

Does pregnancy affect bone density? :-

May be, your unborn baby needs calcium to help his/her bone to grow while in womb. Babies get calcium from what you eat or by supplementation you take. If you don't get enough calcium from food or supplementation, your baby will use calcium from your bone. You can lose bone density during pregnancy, but any bone mass lost is restored after childbirth.

Does breastfeeding affect bone density? :-

Yes, women after breastfeeding lose some bone density. But this loss is temporary.

What can happen if Osteoporosis is not treated? :-

It can lead to serious bone fracture, especially hip and spine. Hip fracture can cause serious pain and disability which may require surgery. Fractures can happen after minor falls.

Clinical features -

Clinical features resulting from fractures include pain, disease, quality of life, physical impairment, increased risk of new fractures.

Consequence of hip fracture in women.

a.20 - 30 % mortality within 1 year.

b.20% severely impaired mobility after 1 yr requiring long term nursing care.

c.50% do not regain previous mobility.

Diagnosis -

It is done by measurement of BMD by DEXA is gold standard.

(1) Prevention of Osteoporosis -

Immobilisation is very important cause of bone loss and bed rest quickly leads to destructive bone loss. For this immobility should be avoided whenever possible.

(2) Physical activity -

Exercise such as walking weight bearing aerobics and resistance exercises were reported to have an effect on BMD and muscle strength. They should be encouraged in Osteoporosis.

(3) Prevention of falls -

The prevention of falls is of crucial importance in the very elderly and the strategies targeted to decrease the most common risk disorders, etc.

- Impaired vision

- cardiovascular disease

- History of falls

- Medication (benzodiazepines)

- Cognitive impairment

- Environment (slippery surface, inappropriate shoes, carpets, insufficient light, etc) are recommended.

(4) Calcium and Vitamin D supplementation -

Main nutrient relevant for bone health are calcium, Vit D and protein. Inadequate intake of these nutrients leads to Osteoporosis.

How much calcium do women need each day?

It depends on the age.

  Age                  Dose 

9 - 18 yrs.   -   1300 mg per day

19 - 50 yrs   -   1000 mg per day 

51 & older.   -   1200 mg per day

Pregnant and nursing women need same amount of calcium.

How much Vit D is needed for women each day?

Upto age 70 yrs - 600 IU

71 & older - 800 IU each day.

Pregnant and breast feeding women of the same age amount of Vit D is 600 IU .Women of all age need to take step to protect their bones.