H E A LT H
OSTEOPOROSIS:
BONE HEALTH FOLLOWING MENOPAUSE
T
ypically strong and resilient
embolism), heart attacks and
TREATMENT
in childhood, bones have
strokes. 20-35% of sufferers aged
The available treatments
a dense, ivory-like outer
75 to 90 years die within 12 months
to reduce risk of fracture
casing or cortex, enclosing an
of fracturing their hip joint, around
act in different ways, either
inner core (also known as medulla)
80% of whom are women.
of soft marrow filling up the gaps
to reduce resorption or to increase formation of bone.
and spaces of the spongy interior.
DIAGNOSIS
Like all living tissue, bone is able
A dual-energy X-ray
to absorb and utilise a range of
absorptiometry (DEXA) scan
reduce the resorption of bone as it
proteins and mineral salts from
provides the gold standard means
normally occurs. The best-known,
the bloodstream for renewal
of diagnosing osteoporosis. It
sodium alendronate, is known to be
and repair. Bones generally stop
expresses bone mineral density
very effective at preventing bone
growing in length after the age of
in terms of standard deviations
loss but tends to irritate the food
16 to 18 years, but their density and
(a statistical unit) below that
pipe (oesophagus). It is given once
strength increase until the late 20s.
of a young adult reference
a week on an empty stomach, and
population. The unit used is
the patient is advised to remain
onwards, however, bones become
presented as a T-score, and the
upright for an hour after taking it.
weaker and more fragile due to
World Health Organisation (WHO)
It often causes heartburn, however,
a loss of mineral salts. This loss
has established the following
and many patients cease to take
intensifies in women as their
guidelines:
it for this reason. Other types of
oestrogen levels fall, peaking at
• T-score of 1 or greater = normal
bisphosphonates are available.
menopause when the production
• T-score between -1.0 and -2.5 =
From the age of around 35
of this hormone from the ovaries ceases altogether. Thinned-down bones are
low bone mass • T-score of -2.5 or less = osteoporosis
weaker and more fragile, and the full-blown disease of osteoporosis
The commonest medications used are bisphosphonates, which
Hormone Replacement Therapy (HRT), has been shown to reduce the risk of fracture and can be used to prevent or treat osteoporosis in women under the age of 60 who
X-rays are helpful for
have no contraindications to the
is responsible for approximately
confirming fragility fractures e.g.
230 000 fractures yearly in the
of the ribs or vertebrae. However,
Calcium compounds such as
UK. The most serious of these
they are relatively insensitive to
carbonate and citrate, and calcium
is a fractured neck or femur
the identification of early disease,
and vitamin D combinations are
(thigh bone) because the long
requiring a bone mass loss of
also widely prescribed to help
period of immobility during
at least 30% before picking up
improve bones. These are the
recovery increases the risks of
diagnostic changes.
building blocks of bone and their
life-threatening conditions such as pneumonia, DVT (deep vein thrombosis) with subsequent blood clot on the lungs (pulmonary
use of HRT.
effect is best when they are given More than one-third of women over the age of 50 and nearly half of those over age 70 are affected by this disease
alongside other treatments such as bisphosphonates and HRT. • First published in Pharmacy Magazine, March 2019
52
SILVER DIGEST // WINTER 2019
