Research suggests that about one in two women over the age of 60 years will experience at least one fracture due to osteoporosis. A DXA scan measures bone density or thickness , usually at the lower spine and at the upper part of the hip.
The Z-score compares your bone mass with what would be expected for a person of your age. The T-score shows how much your bone mass varies from that of a young person with peak bone mass.
T-scores are interpreted as follows:. Around the time of menopause, you can reduce your risk of developing osteoporosis by following a few lifestyle recommendations, such as:.
Exercising regularly throughout life can reduce the risk of osteoporosis. Doing some type of physical activity on most days of the week for between 30 and 40 minutes is recommended.
Two types of physical activities that are most beneficial to bones are weight-bearing and resistance-training exercises. In addition to reducing bone loss, physical activity will improve muscle strength, balance and fitness, and also reduce the incidence of falls and fractures. Be guided by your healthcare professional when deciding on your exercise program. General recommendations include:. Weight-bearing exercise refers to any exercises where your feet and legs bear your body weight.
Examples include walking, running, tennis and dancing. Studies to evaluate the effects of weight-bearing exercises show a drastic improvement in bone mass when this activity is performed at high intensity for example, walking at a fast pace or jogging.
Resistance-training exercise is also known as strength-training exercise. Strength training uses weights of some kind — for example, machines, dumbbells, ankle or wrist weights — to create resistance.
Resistance training helps build muscle mass and places a load force on the bones of the involved limbs. It also includes exercises that use your own body weight as the load, such as push-ups, where the load is placed through the arms and shoulders. To avoid injury, get direction and advice from an accredited trainer, exercise physiologist or physiotherapist. Each type of medical treatment for osteoporosis has associated benefits and risks.
Discuss these with your doctor prior to choosing and commencing treatment. Your doctor will recommend treatment choices based on your age, health and risk factors for fracture. Some treatments are only available in Australia under the Pharmaceutical Benefits Scheme PBS based on your age, bone density test result and history of fracture.
Bone cells are constantly being broken down and renewed. Bisphosphonates may be taken by tablet daily, weekly or monthly, or by an intravenous infusion once a year. They are only available in Australia on the PBS for use in treating established osteoporosis with fracture, or women over 70 years with osteoporosis.
The most common side effect of treatment with bisphosphonates in tablet form is gastrointestinal stomach and gut upset, most commonly in the form of reflux. A very rare side effect is osteonecrosis of the jaw, which involves death of the cells in the bone of the jaw, and is associated with prolonged healing. The female body contains oestrogen receptors in many body tissues, including bone tissue.
These receptors respond to the hormone oestrogen. Selective oestrogen receptor modulators SERMs are medications that work by blocking the oestrogen effect at some receptor sites while prompting an oestrogen effect at others.
In bone, they work like oestrogen and lead to an increase in bone mass density , mainly in the spine less in the hips. MHT relieves menopausal symptoms such as sleep disturbance, vaginal dryness, hot flushes and night sweats. When taken around the time of menopause, MHT can also prevent bone loss.
Starting MHT soon after menopause will give maximum benefit. MHT is considered first-line treatment for osteoporosis in women less than 60 years of age, unless there is a medical reason for not taking it. Some studies have shown that MHT can increase bone density by around five per cent in two years. On average, MHT reduces the risk of spinal fractures by 40 per cent. Bone loss will resume once MHT is stopped. International experts have stated that for healthy women around the time of menopause, the benefits of MHT far outweigh the risks.
If you choose to use MHT for bone health, it is recommended that you do so in consultation with your treating doctor. Make sure that you fully understand the risks and benefits of this therapy. Tibolone is a tablet form of low-dose hormone therapy for treating menopausal symptoms. Bones are constantly changing through life — breaking down resorption and being renewed formation.
Osteoporosis is what happens when resorption occurs more quickly than formation, leading to loss of bone strength and density. The bones become fragile and fracture more easily. Usually there is no sign that osteoporosis is developing until a fracture occurs. Pain in the spine will occur most commonly with arthritis. Pain only occurs with osteoporosis if there has been a fracture.
Fractures are most common in the spine, hip and wrist and can occur after only a minor fall a minimal trauma fracture. Osteoporotic fractures of the spine cause loss of height, and gradual development of a rounded and stooped appearance. Spinal fractures do not always cause pain. Exercising regularly throughout life may reduce the risk of osteoporosis.
Doing some type of physical activity on most days of the week for minutes is recommended. Physical activities that are beneficial in preventing fracture are weight bearing and resistance training exercises. Studies have shown that vigorous exercise e. Resistance training exercises are also known as strength training exercises.
Strength training uses weights of some kind — for example machines, dumbbells, ankle or wrist weights — to create resistance, which helps build muscle mass and places an extra load on the involved limb bones. Recent studies have also shown that swimming is helpful, since it requires your body to move against the resistance of the water.
Physical activity improves muscle strength, balance and fitness, which reduces the risk of falls and fractures. Risk assessment, diagnosis and management of osteoporosis are summarized in this algorithm from Osteoporosis Australia. Access the PDF here: Osteoporosis risk assessment, diagnosis and management.
Osteoporosis is commonly diagnosed with a bone mineral density scan which uses a specialised x-ray technique called DXA DXA. Bone density scans may be advised around the time of menopause for women with risk factors such as early menopause, family history of osteoporosis, thyroid or parathyroid disease, coeliac disease, rheumatoid arthritis, chronic kidney or liver disease, those taking corticosteroids, or a history of previous fractures from a minor incident.
DXA test results are presented as a T-score and a Z- score. The T-score compares the bone density of the woman being scanned with that of a young woman when peak bone mass is at its best. The Z-score compares the bone density of the woman being scanned with that of a woman of the same age.
Z-scores, not T-scores, are used in premenopausal women. When a person has a minimal impact fracture of a major bone, regardless of the T-scores, osteoporosis is also diagnosed. These tools can be used in people over the age of to calculate the probability of an osteoporotic fracture based on a variety of established clinical risk factors and do not always require a DXA scan measurement.
Although osteoporosis indicates a high risk of fracture, many fragility fractures occur in people with bone density levels greater than Risk calculators take into account other factors that increase risk of fracture and are useful in deciding who needs drug treatment to reduce their risk of fracture.
A number of medical treatments are available for the management of osteoporosis. Treatments aim to strengthen existing bone, help prevent further bone loss and most importantly reduce the risk of broken bones.
Vitamin D deficiency is common in Australia and New Zealand. Studies indicate that 30 to 50 per cent of postmenopausal women are deficient in vitamin D. Up to 60 per cent of postmenopausal women are not meeting their required dietary calcium intake.
Calcium is the main mineral within the human skeleton and vitamin D is important for helping the calcium get into bone. Five to fifteen minutes of exposure to sunlight every day can also boost vitamin D production and contribute to bone health. The recommended daily intake of dietary calcium is mg.
Unlike bisphosphonates, denosumab does not accumulate in bone. It has a circulatory half-life of approximately 26 days, and like other monoclonal antibodies, the clearance of denosumab is through the reticuloendothelial system and does not depend on renal clearance [ 80 ]. In the last years, many studies has been made to understand how the immune system impacts and regulates the skeleton in physiological and pathological conditions through the immunoskeletal interface.
Although the majority of data derived from studies on animal models, recently new evidence of the crosstalk between immune system and bone has been accumulated in humans in many disease such as postmenopausal osteoporosis.
These data demonstrate that bone loss induced by estrogen deficiency in menopause is a complex effect of a multitude of pathways and cytokines working in a cooperative fashion to regulate osteoclastogenesis and osteoblastogenesis. These discoveries have potential for developing new therapeutic strategies for the treatment of these bone disorders.
In this respect, denosumab, a fully human monoclonal antibody to soluble RANKL, represents a new therapeutic advance in the treatment of osteoporosis with a novel mechanism of action that leads to the decrease of bone resorption and fracture risk. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles.
Journal overview. Special Issues. Academic Editor: Giacomina Brunetti. Received 03 Apr Accepted 10 May Published 23 May Abstract In the last years, new evidences of the relationship between immune system and bone have been accumulated both in animal models and in humans affected by bone disease, such as rheumatoid arthritis, bone metastasis, periodontitis, and osteoporosis. Introduction In the last few years, there have been important advances in understanding the processes that regulate physiological and pathological bone turnover.
Postmenopausal Osteoporosis The decline of ovarian function at menopause results in decreased production of estrogen and a parallel increase in FSH levels. Estrogen Effects on Bone Remodeling Estrogen is the major hormonal regulators of bone metabolism in women and men. Another clinical study underlines the role of T cells in the human postmenopausal bone loss.
B Lymphocyte Alterations in Postmenopausal Osteoporosis B-cell alterations are well documented during aging and estrogen deficiency, but less is known on B lymphocyte status during osteoporosis.
Therapeutic Strategies of Postmenopausal Osteoporosis The treatment of osteoporosis aims to reduce the incidence of vertebral and nonvertebral fractures responsible for the disease-associated morbidity [ 71 ] and stabilize or increase bone mass and strength [ 72 ].
Conclusions In the last years, many studies has been made to understand how the immune system impacts and regulates the skeleton in physiological and pathological conditions through the immunoskeletal interface. Conflict of Interests The authors declare that they have no conflict of interests. References J. Clowes, B. Riggs, and S. Ginaldi, M. Di Benedetto, and M. Arron and Y. Kotake, N. Udagawa, M. Hakoda et al. View at: Google Scholar I. Roato, M. Grano, G.
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