Menopause and osteoporosis.pdf

Dr Ahmed Reda  Definitions:  Menopause: it is the permanent cessation of Menopause: menstruation due to failure of ovarian follicular development in the presence of adequate gonadotropins.  Diagnosis of menopause is established when menstruation stops for 12 months in...

Dr Ahmed Reda  Definitions:  Menopause: it is the permanent cessation of Menopause: menstruation due to failure of ovarian follicular development in the presence of adequate gonadotropins.  Diagnosis of menopause is established when menstruation stops for 12 months in absence of an organic or a pathological cause.  Definitions:  Climacteric: is the physiological period in woman’s Climacteric: life during which ovarian function regresses.  Menopause is only one aspect of the climacteric, during which time women undergo endocrine, somatic and psychological changes that span several years. Stages of Menopause Menopause Pre- Post-menopause menopause Climacteric 4  Hormonal changes after the menopause  FSH, LH are elevated >25 IU/L  Estrogen decreases  Decrease progesterone & inhibin  Testosterone is relatively increased  Clinical changes  Menstrual changes.  Vasomotor instability.  Osteoporosis.  Cardiovascular changes.  Genitourinary atrophy.  Psychological changes.  Skin collagen.  I- Menstrual changes  Most women note a gradual tapering in both amount and duration of flow.  A minority of women have more frequent and heavier bleeding.  Abrupt cessation of menses is fairly rare.  2- Vasomotor instability (Hot Flashes)  The most common and troublesome symptoms for women at the climacteric  Obese women usually are less troubled by hot flashes than thin women  75% of women experience hot flashes within 3 months of menopause  Hot flashes lessen in frequency and intensity with advancing age unlike the other sequelae of menopause that progress with time  4- Cardiovascular changes  Estrogen is a cardio-protective.  It increases the HDL and deceases the LDL.  Risk of cardiovascular disease increase after menopause.  5- Genito Genito--Urinary Atrophy  After the loss of estrogen at menopause, the vaginal walls become pale because of diminished vascularity and thin (typically 3 or 4 cells thick).  Vaginal epithelial cells contain less glycogen, which, before menopause had been metabolized by lactobacilli to create acidic PH.  Loss of this protective mechanism leaves the thin, friable tissue vulnerable to infection and ulceration.  The vagina also loses its rugae and becomes shorter and inelastic. Symptoms secondary to genitourinary atrophy  Dyspareunia.  Vaginitis.  Vaginal dryness.  Dysuria.  Urgency, frequency of urination.  Supra-pubic pain.  6- Psychological changes  Irritability, anxiety.  Depression.  Lack of concentration.  Change of libido.  Alzheimer’s disease.  7- Skin collagen  During the first five years of the menopause, up to 30% of skin collagen can be lost.  The changes can be prevented and in some cases reversed with Estrogen Replacement Therapy (ERT).  Osteoporosis  Reduction of bone mass density with micro- architectural alteration with increase bone fragility.  Imbalance between osteoclastic & osteoblastic activity ( defective remodeling )  What is Osteoporosis?  Loss in total mineralized bone  Disruption of normal balance of bone breakdown and build up  Osteoclasts: bone resorption, stimulated by PTH  Calcitonin: inhibits osteoclastic bone resorption  Major mechanisms: ◦ Slow down of bone build up: osteoporosis seen in older women ◦ Accelerated bone breakdown: postmenopausal  Normal loss 0.5% per year after peak in 20s  Up to 5% loss/year during first 5 years after menopause PTH= Parathyroid Hormone  RiskFactors Risk Factors for for Osteoporosis Osteoporosis Things you can’t change 1 Gender 2 Heredity 3 Age 4 Fracture history 5 Medical conditions (e.g. Hyper-thyroidism, parathyroidism) 6 Medications for chronic diseases (e.g. steroids) Risk RiskFactors for Osteoporosis Factors for Osteoporosis Things you can change 1 Calcium consumption 2 Vitamin D intake 3 Quit smoking or vaping 4 Alcohol consumption 5 Physical activity 6 Posture 7 Low body weight (BMI < 20) 83 Some medications Complications of Osteoporosis fractures Most common sites of fracture are the vertebrae, femur neck and distal radius.  One third of women will suffer vertebral fracture after 65 years of age and hip fracture by age 90.  Hip fractures are associated with 5-20% mortality rate  Diagnosis of Osteoporosis Dual energy X-ray absorptiometry (DEXA)  The fall of Bone mass density (BMD) > 2.5 standard deviation below the mean for young adults ( t-score)  How to interpret the BMD  T score: standard deviation of the BMD from the average sex matched 35-year-old  Z score: less used; standard deviation score compared to age matched controls  WHO: Osteoporosis:T score