Postmenopausal osteoporosis
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■ Outline:
Osteoporosis is a disease that increases the risk of fracture as the amount of bone gradually decreases and structural vulnerability increases, and it is classified into osteoporosis without a specific cause and osteoporosis with a clear cause. Degenerative osteoporosis is the most common cause of osteoporosis.
Degenerative osteoporosis is a phenomenon of aging that is literally getting older and can be classified into two major categories (postmenopausal osteoporosis and geriatric osteoporosis).
■ Synonyms:
Type 1 osteoporosis
■ Definitions:
Osteoporosis is caused by menopause. Clinically, menopause refers to a condition in which menstruation has been broken for 12 months, which is caused by a sharp decline in the production of female hormones in the ovaries. Although women have physiologically distinct menopausal symptoms, men may gradually progress to osteoporosis, which is not as pronounced as women, but in the form of women, because the hormone levels are gradually reduced.
Progressive osteoporosis is caused by a decrease in sex hormones called postmenopausal osteoporosis or type 1 osteoporosis. Therefore, it occurs well between the ages of 51 and 75, and sex ratio of male and female is about 1: 6, which is much higher for women. Because menopause progresses around 50 years old, the amount of bone decreases rapidly after age 50.
Osteoporosis, which occurs most often in the elderly or postmenopausal women, is a disease in which calcium metabolism is abnormal and calcium, bone, and other substances are released from the bone, piercing the bone and weakening the bone as much as possible. When osteoporosis occurs, the bones become weaker, which not only increases the risk of fractures, but also affects symptoms such as back pain, vertebral deformity, and decreased kidneys.
■ Symptom:
Osteoporosis generally has no symptoms. In the case of hypertension or hyperlipidemia, symptoms usually do not occur, but when complications occur, there are unusual symptoms as well. In the case of osteoporosis, if a fracture occurs, the symptoms are accompanied by fracture. Fractures due to osteoporosis can be caused by a mild shock that falls down in a standing position without a major impact.
Since menopausal osteoporosis progresses rapidly with the rapid decrease in female hormones, women who are treated often visit the hospital because of menopausal symptoms and are often diagnosed with osteoporosis by chance. In general, And consists of hard cortical bone. Among these, the sponge bone area decreases rapidly as the sex hormone decreases, so many fractures of the spongy bone area are characteristic of postmenopausal osteoporosis.
Therefore, the wrist bone, spine and many sponge bone components can be fractured well in postmenopausal osteoporosis, who experienced a fracture caused by light shock is likely to be osteoporosis.
In the case of vertebral fractures, most compression fractures occur in the structure of the bones. Therefore, if the upper body gradually bends forward or the key is reduced by more than 3 cm or more than that known to you, or sudden pain occurs, the possibility of osteoporosis is high.
■ Causes / Pathophysiology:
In general, the bone accumulates enough through adolescence, and from then on, the process of replacing old bone with new bone continues. Thus, osteoporosis is a condition in which a sufficient amount of bone has not accumulated, or even when a sufficient amount of bone has accumulated, osteoporosis occurs when the amount is gradually reduced during replacement.
The process of replacing the bones will be easy to understand when we compare the house in which we live. After some time after building the wall of the house, the bricks in the fence will break down and keep the shape of the wall, but the situation will be such that even a slight impact will fall over quickly. At this point we will break down the wall of the poor place and fix the wall with new cement and brick.
This is the same situation as bone replacement. The old bone of our body melts away and is replaced by a sturdy bone by a worker who creates new bone. In this process, when the amount of old bone melts and the amount of new bone is the same, the amount of bone remains unchanged. However, if the amount of molten bone is large, it is natural that the amount of bone gradually decreases. When menopause causes a decrease in female hormones, the bone starts to melt rapidly. This is because female hormones have the same effect of protecting bones.
During the first 5 to 10 years after menopause, the amount of bone meltdown is significantly increased, and then gradually the bone melts. The bones are structured like a net with interlocking vertical and horizontal structures. When the bone starts to melt, these reinforcing structures gradually become thinner and the connection of the structure is broken. Once the structure is disconnected, it is difficult to maintain the original strength of the bone even after the treatment.
Bone Structure of Normal Femur Bone Structure of Normal Femur Bone Tissue of Osteoporosis Patient
■ Diagnosis:
First, you need to have a medical history and a physical examination to find the risk factors for osteoporosis. This includes dietary calcium intake, nutritional status, physical activity, daily life patterns, smoking history, physiological and reproductive history, and family history of osteoporosis or endocrine and metabolic diseases.
Physical examination should include key measurements and assessment of spinal disease. In addition to general X-rays, patients with neurological symptoms may require a magnetic resonance imaging (MRI) diagnosis or computed tomography (CT) scan if fractures are found in people with normal bone mineral density .
Laboratory tests may require anemia, calcium in the blood, liver function, kidney function tests and endocrine tests. In some cases, an overhaul of a suspected secondary osteoporosis other than degenerative osteoporosis is necessary.
One of the important tests is bone density. Based on the definition of the World Health Organization, osteoporosis can be diagnosed by measuring bone mineral density before a fracture occurs. The diagnosis rate depends on the number of bone density tests, the area to be examined, and the time of the test. There is no consensus on when to check someone, but it is better to have a bone density test in menopause. They also have family history or are at risk for osteoporosis. However, many people still get diagnosed after a fracture has occurred.
The bone density test can be used to determine the degree to which bones are broken and can be used as a basis for treatment responses. Measuring any site has important value in predicting the risk of fracture. The bone mineral density of the spine is important for predicting vertebral fractures and the bone density of the femur is important for predicting the fracture of the femur. Osteoporotic fractures are common in the wrist, spine, and femur, so it is best to measure these areas.
However, it is not unreasonable to estimate the risk of fracture and to use it as a treatment standard even if measuring other parts. There are many different methods of measuring BMD, including ultrasound, dual energy X-rays, and computed tomography, all of which are used to predict future fractures.
■ Progress / Prognosis:
In the United States, 13 to 18 percent of postmenopausal white women have osteoporosis, and 30 to 50 percent have a low bone density in the femur (note: bone between the ankle and the knee). There is no accurate statistics in Korea, but it is estimated that there is the same proportion of osteoporosis. The most common fractures due to osteoporosis are wrist fractures, vertebral fractures, and femur fractures. These fractures are usually caused by the elderly and are fully recovered, but chronic pain, sequelae and death may occur.
The most serious problem with femoral fractures is that they cause mortality rates of 10 to 20% within a year. In addition, 25% require long-term care and only about one-third can live before fracture. Vertebral fractures cause disability in daily life due to pain, reduction of height, and deformation of posture. Multiple fractures (note: multiple fractures) may cause pulmonary disease and may cause constipation, abdominal pain, satiety, and loss of appetite due to abdominal deformity.
A 50-year-old American white woman has studied the rate at which fractures can be experienced over an average life expectancy of 16% for wrist fractures, 15% for vertebral fractures, and about 17% for femoral fractures, More than 40%. So, when you get older, you will find that 4 out of 10 people will experience a fracture.
The economic loss due to osteoporosis fracture is also huge. In 1995, in the United States, 432,000 hospital admissions, 2.5 million physician interviews, and 180,000 hospital admissions were due to osteoporotic fractures. At a direct cost, about 16 trillion won has been consumed and it is estimated that this will be further increased by the increase of the elderly population.
■ Complications:
Wrist fracture
A wrist fracture is a fracture of the wrist that consists mainly of a sponge-like sponge. It occurs well when you are lying down with your arms stretched out. For women, wrist fractures begin to increase after age 40. Wrist fractures are well healed and there is no long-term sequelae. Women over the age of 40 need an osteoporosis test and appropriate measures in the event of a wrist fracture.
Spinal compression fracture
It is caused by spontaneous or mild shock and is most common among osteoporotic fractures. The vertebral compression fractures vary in shape, and in some patients, only one vertebral fracture occurs, but in many patients compression fractures occur in multiple vertebrae.
Before these compression fractures occur, there is already a significant loss of spongy structures in the spine. When the fracture site is taken by X-ray, it can be observed that the entire vertebral column collapses from the slightly sloping shape. The site where the most fracture occurs is the lower thoracic spine (thoracic spine) and the upper lumbar spine Of the spine), patients complain of dorsal pain. It is less likely to be fractured by osteoporosis if the pain in the lower lumbar spine and the sacrum (spine of the buttocks) is appealed.
Decreased height can also be a sensitive indicator of compression fracture. However, a reduction in height can also be caused by stenosis of the disc (disk) or postural changes without fracture. There are twelve thoracic vertebrae, of which 5 to 8 thoracic vertebrae are most common in older women and not necessarily associated with severe compression fractures.
Hip joint fracture (Hip joint clinic link)
Clinically, it is thought to be a clinical manifestation of osteoporosis because it occurs in the elderly. However, classification is not meaningful because the two diseases are not separate diseases. Hip fractures are common in people aged 70 years or older and are a cause of older deaths. In general, a femur fracture refers to a fracture of the femur neck (neck of the femur) and large electrons (large femur area of the femur). The older you are, the more bone you have and the more you fall, the greater your fracture.
Hip fractures are expensive because of the need for surgical treatment, and the complications that occur before and after surgery are 5 to 20% mortality. Many older patients have difficulty maintaining preoperative activity after a hip fracture and need long-term care. Because there may also be 5 secondary hip fractures in other areas, diagnostic tests are required and prevention is important.
The area where the fracture is easy
■ Treatment:
Prevention is the best because osteoporosis is a preventable disease and it is not easy to cure in an already advanced situation. It is advisable to detect the risk factors, start treatment early, and treat for a long time. Therapy can be divided into major pharmacological and non-pharmacological treatments.
Diet
All patients need an adequate amount of calcium (at least 1200 milligrams a day), and people who are at risk of underdose are advised to take 400 to 800 units of vitamin D per day. The proper amount of calcium intake is needed both to maximize the strength of the growing bones and to maintain healthy bones thereafter. Since the bones account for 99% of the total calcium in our body, when the calcium intake is insufficient, the calcium is released from the bones to maintain the blood calcium.
Calcium is most effective through milk products such as milk, cheese, and yogurt. Tobacco worsens osteoporosis and is a risk factor for joint fractures. Excessive alcohol also aggravates osteoporosis. You should try to get rid of the habits of eating and eating all the foods evenly in your normal diet.
Regular weight bearing exercise (exercise prescription clinic link)
Weight-bearing exercises (such as walking, jogging, stair climbing, dancing, tennis, etc.) and strength exercises can reduce the risk of falling because they inhibit aging and enhance physical strength and balance. In addition, because there is a little effect of increasing bone density, we are strongly recommended.
Pharmacotherapy
It can be categorized as medicine to prevent bone breakage and to increase the production of new bone, but up to now, it has been used mainly for treatment because it is superior in efficacy and safety. Research continues. Women's hormones are also the most effective treatment because of the prevention and treatment of osteoporosis and various other effects. In addition, alendronate, calcitonin, raloxifene, active vitamin D, and ipriflavone are used in clinical practice.
■ Prevention:
Eat a sufficient amount of calcium.
Adolescents, not just adolescents, are also advised to consume at least 1200 milligrams of calcium daily to maintain a healthy bone. The average calcium intake of Korean people is about 500 to 600 milligrams, which is insufficient for the recommended amount to prevent osteoporosis.
Conduct continuous weight bearing exercise.
It is recommended that you take at least 30 minutes a day, such as walking, jogging, stair climbing, dancing, and tennis, at least three times a week.
Menopausal women supplement female hormones.
Even if it is appropriate for the age of menopause, female hormones have a good effect in preventing osteoporosis and other menopause, so it is better to supplement hormones if you do not have any special taboos.
Be careful not to fall.
Bones with osteoporosis are broken by impact, so it is better to protect the bones from impact. It is also a way to protect your bones by wearing comfortable shoes, illuminating your room's interior, slipping the floor of the bathroom, or improving structures in your living room or room. People who are taking sleeping pills or stabilizers should be more cautious, and it is best to avoid exercising to excessively bend over with exercise for osteoporosis.
It treats the risk factors of osteoporosis early.
If you have a family history of osteoporosis, early menopause, or other osteoporosis-related diseases or medications, consult an expert before taking active care if you are at risk.
If you are diagnosed with osteoporosis, continuous treatment is required.
As chronic diseases such as hypertension and diabetes continue to require treatment, osteoporosis requires continued treatment.
■ To the doctor:
People with risk factors for osteoporosis should consult an expert early on to prevent osteoporosis.
As an adult, a person who has experienced a minor impact fracture
When a family suffered a femoral fracture with a slight impact
If you smoke
Dry physique
Aged 65 or older
female
Female hormone deficiency, menopause, early menopause, ovarian surgery, amenorrhea
When calcium intake is low
Mainly living indoors
Alcoholism
Drugs: Steroid hormones, thyroid drugs, anticonvulsants, agents that affect physiology
People with osteoporosis-related diseases: hyperthyroidism, rheumatoid arthritis, parathyroid disease, liver disease, disorders with absorption disorders, diabetes, chronic lung disease, adrenal disease, hormone deficiency diseases, etc.
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