Postmenopausal Bone Metabolism and Structural Changes
Postmenopausal Bone Metabolism and Structural ChangesDR. dr. H.
Joserizal Serudji, SpOG-KObstetrics and Gynecology
DepartmentFaculty of Medicine of Andalas University
Definitions Menopause: a point in time that follow 1 year after
the cessation of menstruatioinPostmenopause: those years following
this point.The average age of FMP (final menstruation periode):
51.1 yrs the cessation of mensis due ovarian failure may occur at
any age.Premature ovarian failure: cessation of menses before age
40 and is associated with an elevated FSH level.Perimenopause or
climacteric: the time period in the late reproductive years,
usually late 40s to early 50s characteristically: it begins with
menstrual cycle irregularity and extends to 1 year after permanent
cessation of menses.The more correct terminology: menaopausal
transition typically develops over a span 4 to 7 yrs, and the
average age at its onset is 47 yrs.
Influential factorsEnvironmental, genetic, surgical influences
may alter ovarian agingSmoking: advances the age of
menopauseChemotherapy, pelvic radiation, ovarian surgery: lead to
earlier age of menopause Hypothalamus-PituitaryOvarian Axis
ChangesOvarian failure ovarian steroid release ceases, and negative
feedeback is opened GnRH is released at maximal frequency and
amplitude FSH and LH levels rise up (4x).Ovarian ChangesThe process
of atresia of the non dominant cohort of follicles, largely
independent of menstrual cyclicity, is the prime event that leads
to the eventual loss of ovarian activity and menopauseBone
Metabolism and Structural ChangesNormal bone: dynamic, living
tissue that is in a continuous process of destruction and
rebuilding (remodelling)This remodelling (or bome turnover): allows
adaptation to mechanical changes in weigh bearing and other
physical activitiesProcess of remodelling involves: a constant
resorption of bone (by osteoclasts) and a concurrent process of
bone formation (by osteoblasts)During menopause: the rate of bone
mass decline increases to 2 5 % per year for the first 5 10
yearOsteopenia and OsteoporosisBone disorders: characterized by a
progressive reduction in bone mass (typically: trabecular bone) and
predispose to fractures in the spine, hips, and other
sites.Fracture: the most debilitating and costly consequence of
osteoporosis associated with significant morbidity and mortality,
and the risk of dying 2 x higher.Only 40 % of those who sustain a
hip fracture are capable of returning to their prefracture level of
independence
PathophysiologyOsteoporosis: a skeletal disease in which bone
strength is compromise, resulting in an increased risk for
fractureA major proportion of bone strength is determined by bone
mineral density (BMD)Primary osteoporosis: bone loss associated
with aging and menopausal estrogen deficiency ec estrogen
regulatory effect on bone resorption is losts most rapid in the
early postmenopausal years.Secondary osteoporosis: caused by other
diseases or medication.
Pathophysiology, contdAging and a loss of estrogen: lead to
significant increase in osteoclastic activityCa intake or impaired
of Ca: serum level of ionized Ca PTH level stimulates production of
vit. D serum Ca levelIn menopausal woman: estrogen responsiveness
of bone to PTH more Ca removed from bones serum Ca level lowers PTH
level and vit D level 13
Diagnosis of OsteoporosisStandard: BMD reported as
T-scoreT-score of -2.0 means: the BMD is 2 SDs below the average
peak bone mass for a young womanCriteria for Interpretation of BMD
table.
Prevention The most important predictive factors: bone density
in combination with age, fracture history, ethnicity, various drug
treatments, weight loss, and physical fitness.The presence of a key
risk factor should alert a clinician to the need for further
assessment and possibly active intervention, such as calcium
therapy coupled with weight-bearing exercise or pharmacologic
therapy.
Treatment Primary goal: fracture prevention in low BMD women the
aim: to stabilize or increase BMD.Treatment: lifestyle changes or
pharmacotherapyTherapeutic options:Hormonal th/ for
preventionBiphosphonates and selective estrogen reseptor modulator
(SERM) for prevention and treatmentCalcitonin and injectable hPTH
for treatment
Treatment contdNonpharmacologic therapyCalciumVitamin DDiet :
protein supplementationPhysical activity: aerobic exercise
Fall-Prevention StrategiesFalls: responsible for >90% hip
fracturesMinimize falls by: reducing clutter and implementing
nonslip tiles, rug with nonskid backing, night lights.Hip protector
paddingThank a Lot
