Menopause

Menopause Corner
Menopause Corner

Wendy Hoffman blogs about menopause and women's health—particularly focusing on how diet and nutrition can positively affect a woman's life around the age of menopause.

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New Research Findings Are Changing How Doctors Screen For and Treat Osteoporosis

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Despite the continuing advertisements with celebrity spokespersons for osteoporosis drugs like Boniva and Prolia, there has been a lot of debate among medical experts over how to diagnose and treat osteoporosis, a common type of bone disease that occurs when the body fails to form enough new bone. Most women experience accelerated bone loss in the first few years after their last period and it is estimated that twenty percent of American women over the age of 50 have osteoporosis. That's why it's so important to know what your risk factors are for this disease and to take measures to slow, stop or reverse bone loss that might already have begun.

The debate focuses on when and how often women should have a bone mineral density (BMD) test, which has almost become a rite of passage for women hitting middle age. Tests are often ordered for women who don't have a family history of this disease, nor other risk factors that cause bone loss, such as smoking, previous fractures from a minor trauma, or take medications such as steroids. There’s also a lot of discussion on when, if ever, women should be prescribed a bone bolstering drug like Fosamax, Boniva and Actonel.  There’s a growing consensus that physicians have been too enthusiastic in prescribing these medications in cases where the BMD test, called a DXA Scan, reveals only slight bone loss, called Osteopenia.

Some medical experts now believe that mild bone loss should be considered a risk factor, not a disease that necessarily requires medication; and that its importance varies depending on a patient’s age. One study found that bone loss develops so slowly in most women whose bones test normal at age 65 that many can wait as long as 15 years before repeating the test, rather than every two years, which is more typical. 

But what about younger women in the early years of menopause? One year ago, the U.S. Preventive Services Task Force (USPSTF) recommended screening for younger woman of any age whose risk factors are equivalent to those of a 65 year old white woman (white women are used as a benchmark because they have a higher rate of osteoporosis than other ethnic groups). Previously the USPSTF had suggested that women with risk factors wait until age 60 to get screened.

One of those risk factors, according to a recent study out of Sweden, whose findings were published just last week, might be the age when a woman hits menopause. The researchers found that women who reach menopause early - the study participants were 48 when they were first enrolled -  are at significantly greater risk for osteoporosis and bone fracture later in life. They concluded that menopausal women “should have bone density measurements taken in the first decade after menopause.”  

The bottom line is that you should discuss with your physician the need for a baseline BMD test, whose results can be input into a Fracture Risk Assessment tool called FRAX, to calculate the probability of your having a fracture in the next decade.

Together, these evaluation tools can help guide you and your physician in a plan of action for ensuring a lifetime of healthy, strong bones. Instead of a bone-building drug, your physician might prescribe instead weight-bearing exercises several days a week; a diet rich in bone-building minerals such as Calcium, Phosphorus and Magnesium; and supplements like Vitamin D and B-12.

Wendy Hoffman writes about women’s health at www.menopausetheblog.com

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Wendy writes about women's health in midlife.

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