There is a condition that can directly affect quality of life—primarily in women, but to some extent in men as well. This condition is osteoporosis, a “silent” disease that usually shows no symptoms until a fracture occurs.
In modern medicine, preventive screening is considered essential for many conditions that threaten health, and osteoporosis should definitely be included. The first step in prevention is proper awareness. The numbers illustrate the seriousness of this disease:
- Women are at higher risk of developing osteoporosis than men. After age 50, approximately one in two women is affected, compared to one in four men.
- Among women with osteoporosis, one in three will experience an osteoporotic fracture during her lifetime, often resulting from a minor fall.
- Most women with osteoporosis are unaware of their condition because they have never been screened, typically discovering it only after sustaining a fracture.
- Osteoporotic fractures, especially in the spine and hip, negatively impact quality of life, cause disability, and are associated with increased mortality.
Postmenopausal Osteoporosis
In women, osteoporosis is primarily associated with menopause. The sudden drop in estrogen levels during this period reduces bone density, making bones more fragile and increasing the risk of low-trauma fractures—fractures resulting from a simple fall, slip, or sudden movement. Every woman after menopause should be screened for osteoporosis using the following methods:
Bone Density Measurement
This test is simple, quick, safe, and painless. For greater accuracy, it is recommended to measure both the spine and the hip. Results are compared with those of a healthy young adult woman and expressed in standard deviations from the normal range.
- Osteopenia: values between -1.5 and -2.5
- Osteoporosis: values below -2.5
- Severe osteoporosis: values below -3.5
Biochemical Bone Tests
Blood tests evaluate levels of calcium, phosphorus, parathyroid hormone, vitamin D, and alkaline phosphatase. In some cases, a 24-hour urinary calcium test may also be needed.
Radiological Assessment
For patients with a history of spinal pain, X-rays of the thoracic and lumbar spine are required.
Management
The primary goal is to reduce fracture risk. Treatment decisions are based not only on bone density but also on the presence of additional risk factors, such as early menopause, rheumatoid arthritis, chronic obstructive pulmonary disease, sickle cell or Mediterranean anemia, and prolonged use of medications like corticosteroids, antiepileptics, antidepressants, and chemotherapy.
When is treatment necessary?
- Women with a bone density score below -2.5 should begin treatment.
- Treatment is also necessary regardless of bone density if fractures have already occurred or if other risk factors are present.
Osteoporosis Medications
Medications are divided into two main categories: Antiresorptive drugs which inhibit further bone loss and anabolic drugs which stimulate new bone formation. The choice of therapy, timing, specific medications, and duration should be determined by the physician based on each patient’s needs. All treatments should include calcium and vitamin D supplementation, as dietary intake alone is usually insufficient.
Strengthening Bones Before Menopause
What can a woman do to prevent or limit the effects of decreased bone density that occurs after menopause?
The period of skeletal development is critical. While genetics plays a key role, external factors also influence final bone formation. The main factors are diet, sun exposure, and exercise.
Diet should include foods rich in calcium and phosphorus, such as dairy products, small fish eaten with bones, legumes, and nuts. Vitamin D, essential for calcium metabolism, is produced in the skin under sunlight exposure. Ideally, daily sun exposure of 15–20 minutes without sunscreen is recommended year-round. Physical activity plays a key role in forming strong bones, through play in childhood and systematic exercise in adulthood.
By age 18–20, skeletal development is complete, and peak bone mass is achieved by 25. After 25–30 years, bone mass begins to gradually decline. By age 45–50, when menstruation typically stops, menopause negatively impacts bone health.
Excessive alcohol, coffee, and smoking during the critical 25–45 age period negatively affect bones. When combined with poor diet and lack of exercise, this results in relatively low bone mass by menopause, accelerating the development of osteopenia or osteoporosis.
Based on this, can osteoporosis be prevented? Largely, YES. However, some women may develop osteoporosis before menopause, either idiopathically (unknown cause) or secondarily due to chronic conditions (e.g., rheumatoid arthritis, ulcerative colitis, hereditary anemias) or long-term medication use (e.g., corticosteroids).
For all these cases, consult your physician for guidance.
Summary Tips for Healthy Bones
- Maintain a calcium-rich diet at all ages, before and after menopause.
- Ensure safe sun exposure year-round to support vitamin D synthesis.
- If calcium intake or vitamin D is insufficient, supplements are recommended.
- Engage in regular physical activity throughout life.
- Limit or avoid coffee, alcohol, and smoking.