Early Sign of Hip Bone Fracture/ Weaken for Menopause

Early Sign of Hip Bone Fracture/ Weaken for Menopause

Bone is a highly metabolically active tissue; remodeling continues throughout life. The remodeling process is an active coupling of the processes of bone formation and resorption. An imbalance in this active coupling phenomenon, in which the cellular events of bone resorption are quantitatively larger than bone formation, leads to bone loss. A study from the American Society of Plastic Surgeons (ASPS) Plastic Surgery says that loss of facial bone volume plays a significant role in having an "older" looking face, especially in women.


She faces certain health risks due to lower levels of estrogen that cause accelerated bone loss and an increase in LDL cholesterol (the so-called bad cholesterol). Her risks for serious disorders are estimated at 46% for heart disease, 20% for stroke, and 15% for hip fracture. In addition, about 8% of people over 75 have dementia, with postmenopausal women having 1.4 to three times the risk for Alzheimer's disease compared to men.

It is important to take care of your bones early in life. As a woman, your risk of bone loss is higher if you have a family history of osteopenia or osteoporosis. If you are skipping menstrual periods, or have had both ovaries surgically removed (oophorectomy), or are postmenopausal (the time after menopause; especially past the age of 65), you are also at risk for bone loss. The sooner you take steps to prevent bone loss, the lower your risk of osteoporosis later in life.

During a person's lifetime, the body constantly breaks down old bone (through a process called resorption) and builds up new bone. Any time old bone is broken down faster than new bone is made, net bone loss occurs. Bone loss can lead to low bone density (osteopenia), weakness of the bone, and eventually osteoporosis.

Osteoporosis will appear as a reduction in height from the lifetime maximum height. Being at full lifetime maximum height with no height loss whatsoever at 65 years of age is common in healthy individuals. Serious osteoporosis exists when a person of 5' - 10" (1778 mm) tall has lost 1.0" (25 mm) in height or a person of 5' - 3" (1600 mm) tall has lost 0.75" (19 mm) in height.

As women go through menopause, their bodies produce less estrogen. This loss of estrogen is the major cause of bone loss in women later in life, according to the National Institute of Arthritis and Musculoskeletal and Skin Disease. The amount of bone loss is equivalent to one year of rapid bone loss after menopause and is similar in magnitude to what people lose from smoking, failing to exercise or not eating enough calcium.

Interleukin-6 is sensitive to estrogen. When estrogen levels go down, the protein goes up. This explains why women lose bone after menopause. After menopause, a woman’s body begins to lose bone tissue rapidly at an estimated rate of three to five percent a year. One in two women will have an osteoporosis-related fracture in their lifetime, according to the National Osteoporosis Foundation. An average of 24 percent of hip fracture patients over age 50 die in the year following their fracture.

The WHI results show that estrogen plus progestin reduces the rate of hip and spine fractures by one third (34 percent) and reduces the rate of other osteoporosis-related fractures by 23 percent. Results of some small clinical trials also indicated that estrogen reduces fractures in the spine. Research also indicates that women who take estrogen to maintain bone density must continue taking the hormone because its beneficial effects on bone health disappear after hormone use is discontinued.

"Exercise can provide a natural alternative to estrogen and other supplements for women seeking to prevent bone loss after menopause", said Christine Snow, director of the Bone Research Laboratory at OSU and principal investigator in the study. Long-term fitness regimen that includes jumping and "resistance" exercises using weighted vests can prevent significant bone loss in the hip. Long-term weight training may help women's bone and metabolic health by promoting increased production of growth hormone, researchers at the University of Connecticut suggests.

Weight loss during menopause appears to be associated with increased rates of bone loss at the hip, the findings of a long-term study suggest. Even women who are on hormone therapy are "not totally protected from bone loss," Dr. Jane A. Cauley, University of Pittsburgh, Pennsylvania, told Reuters Health.

Weight change leads to changes in bone mineral density, she and colleagues note in a report in The Journal of Clinical Endocrinology and Metabolism, and weight loss during menopause may be particularly worrisome because of concurrent menopause-induced bone loss.

Cauley and colleagues had previously identified greater bone mineral density loss over an 18-month period among women in a lifestyle intervention program designed to promote modest weight loss (low-fat diet and increased physical activity) compared with women simply advised to follow a low-fat diet (control group). They now report bone mineral density and weight measurements among the 373 non-obese pre menopausal women, aged 44 to 50 years, followed for up to 78 months.

Over the 54-month active intervention period, the control group gained 2.6 kg of body weight while the intervention group lost 0.4 kg of body weight on average. However, Cauley notes, the annualized rate of hip bone loss was "6-fold greater" among women who lost weight compared with those in the control group who did not.

"Women who took hormones at the time of menopause experienced slower rates of bone loss," Cauley said. "Nevertheless, if these women also lost weight, they experienced faster rates of bone loss.” The researchers estimate a 5-year bone loss rate of about 7 percent among the women who lost weight. "This amount of bone loss has been associated with an increase in fracture risk," Cauley adds.

When the researchers re-assessed the study population 2 years after the active intervention stopped, they found smaller between-group weight differences and "generally absent" differences in bone mineral density. Cauley notes that the study findings should not discourage women from losing weight, if they need to, since being overweight is linked to a number of health problems. However, she suggests women instituting a weight loss program should be aware of the potential negative consequences on their bone health.

A study by Dr J. Reeve at the Institute of Public Health, University Forvie Site, Cambridge suggested that the known relationship between excessive leanness and risk of osteoporosis and vertebral fracture after menopause might in part be due to fast postmenopausal bone loss. As trabecular bone loss is accelerated relative to cortical bone loss after menopause, regions with substantial amounts of trabecular bone might become fragile sooner.

A study by the American Journal of Clinical Nutrition has shown that postmenopausal women who consumed the highest amount of animal protein had the strongest bones and the lowest percentage of hip fractures. Diets lowest in meat required a longer time for healing of a bone fracture and the slowest recovery time for illnesses in general. Eating meat improves healing and health.

Women with multiple risk factors and low bone density have an especially high risk of hip fracture. Maintaining body weight, walking for exercise, avoiding long-acting benzodiazepines, minimizing caffeine intake, and treating impaired visual function are among the steps that may decrease the risk. In any case, physicians and postmenopausal women should recognize that osteoporosis is unlikely to be prevented by taking estrogen for just a decade or so after menopause.

Heavier drinkers and smoking are even more vulnerable to bone loss and fractures, because of poor nutrition and because they face a higher risk of falling. Certain medications can accelerate bone loss, thus increasing your risk of osteoporosis and hip fracture. Long-term use of corticosteroids may lower bone mass. Other medications that may contribute to bone loss or to calcium or vitamin D deficiencies if used for long periods of time include anticonvulsants, antidepressants, thyroid medications, and certain diuretics and blood thinners.

What we often call a hip fracture is actually a fracture of the neck of the femur (thighbone). The fracture occurs at the upper end of the femur where it meets the pelvic bone. Symptoms of a hip fracture are severe pain in your hip or pelvic area, bruising and/or swelling in your hip area, inability to put weight on your hip or difficult walking, the injured leg may look short than the other leg and may be turned outward. Any time you may fall and are unable to get up or stand.

Radiation therapy to treat cervical and rectal cancer in older women greatly increases the risk of pelvic fractures as these women go on with their lives, researchers at the University of Minnesota shown. Vitamin D sufficiency is more important that high calcium intake. The researchers found that levels of that hormone depended more on vitamin D than on calcium. You need less calcium for normal homeostasis (balance) if your vitamin D (or sunshine) is good. But still you need some calcium in your diet; researchers at Landspitali-University Hospital suggested.

Eleven factors were identified by University of California at Davis School of Medicine that was predictive of hip fracture within 5 years. These factors were age, self-reported health, weight, height, race/ethnicity, self-reported physical activity, history of fracture after age 54 years, parental hip fracture, current smoking, current corticosteroid use and treated diabetes. Incorporating these factors into a clinical algorithm was useful to predict the 5 year risk of hip fracture among post menopausal women of various ethnic backgrounds.

Depression:

Pre-menopausal women with even mild depression have less bone mass than do their non depressed peers, a study funded in part by the National Institute of Mental Health (NIMH), part of the National Institutes of Health (NIH), suggested recently (Jan. 2008). The level of bone loss is at least as high as that associated with recognized risk factors for osteoporosis, including smoking, low calcium intake, and lack of physical activity.

Hip bones, the site of frequent fractures among older people, were among those showing the most thinning in depressed pre-menopausal women. After bone mass reaches its peak in youth, bone-thinning continues throughout life, accelerating after menopause. “Now we know that depression can serve as a red flag — that depressed women are more likely than other women to approach menopause already at higher risk of fractures," said NIMH Deputy Director.

Blood and urine samples also showed that depressed women have imbalances in immune-system substances, including those that produce inflammation, compared to their healthy peers. Compared to the others, the depressed women in this study had higher levels of immune-system proteins that promote inflammation, and lower levels of those that prevent it. This additional finding strengthens the case for a suspected link between depression-induced imbalances in the immune system and accelerated bone loss. "Depression generally isn’t on clinicians’ radar screens as a major risk factor for osteoporosis, particularly for pre-menopausal women. It should be," said the researcher of this study.

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