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Osteoporosis in Women
With the availability of highly sensitive, safe and accurate markers of bone mass and density, it is possible to foretell the potential victims of osteoporosis and initiate appropriate therapy.
Prevention is usually better than cure, and constitutes one of the premier therapeutical strategies. Measures of importance relate to the establishment of peak bone mass in young adulthood. Several studies have supported the view that dietary calcium intake in the formative years of skeletal growth is an important determinant of peak bone mass.
Therefore, sufficient calcium intake has become a vital component of any preventive regimen. Specific guidelines have been issued by FDA. For women who are not yet menopausal, as well those who are taking HRT (up to the age of 65) an intake of 1000mg daily is recommended.
For women beyond the age of 65, as well as women over 50, who choose not to take HRT, 1500mg of calcium per day is advised. Along with calcium, adequate Vitamin D supplementation is required.
Another helpful preventive measure is a scientific exercise programme. A positive association has been reported between activity levels and bone density at several skeletal sites in growing children. Other non-pharmacologic approaches towards prevention and therapy of osteoporosis involve certain dietary modifications such as avoidance of excessive sodium and protein intake.
Diets high in sodium can cause higher urinary calcium excretion, while the acid load of high protein diets can draw heavily upon bone buffer stores, thereby releasing calcium. Smoking is contraindicated while alcohol should be taken with moderation.
Pharmacological Therapy: Most of the pharmacological therapies now available are based on inhibiting bone restoration. Calcium administration is a key treatment strategy in osteoporosis. Vitamin D supplementation should be provided concomitantly. It is now generally felt that the official recommendation for Vitamin D intake of 400 IU should be increased to 600-800 IU in the elderly.
The importance of estrogen in preventing post-menopausal bone loss has been established unequivocally. But this requires indefinite estrogen therapy since it has been observed that bone loss resumes whenever estrogen therapy is withdrawn. Estrogen replacement therapy provides two major benefits- protection against osteoporosis and cardio-vascular diseases.
These benefits need to be balanced against two potential risks. The apparent risk of uterine cancer is essentially negated by the fact that the pro-gestational agent is part of the regimen when uterus is present. Breast cancer, however, continues to be a potential risk for those taking long-term estrogen therapies.
Among other pharmacological therapies, both inject able and nasal calcitonin has been approved by FDA for the therapy of established osteoporosis in post-menopausal women. Bisphosphonates are another group of drugs used in the management of osteoporosis.