prof. Dr. Sezai ŞAHMAY
İ.Ü. Cerrahpaşa Faculty of Medicine, Department of Obstetrics and Gynecology, Department of
Reproductive Endocrinology
Contrary to popular belief, bone tissue has an extremely active structure. Adult bone tissue is a system in which the bone continues to take shape and, in a sense, renews itself in a constant balance of destruction and construction.
Nutritional balance and quality, which starts in the womb in humans, significantly affect the bone structure. Bone structure is stronger in people who are fed with a balanced and calcium-rich diet. The strengthening of this bone structure continues until the age of 30-35. However, after these ages, natural losses in bone structure (osteoporosis) begin. These losses accelerate after menopause. The reason for the increase in the rate of osteoporosis after menopause is not known exactly. However, estrogens are likely to have a direct or indirect effect on bone metabolism. In other words, the period in which the bone structure is strongest in women is around the age of 35, and bone loss begins after this age.
Osteoporosis can be defined as a decrease in bone density, that is, loss of bone tissue. Osteoporosis is one of the aging events in humans.
Along with menopause, both bone formation and bone destruction accelerate, but the balance between them deteriorates. Destruction is more rapid, resulting in net bone loss of between 1% and 5% each year. This rapid period of osteoporosis ends 10-15 years after menopause. By the time a woman reaches 70, she has lost about half of her bone mass compared to pre-menopausal. Many factors can affect the speed of osteoporosis. Risk factors for osteoporosis are summarized in Table-1.
Bone loss, which is called osteoporosis in the medical language, is an aging event that starts after the age of 30-35 in women and 45 in men. However, this loss in women accelerates significantly in the postmenopausal period. In other words, bone loss increases after menopause. This can be considered a physiological event. However, the risk of osteoporosis is even higher in those who have had an early menopause, those who have not given birth, those with a family history of osteoporosis, those who are weak, those who are less physically active, and those who smoke and drink alcohol. (Table-1)
All postmenopausal women experience bone loss at different rates. However, this amount of loss in bones reaches the limit of bone fractures in some women. Two main factors affect fracture formation.
The most important consequence of bone loss is that it results in bone fractures. About half of women will have osteoporotic fractures during their lifetime.
As a result of compression fractures in the spine, slight forward bending (hunching) and short stature draw attention in women. (Figure-3) More serious fractures can be seen usually 10-15 years after menopause. The risk of this fracture increases with age and is about 50% in a 70-year-old woman. As a result of these bone fractures, the death rate is 5-25%, and the disability rate after treatment is 50-80%, depending on the age and activity status of the person.
Generally, the decrease in bone density does not give clinical findings, up to the extent that fractures occur. The occurrence of fractures with minimal trauma is an inevitable consequence of osteoporosis. In fact, fractures seen in older people do not fall because the patient falls, but because the bone breaks spontaneously. The most common fractures resulting from postmenopausal bone loss are wrist, arm, spine and hip (femoral neck) fractures due to falls. Spine fractures, which are seen in a quarter of women over the age of 65, do not usually cause any complaints, but appear with long-term shortening and hunching (dorsal kyphosis). Although it is seen later and rarely, femoral neck fractures are the most feared complication after menopause. The 6-month mortality rate in hip fractures in the postmenopausal period is 10%, 1. at the end of the year, it is reported as 27%. The cause of death in these patients is respiratory system infections due to inactivity and vascular clot occlusions (embolism). Sequelae remain in half of those who can recover, and they cannot return to their former state.
However, the above-mentioned post-menopausal osteoporosis unjustifiably leads to excessive fears of patients. Media misdirection plays a major role in this. It causes unnecessary frequent bone density measurements and unnecessary drug use. Bone density measurements should be made no earlier than 2-3 years. Most of the non-hormonal drugs used also increase bone density, but unfortunately reduce fragility. Another issue is that our country is among the countries with the strongest bone structure and the lowest fracture rate among European countries.
