What does osteoporosis mean for women?
Women have a higher lifetime risk of osteoporotic fractures than the combined risk of breast cancer, endometrial cancer, and ovarian cancer.
Shocking, isn't it? The bronze-level player you thought was actually a king!
Osteoporosis is particularly prevalent among postmenopausal women. A 2016 survey showed that the prevalence of osteoporosis among women over 60 years old in China was as high as 49%.
In addition, it has another characteristic: it often has no symptoms at the beginning. As the disease progresses, obvious symptoms such as stunted growth, hunchback, bone pain, and even fractures appear, earning it the nickname "silent killer."
The reason why osteoporosis is so prevalent among postmenopausal women is mainly due to the decline in ovarian endocrine function after menopause, resulting in a decrease in estrogen levels, which leads to bone resorption by osteoclasts exceeding bone formation by osteoblasts.
Those who build buildings can't compete with those who demolish them; their backbone will inevitably weaken.
Therefore, early prevention and treatment to strengthen bones is the key.
A freshly baked guide to teach you a few tricks
According to the latest guidelines released by the Endocrine Society (TES), there are seven main categories of drugs included in the list of "medications for the treatment of postmenopausal osteoporosis".
I. Bisphosphonates
Mechanism of action: Bone resorption inhibitor
Representative drugs: alendronate, risedronate, zoledronic acid, and ibandronic acid.
Main features:
① Primarily used as an initial treatment option for postmenopausal women at high risk of fracture.
② However, it is not recommended to use ibandronate to reduce the risk of non-vertebral or hip fractures.
Course of medication:
① Reassess fracture risk after 3-5 years of medication. If the risk of fracture remains high, continue treatment. If the risk is low to medium, consider a "bisphosphonate vacation" (i.e., temporarily discontinue bisphosphonates for up to 5 years).
② If a bisphosphonate vacation is started, the risk of fracture should be reassessed every 2-4 years, and the possibility of restarting osteoporosis medication should be considered.
Precautions: Because this type of drug is in oral form, it can easily irritate the digestive tract mucosa. Therefore, it should be used with caution by patients with gastric and duodenal ulcers or reflux esophagitis.
II. Dinosumab
Mechanism of action: Bone resorption inhibitor
Key features: For postmenopausal women with osteoporosis at high risk of fracture, it can be used as an alternative to initial treatment.
Course of medication:
① The recommended dose is 60 mg subcutaneously every 6 months.
② Denosumab needs to be taken on time; otherwise, the bone remodeling effect will reverse after 6 months. Therefore, medication breaks or treatment interruptions are generally not recommended for this drug.
③ It is recommended to reassess the fracture risk after 5-10 years of medication. If the risk of fracture is still high, continue using denosumab or adopt other osteoporosis treatment options.
III. Parathyroid hormone analogs
Mechanism of action: Bone formation promoter
Representative drugs: Teriparatide and Abapatide
Key features: This type of medication is recommended for postmenopausal women with osteoporosis and a high risk of fractures, such as those with severe or multiple vertebral fractures.
Treatment duration: This drug may increase the risk of osteosarcoma formation after 2 years of use. Therefore, the current instructions stipulate that the treatment time should not exceed 2 years. Furthermore, the guidelines recommend that after teriparatide or abapatide treatment, anti-bone resorption drugs (such as bisphosphonates, hormone therapy or selective hormone receptor modulators) should be used to maintain increased bone density.
IV. Romozolomide – Added to the 2020 TES Guidelines
Mechanism of action: It can increase bone formation and reduce bone resorption.
Key features: For postmenopausal patients with osteoporosis at very high risk of fracture, such as severe osteoporosis (i.e., low T value, T < -2.5 and presence of fracture) or multiple vertebral fractures, it is recommended to use for 1 year to reduce vertebral, hip and non-vertebral fractures.
Course of medication:
①The recommended dose for subcutaneous injection is 210 mg per month for 12 months.
② In postmenopausal women with osteoporosis who have completed the course of this medication, it is recommended to use anti-resorption drugs.
Precautions: This medication is not currently recommended for women with a high risk of cardiovascular disease (such as myocardial infarction) or a history of stroke.
V. Selective estrogen receptor modulators
Mechanism of action: Bone resorption inhibitor
Representative drugs: Raloxifene, Bardoxifene
Key features: Suitable for patients with low risk of deep vein thrombosis, high risk of breast cancer, and who are not suitable for bisphosphonates or denosumab.
Precautions: This drug may slightly increase the risk of venous thrombosis. It is contraindicated in patients with a history of venous thrombosis or a tendency to thrombosis.
VI. Hormonal drugs
Mechanism of action: Bone resorption inhibitor
Representative drugs: estrogen, progesterone, tibolone
Main features:
① Hormonal drugs may be considered when the patient has the following characteristics: less than 60 years of age or less than 10 years since menopause; low risk of deep vein thrombosis, making bisphosphonates or denosumab unsuitable; vasomotor symptoms; menopausal symptoms; no contraindications; no history of myocardial infarction or stroke; no breast cancer; and is willing to receive menopausal hormone replacement therapy.
② For women who have had a hysterectomy, estrogen therapy is used only.
Precautions: Long-term use may increase the risk of breast cancer and endometrial cancer, so regular check-ups of the breasts and endometrial hyperplasia are necessary.
VII. Calcitonin
Mechanism of action: Bone resorption inhibitor
Key features: Calcitonin nasal spray is only for postmenopausal women at high risk of osteoporosis who cannot tolerate or are not suitable for the above medications.
After gaining a general understanding of medications, let's learn about the principles of nutrient supplementation.
The perfect duo for bones: Vitamin D and calcium
Calcium and vitamin D are a perfect pair, and their intake is crucial for preventing and treating osteoporosis. They are often used in conjunction with osteoporosis medications.
The recommended daily intake of calcium for the elderly and patients with osteoporosis is 1000-1200 mg/day, and the recommended daily intake of vitamin D3 is 800-1200 IU/day.
Vitamin D supplementation
Vitamin D supplements are divided into regular vitamin D and active vitamin D.
Regular vitamin D is primarily used for vitamin D supplementation in healthy postmenopausal women.
Active vitamin D is more suitable for the elderly, those with impaired kidney function, and patients with osteoporosis who have a deficiency or reduction in 1α-hydroxylase.
Of course, besides supplements, the most important way to supplement vitamin D is to get some sun (between 10 a.m. and 3 p.m., twice a week, exposing both upper and lower limbs to sunlight for 5-30 minutes).
Secondly, you can eat more foods rich in vitamin D, such as fresh shiitake mushrooms, salmon, milk, and eggs.
Calcium supplementation
Try to get as much calcium as possible through your diet. Foods rich in calcium include: dried shrimp, cheese, whole milk powder, sesame seeds, dried kelp, milk, and eggs.
When dietary calcium intake is insufficient, calcium supplements can be given.
However, before taking calcium supplements, blood calcium and urine calcium levels should be measured, and dietary calcium intake should be taken into account to prevent hypercalcemia, which increases the risk of kidney stones and cardiovascular disease.
Also note that vegetables high in oxalic acid (such as spinach and amaranth) can reduce calcium absorption, so try to avoid taking them with calcium supplements.
These are the seven categories of medications and nutritional supplements recommended in the latest TES guidelines. There is no distinction between high and low quality or expensive and cheap medications; the best one is the one that suits you.
Of course, for postmenopausal women at high risk of osteoporosis, nutritional elements can only be used as an adjunct to medication and cannot be used alone to treat osteoporosis.
Finally, it is recommended that women over 50 years of age undergo an osteoporosis risk assessment for early prevention and treatment, leading to better health.
For postmenopausal women with low bone mineral density, high risk of fracture, and undergoing osteoporosis treatment, it is recommended to monitor bone mineral density in the spine and hip every 1-3 years using dual-energy X-ray absorptiometry to assess treatment effectiveness.
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