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Osteoporosis and Estrogen

Updated: Feb 18

WHAT IS THE CONNECTION?


Osteoporosis translates to 'porous' bones, and such bones lose their solid foundation and structure; they become weak. Weak bones are more prone to fractures from minor incidents, such as falling from a standing height or even coughing. Women are twice more at risk than men for osteoporosis, and this risk increases after menopause. To comprehend this statistic, let's find out more about bones.


Bone is a tissue that is a part of the skeletal system. An important thing to know about bone is that the cells are continuously renewing the tissue. Osteoblasts (OBs) are a type of cell that will produce new bone tissue. Whereas, Osteoclasts (OCs) are a type of cell that breaks down old bone tissue. These two bone cells work together consistently; to renew bony tissue and prevent wear and tear of the bone. A balance between OBs and OCs is necessary for optimal bone health. Osteoporosis occurs when there is an imbalance between OBs and OCs. An increase in the activity of the Osteoclasts increases the breakdown of bone. But, Osteoblasts do not offset this action; because their activity decreases in osteoporosis. The outcome of this imbalance? Weak and brittle bones. The balance between OBs and OCs is not the only determinant of bone health. Nutrients play a significant role, as well. The nutrients vital for maintaining bone health are:


● Calcium

● Vitamin D

● Magnesium

● Phosphorous

● Potassium

● Vitamin C


So why do we need these nutrients? Because they are a part of the bone minerals. Bone minerals are the inorganic component of bone tissue and are essential for maintaining bone density and structure. Certain factors may increase one's risk of osteoporosis, and these are:


● Increasing age

● Sex (more common in women)

Estrogen deficiency

● Thyroid issues

● Malabsorption syndromes: these diseases prevent

the absorption of crucial nutrients from the gut

● Low body weight or Body Mass Index (BMI)

● Smoking

● Low physical activity

● A decrease in calcium and Vitamin D intake

● Excessive alcohol consumption

● Excessive caffeine consumption


In women, menopause is one of the prime risk factors for osteoporosis. The reason behind this is the decline in estrogen levels. Estrogen decreases the activity of OCs and increases the activity of OBs; as a result, bone formation increases. Estrogen also promotes mineralization of the bone, thereby increasing bone mineral density. As menopause approaches, the estrogen levels in the body fall, which means that this bone protective function is lost.


What can a menopausal woman do to protect her bone health?


● Increase the intake of Calcium and Vitamin D containing foods: Dairy products (milk, yogurt, cheese) are the primary source of calcium. If someone is following a plant-based diet, they can consume vegetables (broccoli, kale, collards, etc.), fruits, seeds, and nuts (almonds) rich in calcium. Seafood and Fish are a great source of naturally occurring vitamin D. Vitamin D aids in the absorption of calcium by the gut.


● Increase physical activity: regularly exercising increases muscle strength, maintains balance, and maintains bone density. It isn't necessary to engage in high-intensity exercises. Fast-paced walking twice or thrice a week is enough. Weight-bearing exercises or exercises against resistance improves bone density, whereas aerobic exercises increase the functions of muscles, thereby improving balance and decreasing the risk of falls.


● Hormonal Therapy with Estrogen: applying bioidentical estrogen creams which replaces the estrogen that is gone; this is the first step in the medical management of osteoporosis associated with menopause.



It is pertinent to make sure that the estrogen levels are balanced. Hormonal therapy increases the formation of blood clots, which increases the risk of stroke and cardiovascular diseases. Like any prescribed medication, the benefits and risks of taking hormonal therapy are assessed for every individual.


Estrogen plays a role in maintaining bone health, and its fall is associated with osteoporosis. Because of this critical association, women are more likely to suffer from osteoporosis. Menopause is sure to happen, but we can decrease our chances of osteoporosis by maintaining a balanced healthy diet, exercising more often, and monitoring our estrogen levels.









REFERENCES


1) Tella SH, Gallagher JC. Prevention and treatment of postmenopausal osteoporosis. J Steroid Biochem Mol Biol. 2014 Jul;142:155-70. DOI: 10.1016/j.jsbmb.2013.09.008. Epub 2013 Oct 29. PMID: 24176761; PMCID: PMC4187361.


2) Bijelic R, Milicevic S, Balaban J. Risk Factors for Osteoporosis in Postmenopausal Women. Med Arch. 2017 Feb;71(1):25-28. DOI: 10.5455/medarh.2017.71.25-28. Epub 2017 Feb 5. PMID: 28428669; PMCID: PMC5364787.


3) Caputo EL, Costa MZ. Influência do exercício físico na qualidade de vida de mulheres pós-menopáusicas com osteoporose [Influence of physical activity on quality of life in postmenopausal women with osteoporosis]. Rev Bras Reumatol. 2014 Nov-Dec;54(6):467-73. Portuguese. doi: 10.1016/j.rbr.2014.02.008. Epub 2014 Sep 28. PMID: 25458028.


4) Rizzoli R, Bischoff-Ferrari H, Dawson-Hughes B, Weaver C. Nutrition and bone health in women after the menopause. Women’s Health (Lond). 2014 Nov;10(6):599-608. DOI: 10.2217/whe.14.40. PMID: 25482487.


5) Price, C. T., Langford, J. R., & Liporace, F. A. (2012). Essential Nutrients for Bone Health and a Review of their Availability in the Average North American Diet. The open orthopaedics journal, 6, 143–149. https://doi.org/10.2174/1874325001206010143


6) Palacios C. The role of nutrients in bone health, from A to Z. Crit Rev Food Sci Nutr. 2006;46(8):621-8. doi: 10.1080/10408390500466174. PMID: 17092827.

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