Osteoporosis is defined as “the wasting away of bone” and the term literally means “porous bones”. It is often called the silent epidemic as many people can be unaware of its onset and the first indication of the disease can be falling and breaking a bone. It has been considered a natural part of aging although with treatment it is largely preventable.Dr Frederick S Kaplan, a professor of orthopaedic surgery at the University of Pennsylvania describes osteoporosis in the following way:
“if hypertension is a silent killer, osteoporosis is a silent thief. It insidiously robs the skeleton of its banked resources, often for decades, until the bone is weak enough to sustain a spontaneous fracture”
Osteoporosis is most common in the elderly and in post-menopausal women. It is caused by the loss of calcium from the bones. Bones continue to grow and develop throughout childhood and adolescence and the bones are at their most dense around the age of 30, after this the bone mass gradually diminishes. The Royal College of Physicians in the United Kingdom has indicated that the incidence of hip fractures has risen by 254% between 1954 and 1983 and has been rising ever since. Dr Sandra Cabot states that the disease currently affects one in every three women in western society.
Andrew Hampson has identified oestrogen deficiency in women as one of the most important factors in the development of osteoporosis for women and John Studd has stated that women undergoing hysterectomy before they would normally go through the menopause are “more likely to develop osteoporosis” than those in the same age group. Oestrogen deficiency occurs after the onset of the menopause. However, although oestrogen deficiency is a major factor there are others to take into account these include:
- Race, if you are white or Asian you are slightly more at risk
- Build, if you are fine boned you will have a higher risk
- Being Underweight
- Diet consistently low in calcium and high in phosphates
- Excessive Alcohol and Caffeine intake
- Family history of Osteoporosis
- Lack of exercise
- Use of Cortisone-like drugs
- Vitamin deficiency
- Being a Woman, it is estimated to be six to eight times more common in women than in men as women have a lower bone mass to start with.
There are two types of osteoporosis. Type 1 is caused by a lack of sex hormones and results in loss of the inner layer of bone called the trabecular bone. Type 2 is caused mainly by a lack of calcium and/or vitamin D in the diet, this causes a loss of the outer layer of the bone called the cortical bone.
From the above it is obvious then that a woman who goes through the menopause early, due to having a hysterectomy, will be more at risk of type 1 osteoporosis as she will have longer without oestrogen. Women that have consistently light periods and/or have a time without menstruating at all will also be more at risk from this type of oestrogen.
There are three hormones that control the calcium levels in the blood, they are the parathyroid hormone, 1,25 dihydroxy-vitamin D and calcitonin. They also control the uptake of calcium by the bones. The rate of absorption varies through out your life and is decreased by the risk factors outlined above and increased at times of hormone increase such as during pregnancy. Cells called osteoblasts work on the creation of new bone and cells called osteoclasts work to reabsorb calcium into the blood, it is this re-absorbtion into the blood stream that causes osteoporosis.
It has been recommended that all women have a bone mineral density (BMD) test before they undergo a hysterectomy, this will determine how strong your bones are to start with and will provide a point of reference for later on. After the menopause, if you do not wish to take Hormone Replacement Therapy, it would be advisable to have regular BMD tests to ensure your continued health.
Regular blood tests to determine your levels of oestrogen are also recommended, particularly if you have a hysterectomy that leaves your ovaries intact. Your GP or gynaecologist should be able to arrange both of these procedures for you.
The most common way to prevent osteoporosis due to poor oestrogen levels is to boost the levels with Hormone Replacement Therapy. Hormone Replacement Therapy (HRT) puts oestrogen back into the body, that would normally have been produced by the ovaries. HRT has been shown to retard, stop and even reverse bone loss after the menopause. It is recommended that HRT is taken for a period of not less than five years, if it is taken after a natural menopause, to give a maximum effect of prevention.
Exercise is also recommended as this helps to strengthen bones and keep them strong. However, the type of exercise is very important, it should be regular and it should be weight bearing. Weight bearing exercises include any type of exercise that involves upright movement so that pressure is exerted through the spine, pelvis and legs and includes walking, jogging, aerobics and yoga.
Diet is also particularly important, it should contain high levels of calcium and vitamin D (Vitamin can also be obtained from being out in the sunshine) and should be low in fat and high in fibre.
There are many good books about osteoporosis and its prevention, your local library will have a selection of them. Some of the best are supported by the National Osteoporosis Society. You can also check the resources section of this site for other links and books.
The National Osteoporosis Society works towards eradicating osteoporosis through education and information. It is a charitable organisation that is independent, unbiased and has a panel of specialist medical advisers.
The Pocket Guide to Hysterectomy – £5.50 from The Hysterectomy Association. This is essential reading and tell you everything you need to know about the menopause after a hysterectomy.