Postmenopausal Women and Osteoporosis

Postmenopausal osteoporosis is a silent disease with not much of symptoms until fractures occur. It is characterized by low bone mineral density (BMD) and changes in bone microarchitecture that reduces bone strength and there is increase in risk of fractures [1]. After menopause, estrogen deficiency is the major contributing factor. Because of this there is an increase in RANK-ligand (RANKL) and a decrease in osteoprotegerin (OPG) secretion from osteoblasts. This imbalance induces fast bone loss, and thus there is increase in risk of fractures. WHO has identified osteoporosis as a major public health concern [2]. Osteoporosis is widely recognized as an important public health problem because of the significant morbidity, mortality and costs associated with its complications-namely fractures of the hip, spine, forearm and other skeletal sites [3]. The incidence of fragility fractures is highest among elderly white women, with one in every two women suffering an osteoporosis related fracture in their lifetime [4]. Each year in the UK an estimated 260 000 osteoporotic fractures occur among women aged 50 years and over, including over 70000 cases of hip fracture [5,6]. For the Indian population, the exact figures on the prevalence of osteoporosis are not available, but the estimation is that more than 61 million Indians have osteoporosis with women accounting for 61% of them [7,8].

A study was done to determine the prevalence of osteoporosis in Indian women and reported that 106 of the studied 200 patients had low BMD (osteopenia and osteoporosis) [9]. According to WHO criteria, osteoporosis is defined as the T-score of less or equal to 2.5 and osteopenia as the T-score between 1.0 and 2.5. The femoral neck and lumbar spine are recommended as the anatomic region of interest [10]. BMD decreases with age; thus, primary osteoporosis mainly occurs in women 10-15 years after menopause. Although for many years there was awareness of the morbidity and mortality associated with fragility fractures, but real progress only came with the ability to diagnose osteoporosis with BMD machines before the occurrence of fractures. Measurements of bone mineral density (BMD) played a crucial role. Until the mid-1980s bone density measurements were used mainly for research, and it was only with the introduction of dual‐energy x ray absorptiometry (DEXA) scanners in 1987 that they entered routine clinical practice [11]. The lumbar spine (lower back) and the hip are the skeletal sites usually examined by bone densitometry.

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