Study of Bone Density in Menopausal and Perimenopausal Women

Arunmozhi, P (2006) Study of Bone Density in Menopausal and Perimenopausal Women. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: Improved healthcare services and socio economic growth has lead to increase in the life expectancy at birth and the number of elderly persons in our country. This has posed a new challenge to the health needs and care of elderly men and women. The menopause is that point in time when permanent cessation of menstruation occurs following the loss of ovarian activity. The years prior to menopause that encompass the change from normal ovulatory cycles to cessation of menses are known as the perimenopausal transitional years, which is marked by irregularity of menstrual cycles. Epidemiological studies have shown that during this phase women are at increased risk for arterial diseases, prone to urogenital problems and osteoporosis. Of these, osteoporosis is the most common consequence of menopause and currently is considered a major public health concern. Osteoporosis and its associated risk of fractures are preventable if diagnosed in time. Half of all the post menopausal women will have an osteoporosis related fracture during their lives including one quarter who will develop a vertebral deformity and 15% who will suffer a hip fracture. As early as 1975 it was acknowledged that bone density measurements were related to future fracture risk. In the 1990’s, the magnitude of this risk in relation to the age and bone density was carefully measured in several well designed longitudnal studies. Several techniques exists for measuring bone mass or density. Quantitative Ultrasound (QUS) is a newer evolving promising technique which is finding increasing application. Retrospective and prospective studies have shown that QUS may be an alternative or complementary investigation to Dual Energy X-Ray Absorptiometry (DXA). QUS has been used in this study as a screening tool as it is inexpensive relatively portable and free of ionizing radiation. AIM OF THE STUDY: 1. To assess the level of osteoporosis in perimenopausal and menopausal Women. 2. To screen the post-menopausal women having either natural or surgical menopause who are at high risk to have fractures. 3. To analyze the role of risk factor in identifying high risk women. MATERIALS AND METHODS The present study has been conducted taking 98 perimenopausal and 112 postmenopausal women in age group from 40 and above between the period of Jan’04 to Aug ’05. The study was conducted at Kilpauk Medical College, Kilpauk, Chennai Study Design: Randomized prospective study. Inclusion Criteria: Perimenopausal women age ≥ 40 yrs. Post menopausal women who had experienced surgical/natural menopause irrespective of age. Exclusion Criteria: 1. Women with preexisting atraumatic fracture. 2. Patients with secondary osteoporosis. 3. Women with chronic illness. 4. Women with current use of thyroid hormones or any other drug that might affect bone mass like diuretics, anticonvulsants, barbiturates. SUMMARY: • 98 perimenopausal women and 112 post menopausal women from age group 40 years and above were selected according to the inclusion and exclusion criteria. • The mean age of the study group was 52.72 years. • 11.42 % of the study population had undergone surgical menopause. • The mean age of the women who had undergone surgical menopause was 48.83 years and 59.76 years was the mean age of the study group who had experienced natural menopause. • 81% of the population were from urban area and 53% of the study population had no formal education. • 29% of the study group had a BMI less than 25. • Bone density was measured in the right heel using Achilles Lunar Calcaneal Ultrasound. • The results were interpreted using T-Score and Z-Score criteria for osteopenia and Osteoporosis. • A body mass index less than 25, family history of fracture, lack of physical exercise, high caffeine intake, low calcium intake were associated with osteoporosis and the association was found to be statistically significant for each of the above risk factors. • In the perimenopausal women, 21% had osteopenia and 8% had osteoporosis. • In the menopausal women, 44% had osteopenia and 14% had osteoporosis. • In the women who had undergone surgical menopause, 54% had osteopenia and 21% had osteoporosis. • 76% of the study group had a normal bone density when compared to mean bone density for persons of the same age and 24% had low bone density. CONCLUSION: By its nature osteoporosis progresses silently for years without symptoms and is therefore a “silent bone thinning disease” without symptoms. The bone is a mineral bank whose assets must be built up, maintained and protected. The development of lifelong habits of nutrition and weight bearing exercise, avoidance of risk factors that promote the development of osteoporosis and timely management to decrease the withdrawal of bone from the bank are necessary to protect these vital assets from the silent thief osteoporosis. Bone densitometry has well established usefulness in assessing osteoporosis and fracture risk. Although DEXA (Dual Energy X-Ray Absorptiometry) is the Gold Standard test in the diagonosis of osteoporosis, DEXA has the following disadvantages. • The equipment is costly and is not portable. • The procedure involves radiation exposure. • It is available only in specialist institution. • It requires time and operator skill. The cost of DEXA precludes its use for screening purposes, especially in developing countries like India where maternal and child health programs receive major chunks in funds from health budget and financial support to programs for geriatric health problems may be negligible. This is a small clinical trial to study the bone mass of perimenopausal and menopausal women and to diagnose the level of osteoporosis in the community. Calcaneal ultrasound is newer evolving promising tool to assess bone density as it is precise, noninvasive, quick and cost effective.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Bone Density ; Menopausal ; Perimenopausal Women.
Subjects: MEDICAL > Obstetrics and Gynaecology
Depositing User: Subramani R
Date Deposited: 05 Dec 2017 16:05
Last Modified: 05 Dec 2017 16:05

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