Osteoporosis: The Silent Threat to Menopausal Women

For menopausal women, health problems may not only be those clearly visible, such as hot flashes, insomnia, vaginal dryness, urinary tract infections, and deteriorating cognitive quality, but there is also a significant silent threat: osteoporosis, which mostly shows no symptoms until a fracture or break occurs.

What is Osteoporosis?

Osteoporosis is a condition where bone mass or bone density decreases, resulting in reduced bone strength. When bones become osteoporotic, they become fragile and are at risk of breaking easily even from minor impacts.

Normally, bone mass accumulates to its peak between the ages of 25-30, which is when hormone levels are at their highest. Bone mass remains stable until about age 40, after which it gradually decreases by an average of 0.5-1% per year. The extent of this decrease depends on lifestyle factors such as diet, exercise, certain diseases, medication use, and importantly for women, menopause.

Most women enter menopause between the ages of 48-52, during which the body begins to lack estrogen, a hormone responsible for promoting bone mass formation and preventing bone loss. Without estrogen, bone mass rapidly decreases because bone resorption exceeds formation. In the first 5 years after menopause, bone mass can decrease by as much as 3-5%. The bones most affected are those rich in spongy bone, such as the spine, thigh bones, and wrist bones. Without diagnosis and prevention, osteoporosis may only be detected after a fracture has occurred.

Preparing Your Health Before Osteoporosis Occurs

All women should learn to take care of themselves as they approach menopause, before developing low bone mass. If menstrual cycles become irregular, hormone testing and bone density scans should be performed. Since sex hormones affect other hormones that regulate aging and degeneration, testing for sex hormones and related hormones is recommended to prevent overall body degeneration and maintain long-term good health.

If bone mass is found to be decreasing or if there is low bone mass or osteoporosis, hormone replacement therapy (HRT) should be considered for those without contraindications, who are within the age range to benefit from hormones, and who do not have vascular degeneration issues, especially vascular calcification.

Menopausal women benefit from hormones in many ways, primarily by strengthening bones, reducing the risk of cardiovascular disease and diabetes, improving sleep quality, enhancing mood, reducing anxiety and depression, and improving skin strength and moisture, which helps reduce wrinkles.

Forms and Types of Hormone Replacement Therapy

With the current forms and types of hormone replacement therapy, combined with highly safe usage measures and extensive supporting research, proper use of hormone replacement therapy does not increase the risk of breast cancer or endometrial cancer.

In addition to hormone replacement therapy, menopausal women should also receive essential nutrients to enhance bone quality and strength as follows:

1. Calcium: It is recommended to consume 1000 mg per day. The best sources are natural foods such as low-fat milk, small fish, small shrimp that can be eaten whole, dark green leafy vegetables, and sesame seeds. If intake is insufficient, calcium supplements should be taken, preferably those derived from natural products such as corn or fish flakes, which are better absorbed than synthetic calcium. Besides calcium, other minerals that help strengthen bone tissue include magnesium, boron, strontium, zinc, and manganese, which should also be taken in appropriate amounts. If unsure, consult a doctor before starting supplementation.
2. Vitamin D: All women should maintain vitamin D levels of at least 30 ug/ml to aid calcium absorption from the digestive tract, regulate the process (which requires vitamin K2) of transporting calcium into bones, enhance insulin response from the pancreas, and support immune system cells. Importantly, almost all tissues in the body require vitamin D to help prevent chronic non-communicable diseases, including nearly all types of cancer. Normally, human skin synthesizes vitamin D well from sunlight between 10:00 AM and 2:00 PM. If liver and kidney function are good, 20-30 minutes of sun exposure during this time increases vitamin D activity.
3. Vitamin K2: This vitamin is important for the function of the protein osteocalcin, which is produced by bone-forming cells under the influence of estrogen. Vitamin K2 helps deposit calcium in bones and teeth, prevents calcium buildup in tissues and organs, and also prevents calcium precipitation in the urinary tract, thus playing a role in preventing kidney stones.

Currently, Thailand has fully entered an aging society. Preventing degenerative diseases is therefore a top priority, and osteoporosis is a silent threat that can be prevented if all women pay attention to their health care.