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Osteoporosis a preventable menopausal concern
Screening key to maintaining bone density
Published Thursday, April 12, 2012 7:12 am
by Yvette Bessent M.D.

Yvette Bessent M.D.

This column is one of a regular series of columns submitted by Carolinas HealthCare System Physician Diversity Advisory Committee. For more information go to www.carolinas.org.

Many women are familiar with the term, “osteoporosis,” but for some an understanding of its precursor, osteopenia, and its manifestation in the menopause remains elusive.

Osteopenia represents a low bone mass or increased fragility of the bony architecture.  An inability to prevent the progression of this problem leads to osteoporosis. Both conditions are known to increase the risk of hip and spine fracture. Hip fracture patients are widely known to have a 20 percent illness and potential death rate, usually secondary to blood clotting complications. Spinal fractures are actually more common and account for issues with pain, deformity, loss of mobility and detrimental effects on other organ systems. 

Approximately 20 percent of women age 50 and older have osteoporosis, while another 30 to 50 percent have osteopenia. The precursor is largely preventable and reversible with timely and accurate screening and the institution of medical interventions.

Bone is constantly being remodeled in that it is formed and broken down by specific cells on the surface. The process remains in balance and bone mass peaks at about 30 years of age. However, in the first five to eight years after menopause, women lose up to 2 to 5 percent bone per year. The balance of the remodeling becomes more disturbed in women than men as a result of menopausal changes that result in fragility.

There are multiple risk factors contributing to the incidence of osteoporosis in women. Some significant factors include: family history, prior history of fracture, Caucasian or Asian race, smoking, low body weight coupled with small or petite frame, low calcium intake, certain medical conditions and certain medications.

The primary screening tool used to evaluate potential bone loss is dual energy X-ray absorptiometry, better known as a DEXA scan. This scan measures bone mass which accounts for a large part of bone strength. Osteopenia is a density measurement somewhat better than that for osteoporosis. The DEXA scan for the hip and spine is the preferred method to evaluate bone mass because of its high precision and accuracy and modest radiation exposure. Other tests sites, i.e. wrist, ankle, can possibly identify low bone mass but might not be as useful as hip and spine due to lack of precision.

The timeframe for screening is debatable and should be based on each individual woman’s risk factors. It should be kept in mind that the highest rate of change is usually 3-5 years after the onset of the menopause. Women found to have osteopenia should be evaluated for lifestyle changes that could reverse their findings. Sedentary lifestyle is associated with reduced bone mass and weight-bearing exercise stimulates new bone formation and increases in muscle mass. Both of these are components which increase bone strength.

Vitamin supplementation can be used as additional therapy for improvement in bone loss. Recommended daily requirements for bone health during menopause are 1200-1500 mg of calcium and 800-1000 vitamin D. 

Women should be educated about the known preventive measures they can take to help assure adequate bone health. These measures include: calcium and vitamin D supplementation, consistent exercise, smoking cessation, fall prevention practices and perhaps decreasing alcohol consumption. 

Screening tests should begin for women based on their risk factors, and a DEXA scan should be considered the test of choice over an ankle or wrist evaluation. Abnormal results should be treated and re-screenings scheduled at two-year intervals as changes in bone density need not be assessed sooner.

Yvette E Bessent MD practices at Northcross Obstetrics & Gynecology Associates in Huntersville.


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