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MENAPOUSA ( LONG TERM COMPLICATION)
Osteoporosis is caused by estrogen deficiency after menopause. It leads to reduced bone density and increased fracture risk. Over 50% of postmenopausal women suffer osteoporotic fractures. Risk factors include advancing age, family history, smoking, excessive alcohol, low body weight and falls. Diagnosis involves testing for bone mineral density loss using DXA scanning or calculating fracture risk with FRAX. Prevention focuses on exercise, nutrition, fall prevention and medications. Cardiovascular disease risk rises after menopause due to declines in estrogen and HDL cholesterol and increases in blood pressure and LDL cholesterol. Risk is assessed through history, exams and testing to determine prevention strategies. While estrogen was thought to benefit brain function,
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MENAPOUSA ( LONG TERM COMPLICATION)
- 1. Long term complicationof menopause Osteoporosis Dementia Cardiovascular disease Medical student MBBS year 4 UniSZA – Siti hamidah
- 2. OSTEOPOROSIS • Mainly inpostmenopausal • Estrogen as antiresorptive agent on bone • Estrogen deficiency reduced bone density, increased bone fragility fracture risk • 50% women suffer osteoporotic fracture • Preventive measure of high risk Ministry of Health Malaysia (2012). Clinical Practice Guidelines:Osteoporosis. Malaysia
- 3. Risk of osteoporoticfracture in postmenopausal women Non-modifiable 1. Advancing age 2. Ethnic group (Oriental & Caucasian) 3. Female gender 4. Premature menopause (< 45 years) including surgical menopause 5. Family history of osteoporotic hip fracture in first degree relative 6. Personal history of fracture as an adult Modifiable Low calcium and/or vitamin D intake Sedentary lifestyle Cigarette smoking. Excessive alcohol intake (>3 units/day) Excessive caffeine intake (>3 drinks/day) Low body weight (BMI < 19kg/m2) Estrogen deficiency Impaired vision Recurrent falls Ministry of Health Malaysia (2012). Clinical Practice Guidelines:Osteoporosis. Malaysia
- 4. Presentation asymptomatic and diagnosisis made only after a fracture Common: 1. Increasing dorsal kyphosis (Dowager’s hump) 2. trauma fracture 3. Loss of height 4. Back pain Ministry of Health Malaysia (2012). Clinical Practice Guidelines:Osteoporosis. Malaysia
- 5. diagnosis • made afterexcluding secondary causes • history, physical examination • laboratory investigations gold standard bone mineral density (BMD) using dual energy x-ray absorptiometry (DXA). If not available, calculating the risk of fractures using Fracture Risk Assessment Tool (FRAX) can help in deciding treatment strategies Ministry of Health Malaysia (2012). Clinical Practice Guidelines:Osteoporosis. Malaysia
- 6. criteria • individual's age(40-90 y) , sex, weight, height, prior fracture, parental history of hip fracture, • smoking, long-term use of glucocorticoids, rheumatoid arthritis and alcohol consumption. Ministry of Health Malaysia (2012). Clinical Practice Guidelines:Osteoporosis. Malaysia
- 7. screening • based onage and weight, Osteoporosis • Self-Assessment Tool for Asians (OSTA), was developed for postmenopausal Asian women. Ministry of Health Malaysia (2012). Clinical Practice Guidelines:Osteoporosis. Malaysia
- 8. investigation The main aimsof investigations are to: • 1. Confirm the diagnosis of osteoporosis • 2. Assess fracture risk • 3. Exclude secondary causes Initial investigations include: • 1. Full blood count and erythrocyte sedimentation rate (ESR) • 2. Bone profile: serum calcium, phosphate, albumin • 3. Alkaline phosphatase • 4. Renal function • 5. Plain X-rays Ministry of Health Malaysia (2012). Clinical Practice Guidelines:Osteoporosis. Malaysia
- 9. Prevention • Exercise • Nutrition:Calcium,protein and vit D • Limit smoking,caffein • Fall prevention (reduced muscle strength,Low vitamin D levels,Poor vision,Hazards in the home (e.g. inadequate lighting, slippery floors) • Bisphosphonate (reduce bone absrption) • Raloxifene (selective estrogen receptor modulator) • Tibolone, selective tissue estrogenic activity regulator. Increases lumbar spine BMD by 6.6% and hip BMD by 2.8% with decrease in vertebral fractures by 45% and non-vertebral fractures by 26%. • HRT Ministry of Health Malaysia (2012). Clinical Practice Guidelines:Osteoporosis. Malaysia
- 10. Cardiovascular Diseases • Adecline in estrogen level may be a factor because it believed to have positive effect on the inner layer of arterial wall, help to keep it flexible • Associated with increase bp after menopause, LDL cholestrol increase and HDL cholestrol tend to decline (American heart association)
- 11. Refresh……. • Cardiovascular disease(CVD) includes: 1. Coronary heart disease (CHD) as manifested by angina pectoris, MI, heart failure (HF) and coronary death 2. Cerebrovascular disease manifested as transient ischaemic attack (TIA) and stroke 3. Peripheral arterial disease (PAD) manifested as intermittent claudication and critical limb ischaemia (CLI) 4. Aortic atherosclerosis and thoracic or abdominal aortic aneurysm. Although these are manifestations of atherosclerosis, in some clinical studies, they are not included in the definition of CVD CPG prevention cardiovascular disease in women 2008
- 12. CARDIOVASCULAR RISK FACTORS a)Non-modifiable risk factors 1. personal history of CHD and/or CHD equivalents 2. age (over 55) 3. family history of premature CHD b) Modifiable risk factors 1. dyslipidaemia 2. hypertension 3. diabetes mellitus/pre-diabetes 4. metabolic syndrome 5. obesity 6. smoking 7. physical inactivity CPG prevention cardiovascular disease in women 2008
- 13. Assessment of CVDrisk involves: –– History: Looking for symptoms of CHD or CHD Equivalents, family history of premature CHD, smoking status, physical activity –– Physical Examination: Height, weight, BMI, waist circumference, pulses, blood pressure –– Investigations: Blood sugar, lipid profile CPG prevention cardiovascular disease in women 2008
- 14. TOTAL CARDIOVASCULAR RISK ASSESSMENT •Framingham Risk Score (FRS) • SCORE system • WHO/ISH Cardiovascular Risk Prediction Charts CPG prevention cardiovascular disease in women 2008
- 15. RECOMMENDATIONS FOR PREVENTION OFCVD IN WOMEN • Lifestyles changes : dietary, exercise, weight reduction, stop smoking • aspirin CPG prevention cardiovascular disease in women 2008
- 16. DEMENTIA • Estrogen stimulatesthe brain’s neurotransmitter that are responsible for memory and language Healthline.com • However the link between circulating estrogen and cognitive impairment is weak • Clinical trial of midlife hormone therapy have not shown improved cognition By the north american menapouse society : www. Menapouse.org