Women are more likely to have osteoporosis because of hormonal changes of menopause which make bone loss worse. The female hormone oestrogen is essential for healthy bones. Causes for osteoporosis can be decrease in estrogen in women at the time of menopause.After the menopause, oestrogen levels fall. This can lead to a rapid decrease in bone density.

In recent years, osteoporosis has become a leading cause of morbidity and mortality in elderly women. Research has demonstrated that the prevention of osteoporosis and osteoporosis-related fractures may best be achieved by initiating sound health behaviours early in life and continuing them throughout life. Evidence suggests that osteoporosis is easier to prevent than to treat. In fact, healthy early life practices, including the adequate consumption of most nutrients, calcium in particular, and regular physical activity, contribute to greater bone mineral mass and optimal peak bone mass. Bone is living tissue that responds to exercise by becoming stronger. Two types of exercises are important for building and maintaining bone mass and density: Weight-bearing exercises, in which bones and muscles work against gravity and resistance training that use muscular strength to improve muscle mass and strengthen bone. Exercise can also improve gait, balance, coordination, proprioception, reaction time, and muscle strength, even in very old and frail elderly people. Overall, the evidence strongly suggests that regular physical activity, especially started in childhood and adolescence, is a cheap and safe way of both improving bone strength and reducing the risk to fall.

As the incidence of osteoporosis-related fractures is increasing and constitutes a major health problem their prevention is of great importance. Physical activity, combined with adequate calcium intake and hormone levels, is necessary for the formation and maintenance of bone tissue. The effects of physical exercise on bone tissue variables are most beneficial when it is intensive, regular, and of weight-bearing character. Physical exercise may also be of value in the future treatment of osteoporosis. In addition to its skeletal effects, such exercise improves physical fitness, muscle strength and co-ordination, resulting in a reduced risk of fractures and improved quality of life.

PREGNANCY RELATED OSTEOPOROSIS

Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition in which women suffer fragility fractures, most commonly vertebral, during the third trimester of pregnancy or early postpartum. Experts have suggested many possible reasons for pregnancy-associated osteoporosis, including the following.Pregnancy might trigger a sudden and unusual reaction in previously healthy bones.Normal levels of bone loss in pregnancy might lead to further bone loss in women who already have quite weak bones. However, having low bone density before getting pregnant doesn't seem to lead to faster bone loss or broken bones during or after pregnancy.

Disuse osteoporosis is another condition that causes bones to lose density and become weak. It can occur when someone is unable to put weight on their bones. This can happen when someone is on extended bed rest, paralyzed, or wearing a cast

Bone fractures in older adults are often preceded by a loss of muscle mass and strength. Likewise, bone loss with prolonged bed rest, spinal cord injury, or with exposure to microgravity is also preceded by a rapid loss of muscle mass. Recent studies using animal models in the setting of hindlimb unloading or botulinum toxin (Botox) injection also reveal that muscle loss can induce bone loss. Moreover, muscle-derived factors such as irisin and leptin can inhibit bone loss with unloading, and knockout of catabolic factors in muscle such as the ubiquitin ligase Murf1 or the myokine myostatin can reduce osteoclastogenesis. These findings suggest that therapies targeting muscle in the setting of disuse atrophy may potentially attenuate bone loss, primarily by reducing bone resorption. These potential therapies not only include pharmacological approaches but also interventions such as whole-body vibration coupled with resistance exercise and functional element

A nutritious diet including calcium-rich foods and regular exercise throughout a person's life (including during childhood and adolescence) will reduce the risk of osteoporosis in later years. People with existing osteoporosis can also benefit from exercise.

Physical activity plays an important role in maintaining or enhancing bone health. Jumping exercise increases bone mineral content(BMC)in prepubescent children(premenarcheal girls). Bone mineral density(BMD)is higher in adolescent athletes who are engaged in weight-bearing activities. Jumping exercise, muscle strengthening exercise, and weight-bearing plus muscle strengthening exercises increase BMD in young adults and premenopausal women. Walking, aerobic weight-bearing exercise, muscle strengthening exercise, and weight-bearing plus muscle strengthening exercises maintain or increase BMD in postmenopausal women. Proper exercise and sports activity at each life stage are important strategies for preventing osteoporosis.

The significant biochemical and physiological effects of psychological stress are beginning to be recognized as exacerbating reason for osteoporosis. There is possibility of link between osteoporosis and chronic psychological stress .

Hence it is important to consider few factors as a female to prevent osteoporosis ,first and foremost good nutrition , regular exercise and weight training and correction of vitamin D and calcium levels.

Last but not least its important to also have good emotional health .



Dr Sonal Mahalwar
Chief musculoskeletal radiologist
Center for sports injury
Safdarjung enclave