MENAPOUSA ( LONG TERM COMPLICATION)

Long term complication of menopause

Osteoporosis

Dementia

Cardiovascular disease

Medical student MBBS year 4 UniSZA –Siti hamidah

OSTEOPOROSIS

• Mainly in postmenopausal

• 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

Risk of osteoporotic fracture inpostmenopausal women

Non-modifiable1. Advancing age2. Ethnic group (Oriental & Caucasian)3. Female gender4. Premature menopause (< 45 years) including surgical menopause5. Family history of osteoporotic hip fracture in first degree relative6. Personal history of fracture as

an adult

ModifiableLow calcium and/or vitamin D intakeSedentary lifestyleCigarette smoking.Excessive alcohol intake (>3 units/day)Excessive caffeine intake (>3 drinks/day)Low body weight (BMI < 19kg/m2)Estrogen deficiencyImpaired visionRecurrent falls


Presentation

asymptomatic and diagnosis is made only after a fracture

Common:

1. Increasing dorsal kyphosis (Dowager’s hump)

2. trauma fracture

3. Loss of height

4. Back pain


diagnosis

• made after excluding 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


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.


screening

• based on age and weight, Osteoporosis

• Self-Assessment Tool for Asians (OSTA), was developed for postmenopausal Asian women.


investigation

The main aims of 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

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


Cardiovascular Diseases

• A decline 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 cholestroltend to decline

(American heart association)

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

CARDIOVASCULAR RISK FACTORSa) Non-modifiable risk factors1. personal history of CHD and/or CHD equivalents2. age (over 55)3. family history of premature CHD

b) Modifiable risk factors1. dyslipidaemia2. hypertension3. diabetes mellitus/pre-diabetes4. metabolic syndrome5. obesity6. smoking7. physical inactivity


Assessment of CVD risk 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


TOTAL CARDIOVASCULAR RISK ASSESSMENT

• Framingham Risk Score (FRS)

• SCORE system

• WHO/ISH Cardiovascular Risk Prediction Charts


RECOMMENDATIONS FOR PREVENTION OF CVD IN

WOMEN

• Lifestyles changes : dietary, exercise, weight reduction, stop smoking

• aspirin


DEMENTIA

• Estrogen stimulates the 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

Health & Medicine

MENAPOUSA ( LONG TERM COMPLICATION)