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Osteoporosis: Marisa, Jeremy, and Eleanor

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by

Minji Kim

on 6 November 2013

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Transcript of Osteoporosis: Marisa, Jeremy, and Eleanor

Osteoporosis: Marisa, Jeremy, and Eleanor
By: Raul Bitar, Fernando Escudero, and Minji Kim
Anatomy and Physiology 1A
Mrs. Lorenza Sordo

Scenario C
What is Perimenopausal?
Perimenopausal or menopausal transitional stage, where the woman's reproductive life decrease, when ovaries gradually begin to produce less estrogen.
Usually starts when a women is in her 40s but can start at 30s or even earlier.
Usually lasts 4 years. Can last few months of also up to 10 years.
Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs.
In the last two years of perimenopause, the decline of estrogen accelerates and women expirience menopausal symptoms.
What is Osteoporosis?
Symptoms of Perimenopause
Perimenopause to Menopause
The terminal stage of perimenopausal stage ends when a woman has gone 1 year without having her period.
Eleanor is a 45 year old perimenopausal women and is considering Hormone Replacement Therapy mainly to prevent osteoporosis.
Eleanor has smoked got the past 20 years and has a family history of breast cancer and heart disease. And two years ago, Eleanor´s mother underwent a double mastectomy because she had breast cancer. And recently Eleanor has started exercising and taking care of herself.
Conditions: She has been experiencing nausea, hot flushes, and her back has been sore on and off.



Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass and density leading to an increased risk of fracture.


Hot flashes
Breast tenderness
Worsening of premenstrual syndrome
Fatigue
Irregular periods
Urine leakage
Urinary urgency (the need to urinate more frequently)
Mood swings
Difficulty sleeping

How menopause affects women's hormonal level
Estrogen stimulates growth of breast tissue, maintains vaginal blood flow, and preserves the bones.
During menopause the levels of estrogen become unpredictable and it falls to a very low level.
Progesterone prepares lining of the uterus for a fertilized egg and helps maintain early pregnancy.
During menopause, the production stops during menstrual cycle when there is no ovulation and after final menstrual period.
How menopause affects women's hormonal level
Testosterone plays the key role in woman's estrogen production. Testosterone also contributes to libido which is sex drive and testosterone helps maintain bone and muscle mass.
During menopause the levels of testosterone declines almost to half of the average production.
Also testosterone production from adrenal glands declines with aging but continues after menopause.
Healthy bones = balanced relationship between calcium and estrogen.
Calcium: important for the protection and growth of bones.
Estrogen: aids the intestinal absorption of calcium, which will eventually reach the bones and make them stronger and grow appropriately.
How does estrogen affect calcium levels in the bone?

Low estrogen levels = the body´s ability to make use of the calcium that is consumed is weak.
During perimenopause and menopause the average production of estrogen in women declines causing women suffer bone loss.
What happens when the balance between calcium and estrogen is broken?
Smoking decreases the levels of estrogen in both male and female causing the body have less ability to absorb vitamin D, and causes the bones not have enough calcium and break easily.


Smoking, Estrogen Level, and Calcium Level
Smoking and Bone Health
Cigarette smoke overwhelms the body's natural defenses that keeps organs, cells, and hormones that are involved in keeping bones healthy.
Smoking also triggers the creation of estrogen destroying enzymes in the liver which leads to bone loss.
Smoke increases the level of hormone cortisol (stress hormone) which leads to bone breakdown.
HRT
Stands for Hormone replacement therapy.
It refers to any form of therapy where the patient receives hormones. It may be due to:
Either to supplement a lack of naturally occurring hormones
To substitute other hormones for naturally occurring hormones.
Hormone replacement therapy for menopause is based on preventing discomfort caused by diminished circulating estrogen and progesterone hormones.
Antiresorptives limit bone loss by decreasing the rate of resorption by osteoclasts, which are the cells the absorb bone. By reducing the speed of the bone absorption done by the osteoclasts, antiresorptives prevent further and more severe bone loss.

Treatments other than HRT
Types of Antiresorptives
Bisphosphonates, calcitonin, and estrogen agonists.
Types of bisphosphonates:
Alendronate: Both men and women can take it. It is ideal for osteoporosis caused by excessive use of steroid medications. It increases bone mass. Taken orally.
Ibandronate: Only women can take it. It specifically helps lower risk of spinal fracture. It can be taken orally or through IV.
Risedronate: It can be taken by both men and women. It is like Alendronate just that it also prevents steroid caused osteoporosis.
Zoledronic Acid: It can only be taken by women. It increases bone mass to protect against bone fractures. It can be taken orally or through IV.

Bibliography
http://www.webmd.com/menopause/hrt-weighing-the-pros-and-cons
http://www.netdoctor.co.uk/ate/womenshealth/206962.html
http://www.webmd.com/menopause/guide/guide-perimenopause
http://www.nlm.nih.gov/medlineplus/ency/article/000894.htm
http://www.livestrong.com/article/454779-the-relationship-between-estrogen-calcium-levels/
http://www.upmc.com/patients-visitors/education/smoking/pages/smoking-and-your-bones.aspx
http://www.endocrineweb.com/conditions/osteoporosis/osteoporosis-drugs-medications
Is HRT good for Eleanor?
Yes and no.

Yes because it treats Osteoporosis and balances hormone levels.

No because, HRT is not recommended for women who have a family history of heart disease or breast cancer. It is not recommended either because the HRT may increase the probabilities of getting a heart attack or stroke.
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