As a physician, with interest and experience in osteoporosis and the menopause, I cannot emphasize enough the importance of the prevention and treatment of osteoporosis. As is now appreciated, a vertebral fracture is associated with substantial morbidity and mortality including loss of functional ability and significant loss of days at work. Moreover, once a patient has suffered a fragility fracture, the risk of future fractures increases 2-5-fold. However, because spinal fractures are largely asymptomatic, these fractures can easily go unrecognized and undiagnosed by busy clinicians. The majority of fractures are due to low BMD. At menopause, estrogen deficiency is a major factor in accelerating bone loss. Therefore, not only do doctors need to be more observant, but also after mid-life, women themselves must become more knowledgeable about changes in their endocrine physiology, if their elder years are to be as healthy as possible.
Furthermore, the reasons that we must seriously consider the issue of healthy elderly life at this time, is that by the year 2020, women over the age of 65 will account for 21 % of the total American female population, according to data from the US bureau of Census. Women born between 1946 and 1964, the so-called baby boom generation, are going to have a longer life expectancy.´
However, the prospects of increased life expectancy are overshadowed by the prospect of a greater incidence of chronic diseases and functional disorders such as osteoporosis. This longer life expectancy is occurring worldwide,-especially among countries that were involved in the 2nd World War. Further projections place the elderly at a constant but much higher level, after the baby boom generation ages.
As the female baby boom generation enters the menopausal stage. all body organs start to deteriorate. The reduction in hormone levels, especially estrogen, leads to various symptoms. The menopausal period generally spans 4 years to as many as 10 years when cessation of ovarian function is complete. During this Lime, estrogen output gradually decreases but is variable from woman to woman.
Representative organs that can be affected by the depletion of estrogen include bone, heart. blood vessels, breasts, urogenital organs, brain, skin and colon.
The menopausal period is a time of sharply reduced bone density and can be associated with debilitating osteoporosis. Hyperlipidemia occurs gradually after the menopause and with aging, leading to elevations in blood concentrations of undesired fats, such as low-density cholesterol and triglyceride. An obvious consequence of hyperlipidemia is coronary artery disease. The coronary vasculature can also be adversely affected directly by estrogen deficiency. It is believed that the series of pathophysiological events related to the cardiovascular system is responsible for the sharply increased incidence of cardiac disease after the menopause.´ Therefore, it is absolutely critical that we recognize and effectively manage this most vulnerable time of change in a woman´ s life. If appropriate measures are not taken, then the chronic disorders of aging will surface earlier and be much more difficult to control.
What we need to know about our mid-life body signals is well defined. Common early symptoms of the perimenpausal period include memory lapses, depression. irritability, anxiety, insomnia, severe sweating (especial] at night). hot flashes, thin, dry, non-elastic and rough skin. dry and itch vagina, frequent urogenital infections, reduced intestinal functions, and collapsed or drooping breasts." Uterine prolapse and urogenital tract dysfunction lead to an increased incidence of incontinence, which may be marked by embarrassing involuntary urination while laughing or sneezing
Men, on the other hand, do not experience an equivalent, rapid fall in androgens in their middle years. But´men can and do feel tired for no apparent reason. have insomnia, lose motivation and confidence, and have digestive or sexual problems. Although not likely, these symptoms could indicate an abrupt andropause due to disease On pogonadl sill).
The logical approach to estrogen loss is estrogen replacement. The controversy surrounding its use continues. even after decades of debate. Despite the controversy. demand for task.
Longevity is determined by how well our bodies compensate for the insults and injuries of life. If we detect disorders before they surface, then deficiencies can be addressed, with optimal treatments, and careful management. Life can be extended and aging can be effectively confronted. We should all then be able to look forward to a comfortable mid-life and a more serene elderly life, riddled less by pain and desolation by diseases such as osteoporosis and chronic cardiovascular disease.
Immortality is certainly elusive. This is not the point. The point is that we should all be able to look forward to life that is not only long but also healthy.
* This article was presented at the 23th Annual Meeting of the International Congress on Art and Community organizing IBC and ABI held in Fairmount Waterfront Hotel Vancouver on July 5. 2002.
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