The first problem of osteoporosis Osteoporosis - he threatens you?   It deserves special attention because of its social importance. The risk of osteoporosis at menopause is its consequences - fractures that causes high levels of morbidity, disability and mortality among women. In some developed countries, the disease incidence reached 40%.

Clinical features and diagnosis of postmenopausal osteoporosis

Osteoporosis is characterized by scant clinical symptoms, and in some women it is asymptomatic. Asymptomatic this disease is clinically manifested only been accomplished fractures. This feature of the clinical picture observed in almost half of all cases.

When the diagnosis of osteoporosis should pay attention for the following complaints:

• the appearance of pain in the spine (lumbar and thoracic), and in the pelvis and tibia
• fractures that occur with minimal trauma and stress. Such injuries can be sudden movement, sneezing or coughing, weight lifting, with a slight drop in height (not higher than own growth). Sometimes fractures occur spontaneously. The characteristic localization of fractures of the distal radius is the bone, ankle, proximal femur, thoracic and lumbar vertebrae
• violation of posture Posture - a few helpful tips for those who want to walk straight , The formation of resistant pain and muscle weakness should be attributed to develop complications. Against this background, there is a decrease disability and loss of the ability to self-care, which leads to the patient's disability.

Given the fact that the clinical picture is not always able to give accurate information about the presence of the disease, it is necessary to resort to laboratory diagnostic techniques. They allow to evaluate the status of bone tissue. By the "gold standard" diagnostic method is DXA, or dual energy X-ray absorptiometry. The presence of osteoporosis is determined on the basis of indicators of bone mineralization. Informative are also biochemical research methods, provides data on the status of the main markers of bone tissue and the rate of bone turnover.

How can I prevent osteoporosis

To prevent the development of dangerous complications of osteoporosis, it is necessary to pay great attention to preventive measures and conduct among women active outreach .  For women who enter the menopause, developed special educational programs that can significantly improve the level of knowledge and to carry out preventive measures .  The main recommendations relating to lifestyle and nutrition .  Physical activity should be moderate, while avoiding falls, sudden movements and lifting .  Avoid a sedentary and inactive lifestyle .  The diet need to include those products which are a source of calcium for the body, namely, fish and seafood, legumes, dairy products .  Balanced nutrition is important for practical recommendations for the prevention of postmenopausal osteoporosis .

The next thing on the question of prevention is to conduct basic treatment or HRT. Hormone therapy has a protective effect on bone, and reduces the likelihood of developing osteporoza, consequently, and bone fractures. It is important to appoint such therapy in a timely manner - if a woman's menopausal symptoms in premenopausal Premenopausal women - one step in a woman's life   and in the early years of the menopause. This period is characterized by the most intense bone loss, so it is crucial to begin treatment within the specified time period. Selection of a particular hormone drug for hormone replacement therapy should be made taking into account the ratio of the potential risks and expected benefits. If hormones are assigned patients older age groups, the dose should be reduced by half. At the age of 60 years after moving to another group of drugs - bisphosphonates and calcitonin. The duration of continuous hormonal preparations Hormonal treatments - not only contraceptives   It must be between three and five years. Throughout the period of receiving the hormones necessary to dynamically monitor the level of bone mineralization indicators that will assess the nature of the disease. Monitoring of treatment should be carried out annually.

During the prevention of osteoporosis necessarily used calcium supplements. This is a necessary component of the whole complex of activities. Recommended dosage of calcium carbonate is about 1000 mg per day.

Marina Solovyov

Because of the hormonal deficit that develops during menopause in a woman's life, there is a large number of diseases. For this reason, it is reasonable to conduct hormonal therapy. Preparations menopause help to achieve the main goal - with the help of drugs to fill the function of the ovaries and prevent the development of serious metabolic disorders.

Basic principles during hormone replacement therapy

This type of therapy for menopause is called replacement therapy (HRT). Hormones input from the outside result in the restoration hormonal women. For menopause is characterized by a deficiency of the natural hormones, so using pharmacological replace such deficiency can normalize the concentration of hormones in the blood of women. Due to this, it is not only the improvement of the general condition, but ensures reliable prevention of complications.

Hormone therapy can be administered only by a physician after a corresponding full clinical and laboratory examination of the patient. Should be taken into account some important points:

• before the start of hormone therapy should be evaluated not only the indications and contraindications for its implementation, as well as the ratio of the potential benefits and risks to the health of women
• approach to therapy should be individualized
• the use of natural hormones with mandatory supervision on the background of the dynamic course of treatment - an objective examination, laboratory monitoring
• to provide optimal clinical effect and prevent the development of side effects or reactions, it is necessary to determine the optimal dose of the drug for hormone replacement therapy, the type and way of administration

Hormone therapy has long-term and short-term indications for its purpose .  It depends on the predominance of certain symptoms in the clinical picture of the climacteric syndrome .  Neurovegetative, cosmetic, psychological symptoms can be stopped for short course of hormone replacement therapy .  The prevention and treatment of late metabolic disorders (osteoporosis and urogenital disorders) we should talk about the appointment of long-term course of therapy .  Hormones are used in several different modes - as monotherapy (assigned only one hormonal drug) and combination therapy .  You can appoint monotherapy for women during menopause, when they removed the uterus .  This condition is mandatory in order to achieve some positive results, as there is a serious risk of cancer in this administration of hormones .  If a woman's uterus is preserved (or is intact), it will be shown combination regimen .

Of estrogen and progestogen HRT

There are several options for the destination combined hormone therapy. For intermittent cyclic purpose, the following drugs - "climate control", "klimonorma", "Divina". If there is a need for continuous hormone administration, then, to this end use "Femoston" mode 1/10 or 2/10. In postmenopausal Postmenopause - is it possible to control it?   continuous combined therapy drugs can be recommended "Kliogest", "Pauzogest", "Indivina", "Femoston" mode 1/5, "Angelique." Another drug for continuous treatment in postmenopausal women is "Tibolone." The peculiarity of the drug is a combination not only estorogennogo and progestin effects and androgenic effects. It is administered continuously in postmenopausal women daily for 2, 5 mg.

Estrogens and progestins after menopause can also be used in monotherapy. Estrogen drugs are prescribed for the treatment of intermittent use for up to 28 days with compulsory week break or continuously. Product form this group of embodiments is represented by several hormones - pills, transdermal patches and gels, lotions, balls for vaginal administration. Skin patches presents two sizes, which differ in dose of hormonal component. A woman uses the patch once a week. It may be applied daily to the skin gels, which contain the estrogen (estradiol at 0, 5, 1, 0 mg). Such gels are available in sachets, they are intended for local use (apply a thin layer evenly on the skin of the buttocks, abdomen). The gel, which contains higher concentrations of estradiol Estradiol, the most important hormone   (1, 5 mg) produced in special flasks. For monotherapy progestogen also can use several routes of administration of hormone drug Hormonal treatments - not only contraceptives . Available in tablets for oral and vaginal use, in which the dose of progesterone is 100 mg. For topical administration, gels recommend progesterone Progesterone - norm and pathology .

If a woman has contraindications for the appointment of hormone replacement therapy or she is not willing to take it, then, as an alternative should be encouraged to plant analogs of hormones, so-called phytoestrogens .  Due to its unique properties, they lead to the elimination of pathological symptoms of menopause .  They contained in soy, red clover, potatoes, black cohosh .  One of the drugs on the basis of black cohosh is "Klimadinon", which is available in drops and tablets .  Tablets should drink twice a day, and drops 30 drops too several times a day .  There is one particularly for the treatment of herbal medicines - it should be long-term .  The clinical effect can be seen only after a few months of continuous drug administration .  This woman must be informed before the start of treatment .  This also applies to hormone therapy .  On average, its duration should be for five years with an annual evaluation of its effectiveness and the dose adjusted .

Marina Solovyov