2024-01-03 15:55:44
January 3, 2024
Osteoporosis is a disease that mainly affects women. Asymptomatic at first, its progression can then cause so-called fragility fractures, which can alter the quality of life of patients. However, the use of screening remains insufficient.
Osteoporosis is primarily a female disease. This involves a reduction in bone mass as well as a degradation of its tissues. Concretely, bone resorption is no longer compensated by the formation of new tissues. Around age 65, 39% of women would be affected. And 70% of them are aged 80 and over. “The number of people affected by osteoporosis in France was estimated at nearly 4 million in 2019, or 5.5% of the total population. As a result, 484,000 fragility fractures would have occurred in the same year,” specifies Inserm, which adds that in 2034, 610,000 people might be affected by this disease, which has been constantly increasing in recent years.
In its special issue of January/February 2024, the magazine 60 million consumers calls on women to request screening. The figures are indeed alarming. According to the HAS, osteoporosis is the cause of significant morbidity and mortality, with 20% postoperative complications and 30 to 50% reduction in autonomy. 10 to 30% of patients become dependent, 25% enter an institution and 20 to 24% die within the year.”
How to detect osteoporosis?
When faced with a suspicion of severe osteoporosis, the reference examination is bone densitometry. “This medical examination measures the patient’s bone mineral density using low-intensity X-rays,” explains Inserm. It is recommended for all patients whose bone has been fractured without significant trauma. In addition, a loss of height of a few centimeters, which may be due to vertebral fractures, should also raise suspicion of osteoporosis. The examination is also recommended for postmenopausal women with risk factors: « a history of cervical fracture without trauma in a first-degree relative; a body mass index (BMI) less than 19; early menopause (before age 40), a history of corticosteroid therapy for more than three consecutive months,” Ameli.fr list.
“Unfortunately, the data show that screening conducted in these contexts remains insufficient in France. Less than 10% of women who have had a severe fracture (vertebra, femur, pelvis) receive appropriate treatment for osteoporosis. deplores Inserm.
Menopause in question
Questioned by 60 Million consumers, Pre. Trémollières, endocrinologist and director of the Menopause and osteoporosis prevention unit at Toulouse University Hospital regrets that “These indications lead doctors to believe that women without risk factors do not suffer from osteoporosis. Which is false, since half of the women affected at the start of menopause had no risk factors! Bone densitometry is an easy and painless test that costs around €40. Not reimbursing it for all women reaching menopause is truly a public health error.” Indeed, menopause is a risk factor in its own right, since, underlines Inserm, at this time, the estrogen level collapses, causing an acceleration of bone loss in women for 5 to 10 years.
What support ?
Treatments for osteoporosis are medicinal. First of all, bisphosphonates, which slow down the activity of osteoclasts, these cells which damage bone tissue. In postmenopausal women, menopausal hormonal treatment (THM), once morest hot flashes in particular, also treats bone loss linked to menopause; the effect on bone mineral density disappearing when treatment is stopped.
But, these treatments would have fallen by 80% because of a distrust of hormones, regrets Professor Trémollières in the columns of 60 Million consumers. According to Inserm, only 6% of women take hormonal treatment for menopause. Yet, “THM prevents bone loss and abnormalities in bone micro-architecture at the start of menopause. It reduces the risk of fracture at all bone sites by 20 to 40% independently of the basal level of risk with a dose-dependent effect on estrogens. write the experts from the National College of French Gynecologists and Obstetricians in 2021 who recommend an analysis of the benefit-risk balance of THM in patients.
It is also possible to prevent osteoporosis. In this context, a healthy lifestyle is essential. Physical exercise affects bone mineral density. Supplementation with calcium and vitamin D also helps strengthen bones. Smoking and excessive alcohol consumption should be avoided because they promote bone loss. The body mass index must also be maintained above 19.
Source: 60 Million consumers, January/February 2024 – Ameli.fr – Inserm – HAS – Menopause, hormonal treatment for menopause and osteoporosis. RPC Menopausal women from the CNGOF and GEMVi, 2021
Written by: Dorothée Duchemin – Edited by Emmanuel Ducreuzet
1704354648
#Osteoporosis #screening #news
