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 Integrative Medicine: Osteoporosis, Heart Disease, and Breast Cancer 
 
The decrease in hormones that occurs soon after menopause can cause a number of uncomfortable symptoms, but the long term effects of hormonal loss can produce devastating (and potentially life threatening) consequences. Estrogen protects the heart and bones from aging. With the loss of this hormone, the incidence of osteoporosis and heart attacks increases with age in high risk women. Breast cancer also occurs much more commonly in postmenopausal women, since immune function diminishes with age. This chapter presents basic facts about these three postmenopausal health problems and offers suggestions for vitamins, minerals, and herbs which can help to prevent them.

Osteoporosis
One of the most serious consequences of postmenopausal aging is the development of osteoporosis. In fact, osteoporosis is a major health problem affecting more than 20 million older Americans, 90 percent of whom are women. One out of three American women will develop osteoporosis after menopause.

The statistics surrounding osteoporosis are astounding. More than 1.3 million fractures occur in the United States each year because of this condition, including 250,000 hip fractures. Eighty percent of these fractures occur in women over 65 with osteoporosis. About one-quarter of these women die within one year from complications caused by their fractures, such as blood clots and pneumonia. Another one-third never regain the ability to function physically or socially on their own. These women spend the rest of their lives requiring long term care in nursing facilities. Besides causing hip fractures, osteoporosis is also responsible for loss of bone in the jaw, gum recession (both of which are early signs of this condition), dowager's humps, loss of height, back pain due to compression and fractures of the vertebra, and fractures of the wrist (known as colles fractures by physicians).

Often these fractures occur in situations that put only mild stress on the bone, and would not normally cause such an outcome. This can include missing a step and falling down, falling on an extended arm, or lifting a heavy object. Because of the underlying weakness of the bone, fractures can also occur spontaneously without any preceding trauma. This is often the case with vertebral fractures.

Risk Factors for Osteoporosis
Not all women have the same risk of developing osteoporosis. Some women maintain strong and heavy bones throughout the lives, while other women develop accelerated bone loss soon after menopause. If you suspect you are at higher risk of developing osteoporosis, become knowledgeable about which factors have actually been linked to a higher incidence of this disease. This will help you and your physician evaluate your own risk when planning an optimal treatment program. These factors include racial background, family history, hormonal status, lifestyle habits, and preexisting health conditions.

Racial Background
Skin pigmentation appears to correlate with bone mass. Black women are less likely to develop osteoporosis than white women. In fact, women at the highest risk are small and fairskinned. These are typically women of northern European ancestry such as Dutch, German, or English background with blond, reddish, or light brown hair and pale skin. Asian women also have a higher risk of developing osteoporosis.

Family History
If your close female relatives suffered from osteoporosis, you run a higher risk of developing this problem. Many women have seen their own mothers or grandmothers develop a dowager's hump or become disabled from fracturing their hips. This can be quite upsetting for the entire family who must deal with the long term disability.

Hormonal Status
The age at which women begin menopause and how much hormonal support they maintain during their postmenopausal years affects bone density. Women who have had a surgical menopause before the age of 40, with removal of their ovaries, are at high risk of developing osteoporosis because of the abrupt withdrawal of estrogen at a young age. Similarly, women who go through an early natural menopause are at high risk of osteoporosis. A woman going through early menopause at age 35 or 40 has as much as 10 to 15 years less estrogen protection of her bones than a woman going through menopause at age 50. Thus, the older you are when going through menopause, the more years of hormonal protection you provide for your bones.

While obesity is a health risk for many diseases such as osteoarthritis and uterine cancer, being overweight does confer some protection against osteoporosis in postmenopausal women. This is because the fat cells produce estrone, a type of estrogen, through conversion of the adrenal hormone androstenedione. This type of estrogen does provide some support for the bones once the ovarian source of estrogen has dwindled.

Lifestyle Habits
Women who engage in regular physical exercise and are more muscular have a lower risk of developing osteoporosis. Physical activity helps keep women flexible and agile, which also reduces the likelihood of fractures. Conversely, inactivity increases the risk. Even young men or women confined to bed for long periods of time show a decrease in bone mass.

Many nutritional factors affect the risk of developing osteoporosis. Women who drink more than two cups of coffee per day or excessive amounts of other caffeine containing beverages like black tea or colas, or consume more than two alcoholic drinks per day are at higher risk. High protein or high salt intake are risk factors, as is inadequate calcium intake. Smokers also run a higher risk of osteoporosis.

Preexisting Health Issues
Women with a history of bulimia, anorexia, or malabsorption syndrome run a higher risk of poor calcium absorption or low estrogen levels. This is often the case in women with anorexia who don't have enough body fat to produce adequate estrogen. Women who use thyroid medication, or cortisone for a variety of conditions or who suffer from an overactive thyroid gland are at higher risk. This is also true of women with chronic kidney disease. All of these conditions can adversely affect the calcium balance in the body.

Diagnosis of Osteoporosis
Excellent tests now exist to evaluate the likelihood of developing osteoporosis. They also allow physicians to diagnose osteoporosis in the early stages before the bone loss is so severe that it causes fractures. These tests include the single photon densitometer, which measures the density of the forearm bone; the dual photon densitometer, which measures the spine or hip bone; and the computerized axial topography scan (also called a CAT scan), which measures bone density in the spine. The CAT scan uses higher amounts of X rays and is a more expensive test. These tests are much more sensitive than the conventional X ray, which picks up osteoporosis only when 30 percent or more of the bone mass is lost.

You may want to have a bone density test if you are trying to decide whether or not to use hormonal replacement therapy (HRT). If the tests show accelerated bone loss for your age group, you should seriously consider the use of HRT unless other major health issues contraindicate the use of hormones. The use of estrogen and progesterone, in combination, not only help to retain calcium in the bones, but appear to promote the growth of new bone. A vegetarian-based diet is optimal for prevention of osteoporosis. A diet high in meat tends to promote loss of calcium from the body.

Heart Disease
Cardiovascular disease is the major cause of death for American women, claiming the lives of half a million women per year. This is twice the number of women who die from cancer per year. While younger women do die of heart disease, it is a rare occurrence; the numbers tend to escalate as women age. Cancer is the main cause of death in women from age 30 to 60 (with heart disease in second place from age 40 to 60). Heart disease becomes the leading cause of death in women by age 60.

Most women die from heart attacks due to coronary artery disease. With coronary artery disease, there is a narrowing of one or more of the arteries that supply blood and oxygen to the heart. This narrowing is due to the formation of plaque in the arteries. Plaque is a thick, waxy, yellowish substance consisting primarily of cholesterol, smooth muscle cells, and foam cells. As the formation of plaque progresses, it can obstruct the flow of blood through the blood vessels. Over time, this can seriously compromise the function of the heart, finally leading to a heart attack. Unfortunately, the obstruction is usually quite advanced before it even begins to cause symptoms. Usually the symptoms consist of chest pain (angina) and shortness of breath on mild exertion.

Risk Factors for Heart Disease
Much research has been done over the past few decades to determine if certain women run a higher risk of developing heart disease. A number of studies have pinpointed factors that appear to be linked to a higher likelihood of developing this disease. These include specific physical characteristics: health factors such as family history, blood lipid profile, hypertension, and diabetes; and lifestyle factors such as smoking, lack of activity, and stress.

Physical Characteristics
Age. As mentioned earlier, the older the woman, the greater her risk of developing heart disease. The highest incidence is in women over 65 years of age.

Body Weight.Women who are between 20 to 30 percent over their ideal weight are considered to be at greater risk of developing heart disease. This was noted in a study done by Harvard Medical School, which tested more than 115,000 women over eight years. Excess weight was found to be a significant factor in women developing coronary artery disease during the period of the study.

Body Shape Distribution of Fat.Not only is overall obesity a risk factor, but how fat is distributed on the body affects heart disease risk, too. Women who distribute their excess weight in their middle or are rounder, shaped like apples, have a higher risk of coronary artery disease than pear-shaped women who distribute their fat in their hips and thighs.

Health Factors
Family History of Heart Disease. You are at higher risk of developing heart disease if your close relatives have had a heart attack at an early age. Statistically, your risk is increased if your father had a heart attack before age 56 or your mother before age 60. Similarly, you are at a higher risk if your grandparents had a heart attack at a young age.

Blood Lipid Profile. Triglycerides are the form in which fat is stored in the body's tissues: three fatty acid molecules hooked to a glycerol backbone. Women with Elevated triglycerides, or triglycerides elevated in the blood to a level of 190 mg/dl or greater, run a higher risk of developing coronary artery disease.

Elevated total cholesterol and LDL cholesterol.Cholesterol is a yellowish, waxy substance manufactured in our body primarily by the liver and, to a lesser extent, by the intestines. We also ingest cholesterol when we eat dairy products or red meat. How effectively cholesterol is used depends upon how efficiently it is transported throughout the body and how well the body can store or dispose of any excess. Transportation in the body is potentially a problem because the fatty cholesterol isn't soluble in blood, which is mostly water. To solve this problem, the body packages the cholesterol with a protein that allows the fat to be mixed with the blood. This process takes place in the liver, where several types of cholesterol-protein mixtures are produced.

(Excerpted from The Women's Health Companion ISBN: 0890877335)
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 About The Author
Susan Lark MDDr. Susan M. Lark is one of the foremost authorities on women's health issues and is the author of nine books. She has served on the faculty of Stanford University Medical School...more
 
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