Obesity, Menopause, and Bone Health Essay
Although obesity had initially been perceived to be beneficial for bone mineral density due to the effect of mechanical loading associated with weight excess, it has been found to be a potential disaster for bone health. Studies have found the harmful effects of excessive body fat on bone health. According to Marzullo et al. (2021), a link exists between chronic obesity, menopause, and bone metabolism. The following are explanations: Menopause causes visceral fat accumulation and sarcopenia, which brings about the mechanical loading effect. However, with fat accumulation, there are reduced vitamin D levels, and secondary hyperparathyroidism occurs, which causes bone loss and increased osteoporosis.
Through obesity, endocrine signals activate, which affects bone health. Type 2 diabetes due to insulin resistance brought about by obesity causes impaired strength of the femoral neck, making it susceptible to fractures (Marzullo et al., 2021). Fractures in menopausal women with obesity are site-specific. According to Piñar-Gutierrez et al. (2022), obese postmenopausal women have a higher risk of humeral fractures and osteoporotic fractures of lower limbs and ankles, while fractures involving the hip and wrist are relatively reduced. Therefore, Sally should appreciate that there is a very high likelihood of developing osteoporosis due to her obesity, and physical inactivity, all of which potentiate osteoporosis associated with menopause.
Yes, Sally is a candidate for hormone replacement therapy to prevent or treat osteoporosis. According to Chin Lim (2023), obese postmenopausal women who require HRT must be thoroughly evaluated regarding their symptoms’ severity. The risk of such patients getting fractures should be adequately evaluated because HRT in postmenopausal women has been associated with a high risk of developing cancer of the breast, venous thromboembolism, and coronary heart diseases (Chin Lim, 2023). HRT reduces the likelihood of developing fractures associated with osteoporosis with the inclusion of vertebral and hip fractures hence is essential for Sally. Her criteria for HRT is the fact that she is obese, which is a risk factor for obesity and that she is postmenopausal.
People with lactose intolerance cannot break down sugars or lactose found in dairy products into soluble molecules that the body can utilize through assimilation (Malik & Panuganti, 2019). This is caused by a lack of the enzyme lactase in their bodies, as in the case of Sally. However, different measures can help such individuals obtain the calcium they will not benefit from cow’s milk due to lactose intolerance. Calcium-rich foods that can be used as alternatives to dairy food include canned baked beans, sardines, oatmeal, tofu, nuts, collard greens, and fortified orange juice (Alkalay, 2021). Supplementing Sally’s nutrition with some of these products will boost her calcium levels in the body and limit the challenge of obtaining it from dairy products.
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References
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Alkalay, M. J. (2021). Nutrition in Patients with Lactose Malabsorption, Celiac Disease, and Related Disorders. Nutrients, 14(1), 2. https://doi.org/10.3390/nu14010002
Chin Lim, C. (2023, January 1). 19 – Menopause and hormone replacement therapy (T. Mahmood & C. C. Lim, Eds.). ScienceDirect; Academic Press. https://www.sciencedirect.com/science/article/abs/pii/B9780323899048000111
Malik, T. F., & Panuganti, K. K. (2019, February 22). Lactose Intolerance. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532285/
Marzullo, P., Mele, C., Mai, S., Nardone, A., Scacchi, M., & Aimaretti, G. (2021). Obesity and Bone Loss at Menopause: The Role of Sclerostin. Diagnostics, 11(10), 1914. https://doi.org/10.3390/diagnostics11101914
Piñar-Gutierrez, A., García-Fontana, C., García-Fontana, B., & Muñoz-Torres, M. (2022). Obesity and Bone Health: A Complex Relationship. International Journal of Molecular Sciences, 23(15), 8303. https://doi.org/10.3390/ijms23158303
Sally is a 60-year-old female who weighs 300 pounds. Her last menstrual cycle occurred at age 47. She has been told that she could not get osteoporosis because of her size; however, she recently read an article that made her anxious that this may not be true. She has never been active in sports and is lactose intolerant. What is the evidence about chronic obesity and bone health during menopause? Would she be a candidate for HRT as osteoporosis prevention/treatment? Because she is lactose intolerant, what are some calcium alternatives to dairy? Use evidence-based research to support your patient recommendations.
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