Post Reproductive Health

Osteoporosis is best defined in terms of whole bone density (apparent density) and is present when this variable falls below the young normal range. Low bone density may be genetically determined or acquired. If acquired it may in principle be due to low bone formation or high resorption. It is most easily produced in experimental animals by calcium deprivation and/or ovariectomy, both of which induce high bone resorption; their effects are additive. The postmenopausal rise in bone resorption is associated with a fall in calcium absorption and a renal tubular leak of calcium which combine to increase requirement of this element but there is also an increase in the sensitivity of bone to resorbing agents. Calcium supplementation inhibits postmenopausal bone loss but not as effectively as oestrogen. Protein and sodium are nutrients which increase calcium requirement by increasing obligatory urine calcium loss. Vitamin D is a nutrient, the deficiency of which increases the risk of hip fracture and the administration of which (with calcium) has been shown to reduce the risk of this fracture in vulnerable nursing-home residents. The implications of these findings are that postmenopausal women should ingest more calcium than premenopausal women, be moderate in their consumption of protein and salt, and receive vitamin D supplementation if their 25-hydroxyvitamin D level falls below about 50 nmol/L.

Ageing may be simply defined but is yet to be well understood. Research in this area is considered a priority, with the population growing older and increasing disability, morbidity and mortality predicted. There are many theories and ageing has been described from changes at the molecular level to characteristics of ageing populations. However, distinguishing cause from effect has proved problematic largely because the underlying reasons for ageing have not been understood. Progress has now been made and the central role for repair processes is increasingly accepted. A number of approaches to modifying ageing have been explored but the only reliable method to alter the rate remains diet restriction. Instituted after weaning, diet restriction slows ageing in a number of species and has an opposite effect when started in earlier life. There is now preliminary evidence that poor early growth is associated with increased human ageing and this is an important area for future research.

An increasing number of older people are retaining their teeth in the UK. Edentulism is gradually declining and will increasingly become a feature of social deprivation. This review covers the processes of ageing in teeth, the peridontium, the oral mucosa, muscles of mastication, salivary glands and taste. Diseases of the oral mucosa, in particular cancer, are examined. Tooth decay and peridontal disease are discussed. The relationship between systemic health and oral health status are becoming increasingly important. The effect of diet and tobacco smoking are explored. Finally, the association between peridontal disease and osteoporosis, atherosclerosis, venous thromboembolism are discussed.

A pilot study was undertaken in 500 women to examine clinical risk factor enquiry and ultrasound densitometry as methods for identifying women at high-risk of osteoporosis in a primary care setting. As a "stand-alone" procedure for dual-energy X-ray absorptiometry (DXA) selection, ultrasound densitometry was as good as clinical risk factor enquiry. However, in combination these methods provided complementary information that increased prediction for osteoporosis. This type of service could easily be used in primary care to identify women at high-risk of osteoporosis and improve cost effectiveness of DXA selection.

Migraine is more common in women than in men, with a prevalence ratio of 3:1 respectively during the early 40s. The years leading up to the menopause mark a time of exacerbation of migraine for many women.1 Menstruation becomes a more prominent trigger and attacks often increase in frequency, as periods become increasingly irregular. Unpredictable attacks, coupled with menopausal symptoms, can make it hard for many women to cope. Unfortunately, women are often told that hormone replacement therapy (HRT) will make migraine worse and they do not receive effective treatment.