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Symptom Management:

Symptom Management

Side Effects of Treatment
Side Effects of Chemotherapy
Pain
Fatigue
Appetite Loss
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Osteoporosis—Maximizing the Health of Your Bones

Symptom and Description Before menopause, the body naturally replaces old bone with new bone. With the change of life the body begins to lose estrogen, and there is a rapid loss of bone mass. The bone becomes more thin and frail. A woman’s risk for bone fracture in the hips, spine, and wrist increases each year after the change.

As a woman ages, the body is also less able to absorb calcium. At the same time there is a loss of calcium from the bones. This further weakens the bones. Low calcium can cause osteoporosis. Steroid therapy can also cause osteoporosis because steroids increase bone loss, reduce calcium absorption, and make bones more frail and likely to break. Thyroid hormone therapy is also associated with increased risk.

All causes of estrogen loss—change of life, removal of the ovaries, chemotherapy, or radiation therapy-result in loss of bone, usually in the first 2 years after loss of estrogen. Even though hormone replacement is the only way to restore bone strength, there are some things you can do to help maintain or even partially restore healthy bone.

Learning Needs To maintain or restore bone strength, you need to know whether you are at significant risk for bone loss and fracture.

1. White and Asian women with small frames who are at or below their ideal weight are at risk for bone loss. Black women have less risk because their bones are more dense.

2. Bone mineral density studies are painless and can predict risk for fracture and may be advised if you are approaching the change or having symptoms. Your doctor may recommend a baseline bone test with a repeat of the test in 2 years to determine your rate of bone loss.

3. Women who have eating disorders or who eat foods low in calcium, drink high-caffeine beverages, drink alcohol, or smoke cigarettes are at high risk for bone loss and bone fracture with aging.

4. Lack of physical exercise can lead to bone loss and calcium loss.

5. Women who for personal or health reasons are unable to take hormone replacement therapy are at high risk, depending on their other risk factors.

Management

1. If hormone therapy is prescribed, it must be continued as ordered by your doctor. When hormone therapy is stopped, bone loss resumes. Do not stop your hormone therapy before consulting with your doctor.

2. Tamoxifen, because of its estrogen-like action helps to prevent the bone loss that occurs with menopause. It also helps prevent breast cancer.

3. Raloxifene is proven to prevent osteoporosis in postmenopausal women. It may also prevent breast cancer.

4. Zometa is given to prevent bone loss, promote bone healing, and perhaps prevent bone metastases.

5. Most women take in only 400–500 mg of calcium daily. Premenopausal women should supplement their diet with 500-1000 mg of calcium a day. Postmenopausal women should add 1500 mg of calcium a day because of reduced calcium absorption. Two Tums 500 supplies 2500 mg calcium carbonate, which provides 1000 mg of calcium. Three tablets provide 3750 mg calcium carbonate, which provides 1500 mg of calcium.

6. Alendronate sodium (Fosamax) may be taken in combination with calcium citrate (Citracal) if osteoporosis is present. Calcium supplements should be taken with food. Orange juice or other acidic foods are especially helpful in aiding absorption.

7. For most people, the average diet and some sunlight exposure provide adequate vitamin D, which is necessary to absorb calcium. Multivitamins with vitamin D, 400 IU daily, may be taken if necessary.

8. Most generic oyster-shell calcium is absorbed. If your calcium tablet does not dissolve in household vinegar after 30 minutes with gentle stirring, select one that does.

9. If you have a history of renal stones, consult your doctor before taking added calcium.

10. Try to eat calcium-rich, low-fat foods, yogurt, cottage cheese, skim milk (with vitamin D), and juices and cereals with added calcium. Minimize caffeine intake. Avoid cola drinks and chocolate as well as red meats, which contain high levels of phosphorus, which affects calcium absorption.

11. Exercise may help to increase bone strength. Stair climbing, racket sports, impact aerobics, jogging, weight training, and dancing are advised. Swimming, walking, and cycling help your heart but do not increase bone strength.

12. If you have weak bones or have had a bone fracture consult your doctor regarding an exercise program.

13. Thirty to 60 minutes of exercise 3 to 4 times a week helps to strengthen bone.

14. Exercise may also help to improve coordination, balance, and muscular strength, which help to decrease the likelihood of falls.

15. If you smoke cigarettes or drink alcohol daily, ask your nurse or doctor about ways you can learn to stop smoking or to drink alcohol in moderation.

Follow-up Consult your doctor if you experience any unpleasant side effects from your medications such as stomach upset or diarrhea.

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