Bone health in midlife women

Abstract

Osteoporosis and subclinical low bone mass are common conditions characterized by a decrease in bone micro-architecture which heightens one’s risk for fractures, disability, and chronic pain. Although men and women are both susceptible, particularly with advancing age, women have an accelerated rate of bone loss as they approach midlife. Many measures exist to assess bone health, but most people are not aware they have low bone density until they experience a fracture, as few visible signs manifest until later stages of the disorder. This chapter explores these measures of bone density including DEXA and ultrasonometry, and biomedical markers such as serum 25(OH)D levels. The case study of serum 25(OH)D levels in Qatar is offered as an example of how self-reported vitamin D deficiency can be compared with measured serum 25(OH)D. This study asked 523 midlife women whether they suffered from vitamin D deficiency and compared their responses to their actual 25(OH)D levels. Agreement between self-reported vitamin D deficiency and measured levels <20 ng/ml was very poor. Most women believed they were vitamin D deficient and even among women with levels ≥ 20 ng/ml, 82% believed they were vitamin D deficient. Among women with levels <20 ng/ml, 13% did not report deficiency. This study highlights that it may be informative to not only document quantitative results, but also to consider an individual’s perception of their own health. Furthermore, the study underscores the challenges that health care providers face in translating an “invisible condition” into something “visible," or meaningful, to the individual.