BMI classification

Body Mass Index (BMI) is a simple index of weight-for-height that is commonly used to classify
underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the
square of the height in metres (kg/m2). For example, an adult who weighs 70kg and whose height is
1.75m will have a BMI of 22.9.
BMI = 70 kg / (1.75 m2) = 70 / 3.06 = 22.9
Table 1: The International Classification of adult underweight, overweight and obesity
according to BMI
Classification

BMI(kg/m2)
Principal cut-off points

Additional cut-off points

<18.50

<18.50

<16.00

<16.00

Moderate thinness

16.00 - 16.99

16.00 - 16.99

Mild thinness

17.00 - 18.49

17.00 - 18.49

Underweight
Severe thinness

Normal range
Overweight
Pre-obese
Obese

18.50 - 24.99
25.00
25.00 - 29.99
30.00

Obese class I

30.00 - 34.99

Obese class II

35.00 - 39.99

Obese class III

40.00

18.50 - 22.99
23.00 - 24.99
25.00
25.00 - 27.49
27.50 - 29.99
30.00
30.00 - 32.49
32.50 - 34.99
35.00 - 37.49
37.50 - 39.99
40.00

Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004.

BMI values are age-independent and the same for both sexes. However, BMI may not correspond to
the same degree of fatness in different populations due, in part, to different body proportions. The
health risks associated with increasing BMI are continuous and the interpretation of BMI gradings in
relation to risk may differ for different populations.
In recent years, there was a growing debate on whether there are possible needs for developing
different BMI cut-off points for different ethnic groups due to the increasing evidence that the
associations between BMI, percentage of body fat, and body fat distribution differ across populations
and therefore, the health risks increase below the cut-off point of 25 kg/m 2 that defines overweight
in the current WHO classification.
There had been two previous attempts to interpret the BMI cut-offs in Asian and Pacific
populations3,4, which contributed to the growing debates. Therefore, to shed the light on this
debates, WHO convened the Expert Consultation on BMI in Asian populations (Singapore, 8-11 July,
2002)5.

The WHO Expert Consultation5 concluded that the proportion of Asian people with a high risk of type
2 diabetes and cardiovascular disease is substantial at BMI's lower than the existing WHO cut-off
point for overweight (= 25 kg/m2). However, the cut-off point for observed risk varies from 22
kg/m2 to 25 kg/m2 in different Asian populations and for high risk, it varies from 26 kg/m 2 to 31
kg/m2 . The Consultation, therefore, recommended that the current WHO BMI cut-off points (Table 1)
should be retained as the international classification.
But the cut-off points of 23, 27.5, 32.5 and 37.5 kg/m 2 are to be added as points for public health
action. It was, therefore, recommended that countries should use all categories (i.e. 18.5, 23, 25,
27.5, 30, 32.5 kg/m2, and in many populations, 35, 37.5, and 40 kg/m2) for reporting purposes, with
a view to facilitating international comparisons.
Discussion updates
A WHO working group was formed by the WHO Expert Consultation 5 and is currently undertaking a
further review and assessment of available data on the relation between waist circumference and
morbidity and the interaction between BMI, waist circumference, and health risk.

Osteoporosis berasal dari kata osteo yang artinya tulang, sedangkan porous berarti
batang. Osteoporosis adalah penyakit yang ditandai berkurangnya massa tulang,
sehingga menyebabkan kondisi tulang menjadi rapuh, keropos dan mudah patah.
Sering disebut juga sebagai silent disease, karena kadang-kadang tidak memberikan
tanda-tanda atau gejala sebelum patah tulang terjadi.
Menurut data Puslitbang Gizi Depkes RI tahun 2006, angka prevalensi osteopenia
(osteoporosis dini) adalah 41,7 % dan prevalensi osteoporosis sebesar 10,3 % yang
berarti 2 dari 5 penduduk Indonesia beresiko terkena osteoporosis.
Beberapa faktor yang meningkatkan risiko penurunan densitas tulang dan osteoporosis
meliputi peningkatan usia, ras kulit putih, berat badan rendah atau penurunan berat
badan yang cepat, riwayat fraktur sebelumnya, dan riwayat keluarga dengan fraktur.
Faktor lain yang memiliki hubungan yang signifikan dengan densitas tulang dan fraktur
adalah merokok, penggunaan alkohol, kopi, asupan rendah kalsium dan vitamin D serta
pengguna kortiko steroid.
Aktivitas fisik dapat membantu memelihara tulang, khususnya latihan beban.Pada
dasarnya, bobot tubuh merupakan beban bagi tulang.Tulang akan giat membentuk sel
ketika ditekan oleh bobot yang berat. Karena posisi tulang menyangga bobot maka
tulang akan terangsang untuk membentuk massa pada area tersebut. Jika bobot tubuh
ringan (kurus) maka massa tulang cenderung kurang terbentuk sempurna.
Penelitian yang dilakukan oleh Prihatini,dkk menunjukkan bahwa status gizi kurus
(IMT < 18,5) mempunyai hubungan yang bermakna terhadap resiko osteoporosis
dibandingkan dengan orang yang ber IMT 18,5.Pada laki-laki beresiko osteoporosis
1,5 kali dan pada perempuan 1,9 kali.Status gizi seseorang berkaitan dengan simpanan
protein dan kalsium yang berperan dalam pembentukan dan pemeliharaan tulang.
Bahan Referensi:
1.
James Johnson. 2005. Osteoporosis Kenali, LaluHindari.
www.promosikesehatan.com

2.

Effendi, Harjanto. 2008.PatahTulang Pada Penderita Osteoporosis.

www.mitrakeluarga.com
3.
Dalimartha, Setiawan. 2005. Mengenal dan Mencegah Osteoporosis.
Jakarta: Penebar swadaya
4.
Prihatini, Sri. Faktor Determinan Resiko Osteoporosis di Tiga Provinsi di
Indonesia. Media Litbang Kesehatan Volume XX Nomor 2 tahun 2010
- See more at: http://stikes.almaata.ac.id/status-gizi-kurus-lebih-beresikoterkenaosteoporosis/#sthash.F9lE4mH2.dpuf

Definition
By Mayo Clinic Staf

Hyperthyroidism (overactive thyroid) is a condition in which your thyroid gland produces

too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's
metabolism significantly, causing sudden weight loss, a rapid or irregular heartbeat,
sweating, and nervousness or irritability.
Several treatment options are available if you have hyperthyroidism. Doctors use antithyroid medications and radioactive iodine to slow the production of thyroid hormones.
Sometimes, treatment of hyperthyroidism involves surgery to remove all or part of your
thyroid gland. Although hyperthyroidism can be serious if you ignore it, most people
respond well once hyperthyroidism is diagnosed and treated.

Symptoms
By Mayo Clinic Staf

Hyperthyroidism can mimic other health problems, which may make it difficult for your
doctor to diagnose. It can also cause a wide variety of signs and symptoms, including:

Sudden weight loss, even when your appetite and the amount and type of food
you eat remain the same or even increase

Rapid heartbeat (tachycardia) commonly more than 100 beats a minute

irregular heartbeat (arrhythmia) or pounding of your heart (palpitations)

Increased appetite

Nervousness, anxiety and irritability

Tremor usually a fine trembling in your hands and fingers

Sweating

Changes in menstrual patterns

Increased sensitivity to heat

Changes in bowel patterns, especially more frequent bowel movements

An enlarged thyroid gland (goiter), which may appear as a swelling at the base of
your neck

Fatigue, muscle weakness

Difficulty sleeping

Skin thinning

Fine, brittle hair

Older adults are more likely to have either no signs or symptoms or subtle ones, such as
an increased heart rate, heat intolerance and a tendency to become tired during
ordinary activities. Medications called beta blockers, which are used to treat high blood
pressure and other conditions, can mask many of the signs of hyperthyroidism.

Graves' ophthalmopathy
Sometimes an uncommon problem called Graves' ophthalmopathy may afect your
eyes, especially if you smoke. In this disorder, your eyeballs protrude beyond their
normal protective orbits when the tissues and muscles behind your eyes swell. This
pushes the eyeballs forward so far that they actually bulge out of their orbits. This can
cause the front surface of your eyeballs to become very dry. Eye problems often
improve without treatment.
Signs and symptoms of Graves' ophthalmopathy include:

Protruding eyeballs

Red or swollen eyes

Excessive tearing or discomfort in one or both eyes

Light sensitivity, blurry or double vision, inflammation, or reduced eye movement

When to see a doctor

If you experience unexplained weight loss, a rapid heartbeat, unusual sweating, swelling
at the base of your neck or other symptoms associated with hyperthyroidism, see your
doctor. It's important to completely describe the changes you've observed, because
many signs and symptoms of hyperthyroidism may be associated with a number of
other conditions.
If you've been treated for hyperthyroidism or currently are being treated, see your doctor
regularly as advised so that he or she can monitor your condition.

Causes
By Mayo Clinic Staf

Multimedia

Thyroid gland

A number of conditions, including Graves' disease, toxic adenoma, Plummer's disease

(toxic multinodular goiter) and thyroiditis, can cause hyperthyroidism.
Your thyroid is a butterfly-shaped gland situated at the base of your neck, just below
your Adam's apple. Although it weighs less than an ounce, the thyroid gland has an
enormous impact on your health. Every aspect of your metabolism is regulated by
thyroid hormones.
Your thyroid gland produces two main hormones, thyroxine (T-4) and triiodothyronine (T3), that influence every cell in your body. They maintain the rate at which your body uses

fats and carbohydrates, help control your body temperature, influence your heart rate,
and help regulate the production of protein. Your thyroid also produces calcitonin, a
hormone that helps regulate the amount of calcium in your blood.

How it all works

The rate at which T-4 and T-3 are released is controlled by your pituitary gland and your
hypothalamus an area at the base of your brain that acts as a thermostat for your
whole system. Here's how the process works:
The hypothalamus signals your pituitary gland to make a hormone called thyroidstimulating hormone (TSH). Your pituitary gland then releases TSH the amount
depends on how much T-4 and T-3 are in your blood. If you don't have enough T-4 and
T-3 in your blood, your TSH will rise; if you have too much, your TSH level will fall.
Finally, your thyroid gland regulates its production of hormones based on the amount of
TSH it receives. If the thyroid gland is diseased and is releasing too much thyroid
hormone on its own, the TSH blood level will remain below normal; if the diseased
thyroid gland cannot make enough thyroid hormone, the TSH blood level will remain
high.

Reasons for too much thyroxine (T-4)

Normally, your thyroid releases the right amount of hormones, but sometimes it
produces too much T-4. This may occur for a number of reasons, including:

Graves' disease. Graves' disease, an autoimmune disorder in which antibodies

produced by your immune system stimulate your thyroid to produce too much T-4, is
the most common cause of hyperthyroidism. Normally, your immune system uses
antibodies to help protect against viruses, bacteria and other foreign substances that
invade your body. In Graves' disease, antibodies mistakenly attack your thyroid and
occasionally attack the tissue behind your eyes (Graves' ophthalmopathy) and the
skin, often in your lower legs over the shins (Graves' dermopathy). Scientists aren't
sure exactly what causes Graves' disease, although several factors including a
genetic predisposition are likely involved.

Hyperfunctioning thyroid nodules (toxic adenoma, toxic multinodular

goiter, Plummer's disease). This form of hyperthyroidism occurs when one or more
adenomas of your thyroid produce too much T-4. An adenoma is a part of the gland
that has walled itself of from the rest of the gland, forming noncancerous (benign)

lumps that may cause an enlargement of the thyroid. Not all adenomas produce
excess T-4, and doctors aren't sure what causes some to begin producing too much
hormone.

Thyroiditis. Sometimes your thyroid gland can become inflamed for unknown
reasons. The inflammation can cause excess thyroid hormone stored in the gland to
leak into your bloodstream. One rare type of thyroiditis, known as subacute
thyroiditis, causes pain in the thyroid gland. Other types are painless and may
sometimes occur after pregnancy (postpartum thyroiditis).

Risk factors
By Mayo Clinic Staf

Hyperthyroidism, particularly Graves' disease, tends to run in families and is more

common in women than in men. If another member of your family has a thyroid
condition, talk with your doctor about what this may mean for your health and whether
he or she has any recommendations for monitoring your thyroid function.

Complications
By Mayo Clinic Staf

Hyperthyroidism can lead to a number of complications:

Heart problems. Some of the most serious complications of hyperthyroidism

involve the heart. These include a rapid heart rate, a heart rhythm disorder called
atrial fibrillation and congestive heart failure a condition in which your heart can't
circulate enough blood to meet your body's needs. These complications generally
are reversible with appropriate treatment.

Brittle bones. Untreated hyperthyroidism can also lead to weak, brittle bones
(osteoporosis). The strength of your bones depends, in part, on the amount of
calcium and other minerals they contain. Too much thyroid hormone interferes with
your body's ability to incorporate calcium into your bones.

Eye problems. People with Graves' ophthalmopathy develop eye problems,

including bulging, red or swollen eyes, sensitivity to light, and blurring or double
vision. Untreated, severe eye problems can lead to vision loss.

Red, swollen skin. In rare cases, people with Graves' disease develop Graves'
dermopathy, which afects the skin, causing redness and swelling, often on the shins
and feet.

Thyrotoxic crisis. Hyperthyroidism also places you at risk of thyrotoxic crisis

a sudden intensification of your symptoms, leading to a fever, a rapid pulse and even
delirium. If this occurs, seek immediate medical care.

http://www.mayoclinic.org/diseasesconditions/hyperthyroidism/basics/treatment/con-20020986

Hyperthyroidism
Share on facebookShare on twitterBookmark & SharePrinter-friendly version
Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition
is often called overactive thyroid.
Causes
The thyroid gland is an important organ of the endocrine system. It is located at the front of the neck just
above where your collarbones meet. The gland makes the hormones that control the way every cell in the
body uses energy. This process is called metabolism.
Many diseases and conditions can cause hyperthyroidism, including:

Eating too much of foods that contain iodine

Graves disease (most common cause of hyperthyroidism)

Inflammation (thyroiditis) of the thyroid due to viral infections, some medicines, or after pregnancy

Noncancerous growths of the thyroid gland or pituitary gland

Some tumors of the testes or ovaries

Taking too much thyroid hormone

Getting medical imaging tests with contrast dye that has iodine

Symptoms
Common symptoms include:

Difficulty concentrating

Fatigue

Frequent bowel movements

Goiter (visibly enlarged thyroid gland) or thyroid nodules

Hand tremor

Heat intolerance

Increased appetite

Increased sweating

Irregular menstrual periods in women

Nervousness

Restlessness

Sleep problems

Weight loss (or weight gain, in some cases)

Other symptoms that can occur with this disease:

Breast development in men

Clammy skin

Diarrhea

Hair loss

High blood pressure

Itchy or irritated eyes

Itchy skin

Lack of, or irregular menstrual periods in women

Nausea and vomiting

Protruding eyes (exophthalmos)

Rapid, forceful, or irregular heartbeat (palpitations)

Skin blushing or flushing

Weakness of the hips and shoulders

Exams and Tests

The health care provider will do a physical exam. The exam may find the following:

High systolic blood pressure (the first number in a blood pressure reading)

Increased heart rate

Enlarged thyroid gland

Shaking of the hands

Swelling or inflammation around the eyes

Blood tests are also ordered to measure your thyroid hormones TSH, T3, and T4.
You may also have blood tests to check:

Cholesterol levels

Glucose

Radioactive iodine uptake

Treatment
Treatment depends on the cause and severity of symptoms. Hyperthyroidism is usually treated with one
or more of the following:

Antithyroid medications

Radioactive iodine to destroy the thyroid gland and stop the excess production of hormones

Surgery to remove the thyroid

If your thyroid is removed with surgery or destroyed with radioactive iodine, you must take thyroid
hormone replacement pills for the rest of your life.
Medicines called beta-blockers may be prescribed to treat symptoms such as fast heart rate, sweating,
and anxiety until the hyperthyroidism can be controlled.
Outlook (Prognosis)
Hyperthyroidism is treatable. Some of its causes may go away without treatment.
Hyperthyroidism caused by Graves disease usually gets worse over time. It has many complications,
some of which are severe and affect quality of life.
Possible Complications
Thyroid crisis (storm) is a sudden worsening of hyperthyroidism symptoms that may occur with infection
or stress. Fever, decreased alertness, and abdominal pain may occur. Patients need to be treated in the
hospital.
Other complications of hyperthyroidism include:

Heart problems such as fast heart rate, abnormal heart rhythm, and heart failure

Osteoporosis

Surgery-related complications, including:

Scarring of the neck

Hoarseness due to nerve damage to the voice box

Low calcium level due to damage to the parathyroid glands (located near the thyroid gland)

Hypothyroidism (underactive thyroid)

When to Contact a Medical Professional

Call your health care provider if you have symptoms of hyperthyroidism. Go to an emergency room or call
the local emergency number (such as 911) if you have:

Change in consciousness

Dizziness

Rapid, irregular heartbeat

Call your health care provider if you are being treated for hyperthyroidism and you develop symptoms of
underactive thyroid, including:

Depression

Mental and physical sluggishness

Weight gain

Alternative Names
Thyrotoxicosis

http://www.nlm.nih.gov/medlineplus/ency/article/000356.htm

The Menopause Exchange

Find out about your thyroid gland

Women are ten times more likely to suffer from thyroid disease than men. The thyroid is a butterfly-shaped gland
situated in the neck. It produces the hormones thyroxine (T4) and tri-iodothyronine (T3). Thyroxine is converted by
the tissues and organs that need it into the active hormone tri-iodothyronine. In healthy people, the production of
these hormones is regulated by the secretion of thyroid stimulating hormone (TSH) from the pituitary gland in the
brain. Thyroid hormones regulate the metabolism of the bodys cells.

Thyroid underactivity
There are two main causes of thyroid underactivity (hypothyroidism) in the UK:

autoimmune thyroid disease

a side effect of treatment for an overactive thyroid or thyroid cancer.

When there is too little thyroid hormone, the bodys metabolism slows down. Symptoms include fatigue, lethargy,
weight gain, dry skin and hair, low mood, impaired concentration and memory and constipation. Thyroxine (or
levothyroxine) is the thyroid hormone replacement recommended in the British National Formulary. Around 3% of
women over 50 are currently treated with thyroxine.

Thyroid overactivity
Thyroid overactivity (hyperthyroidism) is less common, affecting around 1.5% of women of this age. There are two
main causes of hyperthyroidism in the UK:

Autoimmune thyroid disease (Graves disease) accompanied by the presence of TSH-receptor antibodies in
the blood.

One or more benign (non-cancerous) thyroid nodules which secrete excess thyroid hormone.
When there is too much thyroid hormone, the bodys metabolism speeds up. Symptoms include fatigue, sweating,
heat intolerance, weight loss, difficulty sleeping, shaking, palpitations with a fast or irregular heart beat and anxiety.
Patients with Graves disease may develop eye problems such as grittiness and soreness, protrusion of the eyeballs
and rarely, problems with vision. Hyperthyroidism may be managed with a course of antithyroid drugs, radioiodine
treatment or thyroid surgery.

Thyroid and the menopause

As some symptoms of thyroid disease can be similar to postmenopausal symptoms, its not unusual for them to be
incorrectly attributed to the menopause or even put down to stress. To check the diagnosis, a blood test for thyroid
function should be performed. Hypothyroidism is usually managed by a GP whereas hyperthyroidism will be
managed, at least initially, by an endocrinologist in a specialist thyroid clinic. Borderline results may need to be
repeated and monitored for a period of time with specialist advice from an endocrinologist.

HRT and phytoestrogens

Some women who experience severe menopausal symptoms due to oestrogen deficiency may be prescribed HRT.
Women who have no pre-existing thyroid disorder and have normal thyroid function usually adapt well to the effects
of the HRT and their thyroid function remains normal. However, women with pre-existing hypothyroidism treated with
thyroxine, may require an increase in their thyroxine dose after starting HRT. Therefore it is useful for thyroid function
tests to be re-checked after starting HRT.
Soy foods are a traditional component of Asian diets but their alleged health benefits have boosted their popularity in
recent years and promoted more widespread consumption. Suggested health benefits include alleviation of
menopause-related hot flushes and protection against osteoporosis. There are several soybean components that
may contribute to the possible health benefits of soy but most attention has focused on the phytoestrogens, leading to
the development of phytoestrogen supplements and the fortification of foods with soybean constituents.

Despite the possible benefits, there have been some concerns that soy may adversely affect thyroid function and
interfere with the absorption of synthetic thyroid hormone. However there is little evidence that soy foods or
phytoestrogen supplements affect thyroid function in people with normal thyroid function. In people with borderline
thyroid function and low iodine intake, soy foods may increase the risk of hypothyroidism. Therefore, its important for
people who regularly consume soy food to ensure their intake of iodine is adequate. There is also evidence to
suggest that soy foods may inhibit the absorption of thyroxine and increase the dose of thyroid hormone required by
hypothyroid patients.
Women with hypothyroidism who take calcium carbonate supplements should ensure that they dont take their
calcium supplement within four hours of the thyroxine dose. Calcium carbonate may decrease the absorption of
thyroxine by nearly a third when these medications are taken at the same time.

Osteoporosis and thyroid

Thyroid hormone plays a key role in maintaining healthy bones. In post menopausal women, hyperthyroidism is a risk
factor for sustaining a hip fracture. In part, this is due to the effects of excess thyroid hormones on the cycle of bone
production and resorption. Hyperthyroid patients have shorter phases of building bone and longer phases of bone
resorption. Hypothyroidism is also associated with an increase in fracture risk. Whether borderline (subclinical)
hyperthyroidism is associated with an increased fracture risk remains less certain as there is not sufficient data to
draw definite conclusions in all patient groups.

Conclusions
Thyroid disorders may cause similar symptoms to the menopause. HRT and phytoestrogen supplements dont seem
to affect normal thyroid function, but may reduce the absorption of thyroxine medication in those with hypothyroidism.
This article was written by Dr Jackie Gilbert and it was included in issue 54 (Autumn 2012) of The Menopause
Exchange newsletter.

http://www.btf-thyroid.org/index.php/thyroid/articles/the-menopause-exchange

A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open or
compound fracture. Fractures commonly happen because of car accidents, falls or sports injuries. Other
causes are low bone density andosteoporosis, which cause weakening of the bones. Overuse can cause
stress fractures, which are very small cracks in the bone.
Symptoms of a fracture are

Out-of-place or misshapen limb or joint

Swelling, bruising or bleeding

Intense pain

Numbness and tingling

Limited mobility or inability to move a limb

You need to get medical care right away for any fracture. You may need to wear a cast or splint.
Sometimes you need surgery to put in plates, pins or screws to keep the bone in place.

Bone mineral density in hyperthyroidism.

Karga H1, Papapetrou PD, Korakovouni A, Papandroulaki F, Polymeris A, Pampouras G.
Author information
Abstract
OBJECTIVE:
To investigate whether previous hyperthyroidism is a cause of permanent secondary osteoporosis.
DESIGN AND PATIENTS:
In this cross-sectional study, 164 women with untreated or previously treated overt and symptomatic
hyperthyroidism were examined 0-31 years after the initial episode of hyperthyroidism and its treatment,
and were compared with a control group of 79 age-matched women without previous history of
hyperthyroidism. Subjects with current or previous metabolic bone disease, any antiresorptive treatment
for osteoporosis or treatments and habits known to affect bone metabolism were excluded.
MEASUREMENTS:
The age of the first manifestation of the disease, the age at the measurement of bone mineral density
(BMD) at the spine and femoral neck and the interval between diagnosis and treatment of
hyperthyroidism and BMD measurement were recorded and the Z-scores and T-scores of BMD were
analysed.
RESULTS:
Untreated hyperthyroidism and hyperthyroidism up to 3 years after its diagnosis and treatment were
associated with decreased BMD. Three or more years after the first episode of the disease the mean Zscore at both skeletal sites was near zero and not different from the controls. The age at which
hyperthyroidism was manifested for the first time had no effect on the final outcome. Women affected at a
young age (13-30 years) had a more pronounced loss of BMD when examined untreated or early (< 3
years) after diagnosis, but a BMD significantly above zero if examined later (> 3 years). Older women
(aged 51-70 years) showed a similar pattern, although the differences were not significant. Middle-aged
subjects (31-50 years) had the smallest loss of BMD during the first 3 years. Analysis of T-scores of
former hyperthyroid women aged > or = 51 years showed no significantly different relative risk (RR) for

osteoporosis in comparison with the controls. However, the study was not powered enough to give
meaningful RR results.
CONCLUSIONS:
Overt symptomatic hyperthyroidism is associated with decreased BMD during the first 3 years after
diagnosis and treatment of the disease. After this interval, former hyperthyroid women have a Z-score
near zero and not different from women without a history of the disease, apparently because of recovery
of the bone density lost early during the course of the disease. Symptomatic hyperthyroidism does not
seem to be a cause of long-lasting osteoporosis, and the age of the patient during the first episode is
irrelevant.
PMID:

15473879

[PubMed - indexed for MEDLINE]

Menopause berdasarkan rekomendasi WHO tahun 1981 dan telah

diperbaharui kembali oleh Technical Working Party WHO tahun 1994
didefinisikan sebagai : penghentian permanen siklus haid pada wanita yang
disebabkan oleh pengurangan aktifitas folikel ovarium. Diagnosa
berdasarkan pemantauan selama amenorea 12 bulan berturut-turut dan
tidak terdapat penyebab lainnya, patologis atau psikologis.5,7 Postmenopause
dimulai 5 tahun setelah menopause, sedangkan pramenopause terjadi 4-5
tahun sebelum masa menopause. 10,11,15
Hormon estrogen dalam kadar normal akan memicu aktifitas osteoblas
dalam formasi tulang untuk membentuk kolagen. Kadar estrogen yang
sangat rendah dapat menghambat kerja osteoblas dan akan meningkatkan
kerja osteoklas sehingga remodeling tulang tidak seimbang dan lebih banyak
ke proses resorpsi tulang (osteoklas lebih aktif dari osteoblas) sehingga
ancaman terjadinya osteopenia
Universitas Sumatera Utara

sampai osteoporosis. Kehilangan massa tulang pada awal menopause sekitar

10% dan berkelanjutan sekitar 2-5% pertahun.

Pada pasca menopause, terjadi penurunan estrogen yang dapat menyebabkan

meningkatnya resorpsi tulang, dan diduga berhubungan dengan peningkatan sitokin.
Resorpsi tulang tersebut akan meningkatkan kadar kalsium dalam darah sehingga kadar
kalsium dalam tulang berkurang.
Telah banyak diketahui bahwa osteoporosis pasca menopause menunjukkan
bahwa ada gangguan penyerapan kalsium serta rendahnya kadar 1,25
Dehydroxy vitamin D dalam darah.