240 Journal of the College of Physicians and Surgeons Pakistan 2009, Vol. 19 (4): 240-244 INTRODUCTION One of the implications of menopause is post- menopausal osteoporosis, the resultant of bone remodeling in the skeleton secondary to estrogen deficiency. Bone remodeling rates have been shown to double at menopause, triple 13 years later and remain elevated till osteoporosis, contributing to the age related skeletal fragility in women. 1 Osteoporosis affects approximately one in 6 women over the age of 50 in the west. It is characterized by reduction in the quantity of bone during aging process without changing its chemical composition. 2 The loss of trabecular bone is 50% whereas loss of cortical bone is 5% and seen more rapidly during first 3-4 years after menopause. Proportion of elderly in Pakistan is growing steadily and persons more than 65 years are estimated to be 4%. Over half of women over the age of 60 years live in the developing countries. 3 Health care providers in developing countries often have limited information regarding physical, psychological and social problems of aging. These women do not understand their unique health risks. Moreover, their financial and physical limitations further reduce their access to medical services. 4,5 The average age at menopause in the developed nations is 51 years while the worldwide life expectancy of women has lengthened to approximately 62 years. 1 According to local studies, the average age at menopause in Pakistan is estimated to be 47 years while female life expectancy is 64 years as compared to 70 years in other Asian countries. 2 The rural study in Punjab province reported mean age at menopause 49+ 3.6 years; the median being 50 years. The majority of women (22.3%) reached menopause at 50 years followed by 13.9%, who became menopausal at 49 years. 6 Menopause is said to have occurred if menstruation has stopped for atleast one year. The word ‘menopause’ refers to the last menstrual bleed and the diagnosis is retrospective. It is generally considered to have occurred retrospectively after one year of amenorrhea. ABSTRACT Objective: To assess the association of osteopenia and osteoporosis with menopause and compare the health seeking behaviour of women related to menopause in different strata of society. Study Design: A cross-sectional study. Place and Duration of Study: Three different socioeconomic strata of Karachi from May till August 2004. Methodology: A sample of 925 women, over 35 years of age, was selected from 16 clusters of 250 households (50 houses in each cluster). All apparently healthy women having age between 35 and 50 years were selected in the cluster houses. Those who were not willing to be the part of the study or giving history of taking treatment for any disease for more than 4 weeks were excluded. In-depth interviews were conducted at their houses by the fourth year medical students trained and supervised by the senior faculty of the Medical College. T-scores were calculated to get BMD (Bone Mineral Density) for all the subjects through heel ultrasound. Results: A total of 287 women were found to be experiencing menopause. The mean age of menopause was 47.8 + 4.7 years. Out of those 287 women, 135 (47%) wanted their menses to continue and 235 (82%) had consulted a physician after menopause. There was a significantly lower score of BMD of postmenopausal women (mean = -1.833 + 0.65) compared to pre-menopausal women (mean = -1.597 + 0.60, p=0.016). Out of the 925 women interviewed, 53% had consulted a physician for various symptoms related to menopause. The symptoms experienced by pre-menopausal women included lack of sleep (25%), fear of becoming sterile (13%) and urinary incontinence (18%). Conclusion: The average age of menopause was found to be similar to other studies of the country. Lower bone mineral density was found in greater proportion among older females. Majority needed intervention inclusive of awareness through health education and medication. Key words: Menopause. Age. Bone mineral density. Health seeking behaviour. Symptoms. 1 Department of Community Medicine/Community Health Sciences 2 , Karachi Medical and Dental College, Karachi. 3 Department of Obstetrics and Gynaecology, Abbasi Shaheed Hospital, Karachi. Correspondence: Dr. Farah Asad, A-517, Sector 11-B, North Karachi, Karachi-75850. E-mail: mansuri_21@hotmail.com Received August 02, 2007; accepted January 23, 2009. Association of Menopause with Osteopenia and Osteoporosis: Results from Population Based Study Done in Karachi Lubna Baig 1 , Farah Asad Mansuri 2 and Saadiya A. Karim 3 ORIGINAL ARTICLE