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Hormone Replacement Therapy for Promoting Bone Health Among Postmenopausal Women

The hormonal imbalance that most women experience during their natural menopause stage is one of the main causes of postmenopausal osteoporosis. This is because the decrease in estrogen levels in the body can cause loss of bone mineral density, making them more prone to bone fractures in their lifetime. 

So what exactly is the purpose of hormone replacement therapy on bone health for postmenopausal women? Estrogen medications are given during hormone therapy to suppress bone resorption cells (osteoclasts) and stimulate the development of bone forming cells (osteoblasts). It helps maintain bone mass and protect against bone loss and osteoporotic fracture.

How HRT treats postmenopausal osteoporosis

Many women have been benefiting from hormone replacement therapy for decades. Also called menopausal hormone therapy, it is a treatment that helps provide relief from common menopause symptoms such as hot flashes, night sweats, mood swings, and vaginal dryness. 

There are two main types of hormone therapy used for menopause symptoms, namely estrogen therapy and combined HRT (estrogen and progestin). Doctors typically prescribe taking estrogen-only drugs such as conjugated estrogen and estradiol for women who have had a hysterectomy. Meanwhile, estrogen-progesterone therapy is best recommended for postmenopausal women and those who still has their uterus. 

Patients can take hormone therapy in different ways: oral HRT (tablet and pill forms), transdermal estrogen (patches attached to the skin), subcutaneously (HRT implants or pellets), and gels or creams (applied for direct absorption on the skin). 

The amount of dosage and how long a menopausal woman will take the hormones depends on the degree of the menopause symptom. HRT can be taken for as long as needed until the doctor decides to gradually take them off the therapy. For the specific treatment of osteoporosis, there are common ways of taking HRT: 

  • Cyclical or sequential combined therapy - It refers to the method of taking estrogen continually while progesterone is administered around 12 days per month. 
  • Continuous combined therapy - Unlike cyclical combination HRT, this requires taking estrogen and progesterone together throughout the month. This is usually prescribed for the first year of their postmenopause phase. 
  • Estrogen-only therapy - The most common type of HRT for prevention of osteoporosis. Medications for estrogen replacement therapy (like conjugated equine estrogen) are taken continuously as prescribed by the physician. This is also given as a medication after hysterectomy to lessen symptoms of surgical menopause for young women. 
  • Tibolone - It is an artificial steroid medicine that has the similar effects of taking combined estrogen and progestin therapy. It’s a prescription drug that is taken at least once a day. Like most HRT medications, it has the same benefits of relieving menopause symptoms, as well as inhibits bone resorption to prevent osteoporosis-related fractures. 

Is HRT for osteoporosis safe?  

Hormone replacement therapy is a generally safe and effective treatment that has proven benefits for women. However, its results can vary from one person to another depending on the dosage prescribed by the doctor and how well the body responds to the medication. 

Some of the factors that can affect the effects of HRT are age, weight, family history, and pre-existing medical conditions. Use of estrogen therapy is restricted for females with a history of heart disease, breast cancer, uterine cancer, liver disease, or blood clots.

Women with a history of blood clotting may be at risk for venous thromboembolism when taking oral estrogen, in which case they are suggested to take transdermal HRT. Long-term use of HRT can also constitute risks for endometrial cancer, breast cancer, and cardiovascular disease.

Hormone replacement therapy can also be used as viable treatment for postmenopausal women with primary hyperparathyroidism. It is a condition where the body produces excess parathyroid hormone which can lead to bone loss and increased fracture risk. HRT helps slow down bone turnover and improves bone density. 

When should you start HRT for osteoporosis prevention?  

The ideal age at which to start hormone therapy is at their early 40s. At this age, many women experience early menopause symptoms which causes them to lose estrogen prematurely, leading to increased chances of hip fracture and vertebral fracture from loss of protection in the bones. 

Postmenopausal women who are at their mid 50s to 60s can also get HRT to strengthen their bones. Patients who are planning to start hormone therapy should visit their primary care physician to get a quick consultation. It’s important to know the possible benefits and risks of the therapy and to disclose essential information about their medical history so the doctor can create a treatment plan that will meet their needs. 

Postmenopausal HRT to protect against osteoporosis and maintain bone health would need more than five years of continuous treatment. Getting regular check-ups would be beneficial in determining if there should be changes in the dosage of the medication to ensure its effectiveness. If you decide to quit the therapy, the hormones will lose its effects on your bones and can increase risk of fractures.

Possible side effects of HRT 

As with all medications, the side effects of postmenopausal hormone therapy are minimal and do not last for a long time. Common side effects associated with estrogen medications are breast tenderness and swelling, leg cramps, indigestion, nausea, and bloating. Meanwhile, side effects of progesterone therapy can include mood swings, headaches, depression, and back aches. 

Gaining weight may also be evident among women who are taking hormone replacement therapy. This can be remedied by maintaining a healthy lifestyle and regular exercise regimen to manage fat in the body. 

Women specifically taking tibolone or combined HRT can also experience spotting or irregular bleeding within the first 6 months of the treatment. Usually, a change of medication or lowering of dosage is needed to minimize side effects of hormone replacement therapy. 

Understanding bone health among women 

To better get a grasp of what causes postmenopausal osteoporosis among women, it is important to understand the science behind bone formation. The bone is a living tissue and they  undergo a constant process of regeneration or remodeling to sustain bone health in everyday activity.  There are three main types of cells that are essential in the development of new bones: 

  • Osteoclasts - These are cells responsible for bone turnover activity and they are usually found in the bone marrow. Osteoclasts have a vital role in bone remodeling as they break down the bones to make way for new ones. 
  • Osteoblasts - These are cells that work together with osteoclasts to build new bones in the body. They are also known as structural cells and are in charge of creating a protein mixture called osteoid (consists mostly of collagen) which controls deposit of calcium and other minerals in the bone. 
  • Osteocytes - These are cells found in most bone tissues. It helps regulate the functions of osteoblasts and osteoclasts as they act as sensory receptors that can detect fractures or deformations in the bone. They can transmit signals to other osteocytes to start the process of bone regeneration. 

Calcium is an important mineral in helping the body build strong bones from childhood until adulthood. It provides the skeletal structure and improves bone strength until the body reaches its maximum amount of bones (peak bone mass). 

Women typically achieve peak bone mass between the ages of 25 to 30. Once the bones reach optimal strength and density, the body’s normal bone production is slowed down and begins to lose bone mass. Rapid bone loss is more experienced by women in the first five years of the postmenopause stage. This drastic change is highly caused by the increased loss of estrogen at menopause. 

How is menopause related to osteoporosis? 

Most of the sex hormones in the body, particularly the estrogen and testosterone, have a substantial role in sustaining bone health. For women in particular, the estrogen hormone influences the bone producing function of osteoblasts. 

With estrogen deficiency during menopause, the osteoblasts are unable to produce bones normally which accelerates bone loss. In the first five to ten years after menopause, women can lose a total of 10% to 20% of bone density. This makes women more vulnerable to osteoporosis-related fractures than men.

Among the other factors that can increase chances of osteoporosis are family and medical history (if anyone has had osteoporosis), having a sedentary lifestyle, amount of daily calcium intake, and current medications (ie. long-term use of steroids). Women with slim figures are also at greater risk of developing osteoporosis since their body structures are thinner and have less bones than women with larger body frames. 

There is also a high risk for bone loss for women who are pre-diagnosed with hyperparathyroidism (overactive thyroid gland), arthritis, liver and kidney disease, chronic pancreatitis, Crohn’s disease, celiac disease, and other inflammatory conditions.

How is osteoporosis diagnosed? 

One way to determine if a person has osteoporosis is to undergo a bone density exam. Doctors may conduct a dual-energy absorptiometry scan (DEXA) which is a quick test that uses X-rays to measure bone density at the hips and spine. They can also suggest a peripheral dual-energy absorptiometry (P-DEXA) which is a variation of the DEXA and measures bone mass in peripheral areas of the body such as in the arms or legs. 

Another medical exam is the quantitative computed tomography (QCT) which is usually performed with a CT machine. Results of this particular test can show possibilities for fractures and can likewise monitor effects of therapy. Compared to DEXA exams, the QCT requires higher exposure to radiation. Doctors may also do a quick ultrasound which uses sound waves in the heels to measure bone mineral density. 

Additional exams such as calcium blood tests and Vitamin D tests may also be done to determine other causes of osteoporosis. A calcium test requires extraction of blood from an arm vein which will then be examined in a laboratory. It determines whether you have enough calcium to sustain the bones. Blood extraction is also performed for a Vitamin D test to check if you have Vitamin D deficiency which can allude to bone disorders or osteoporosis. 

Alternatives to hormone replacement therapy 

Certain over-the-counter drugs and prescription medicines can also be used for osteoporosis prevention and treatment. Among the available alternatives to promote good bone health are: 

Bisphosphonate medications

The bisphosphonates family of drugs are effective in preventing loss of bone mineral density and treating osteoporosis. They work by slowing down the process of bone turnover, and they can curb risks of hip and spine fractures. 

It can be taken orally, intravenous infusion, or by injection. The popular bisphosphonate medications include zoledronic acid (usually administered via infusion), ibandronate, risedronate tablet, and alendronate pills. Oral bisphosphonates are taken weekly while the infusions are performed yearly and intravenous injections are given every three months. 

Selective estrogen-receptor modulator (SERMs) 

Raloxifene is a popular SERM drug used for estrogen therapy. It has the same properties and functions of the estrogen hormone, making it an effective medication to treat postmenopausal bone loss. Similar to how estrogen supports the bone production, Raloxifene can help keep the bones strong and reduce likeliness of fractures. It can also minimize chances of being diagnosed with invasive breast cancer after menopause

Naturopathic approach

Bones are living tissues and they also need nutrients to help promote their growth and maintain good bone health. Doctors may recommend a naturopathic approach where patients use natural remedies such as herbal treatments and nutritional supplements to stimulate the body’s own healing properties. 

Soybeans is a good source of isoflavones which have the same chemical structures and functions of estrogen, and are fundamental in reducing risks of osteoporosis diseases. Likewise, most soy products like soy milk and tofu are also providers of calcium and vitamin D which strengthen the bones. 

Herbal plants such as red clovers and horsetail (taken as herbal compress or mixed in teas) also contain medicinal properties that can help in bone healing and formation. However, it is advised to consult first with healthcare providers and doctors before taking herbal treatments to know the possible health risks. 

Traditional Chinese health practices such as acupuncture and tai chi may also be useful in treating osteoporosis. Acupuncture involves inserting of needles at target points in the body to stimulate healing. On the other hand, tai chi is a form of exercise inspired by martial arts and it uses different postures to improve muscle strength and movement, and improve joint pain. 

Read also: Is Bioidentical Hormone Replacement Therapy Right For You? 

Vitamin supplements 

The most important vitamins and minerals needed for bone development are calcium, magnesium (helps absorb calcium for bone building), Vitamin D (maintains bone tissues), and Vitamin K (stimulates functions of the osteoblasts). 

Upon doctor’s recommendation, women with calcium deficiency can take calcium carbonate and calcium citrate. Getting daily sun exposure for at least 20 minutes can be a good source of Vitamin D, as well as eating enough eggs, fatty fish, and milk. Individuals can also enhance their magnesium and Vitamin K levels by consuming green vegetables, beans, peas, and whole-grain cereals.   

Tips for osteoporosis prevention after menopause 

Taking medications and hormone replacement therapy for osteoporosis treatment will be more effective once you start being more conscious about your lifestyle and activities. Maintaining good bone health for postmenopause can be done by doing:  

  • Weight-bearing exercise - Walking, jogging, hiking, climbing, jumping and aerobics are popular forms of weight-bearing exercises. These activities require the feet and legs to support body weight while moving, and it is useful in strengthening the muscles and joints. Having at least 30 minutes of exercise daily helps in increasing bone mass. 
  • Resistance exercise - Unlike weight-bearing exercises, resistance routines activate contractions of the muscles to boost bone strength. Using weightlifting equipment or doing pull-ups and push-ups are examples of resistance exercises. 
  • Stop smoking - The nicotine in cigarettes can limit the body’s ability to ingest calcium and speed up the breakdown of estrogen hormones which leads to faster loss of bone density.  
  • Limit alcohol and caffeine consumption - Alcoholic and caffeinated drinks such as coffee and soft drinks can weaken the bone structure as they inhibit the body’s amount of calcium intake.
  • Eat healthy - Incorporating calcium-rich food in the diet can help assure that the body receives enough minerals to facilitate bone regeneration. Fresh fruits, vegetables, and fatty fish are also good sources of vitamins D and K which are fundamental for suppressing bone loss. 

Safe and effective hormone therapy at Revitalize You MD 

Postmenopausal women can protect themselves from osteoporosis and maintain good bone health for their remaining years with hormone replacement therapy. To start the treatment, you should first find a trusted med spa or health clinic to assist in getting you on board for the therapy. 

At Revitalize You MD, we assure that every client receives the best hormone therapy experience that is customized to their needs. With a team of certified medical experts, we are committed to providing products and services that will help clients achieve total wellness. Book a free consultation to learn more about how our HRT treatments and other offers. 


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