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Bone Health and Estrogen

Bone Health and Estrogen

by Dr. Barb DePree MD

This is the second in a series of posts based on Estrogen Matters: Why Taking Hormones in Menopause Improves Women's Well-Being, Lengthens their Livesand Doesn't Raise the Risk of Breast Cancer and on Dr. Barb's interview with the authors. You can read the first in the series, about hormone replacement therapy, here.

You may want to sit down while reading this post, because everything you think you’re doing to protect your bone health probably isn’t—or at least not as much as you think.

Like thinning hair, bone weakening is a normal part of aging. Osteoporosis is different. It’s when cavities develop inside the bone, thinning the bone and making it more brittle. When that happens in the femur, the result can be a hip fracture. And people who have a hip fracture are twice as likely to die in the five years after as people who haven’t had a hip fracture.

Taking calcium to prevent osteoporosis doesn’t help. Yes, you read that right.

Here’s why. Bone is made of an outer shell and the osteoid, an inner network of collagen fibers that allow the bone to flex without breaking. Calcium strengthens the outer shell, but it doesn’t help the osteoid, write the authors of Estrogen Matters. “Calcium supplements... are ineffective in preventing postmenopausal osteoporosis or fractures because they do not affect bone resilience.”

And while weight-bearing exercise makes bones stronger and more resistance to fracturing before menopause, it doesn’t after you’ve gone through menopause.

So, calcium and exercise don’t help with osteoporosis. What about Fosamax, Aredia, Zometa, and other bisphosphonates? They can, but only in certain circumstances. They can stave off osteoporosis in women who are at high risk (i.e., women who are white or Asian, very thin, or went through menopause early), and they can hold further bone loss at bay in women who already have it. But once you have osteoporosis, bisphosphonates won’t reverse it.

Not every woman tolerates bisphosphonates well, with side effects including digestive issues, fatigue, and insomnia. In addition, when taken over the long term, bisphosphonates may actually increase the risk of atypical hip fractures.

Calcium and vitamin D do not prevent menopausal bone fractures.

Is there a better answer? Estrogen replacement therapy or HRT was the standard approach in the 1970s, 80s, and 90s—until the WHI report—because it was effective. Multiple studies have shown that estrogen significantly reduces the risk of hip fracture, some by as much as 50 percent. In fact, no therapy has proven to be better at preventing osteoporosis and fractures in the spine and hips.

In order for it to be entirely effective, however, women have to begin taking it in menopause and continue for the rest of their lives. We need to think of osteoporosis as a chronic condition, like hypertension or diabetes. Treatment through medication is of benefit, and when the treatment stops, the chronic condition continues its progress. Once a woman stops taking estrogen, she loses its protection. And, of course, being on any medication for the rest of your life isn’t something you should take lightly.

I encourage you to investigate HRT or ERT as an option regardless of what you’ve heard about it. As always, talk to your doctor about your bone health, your particular health history and condition, your quality of life goals, and what course of action is best for you.


  • Judith,
    It has been my experience that for those women with localized endometrial adenocarcinoma (contained in the uterus) that our oncologist are supportive of using estrogen therapy. Admittedly this is a difficult conversation and recognizing low risk of recurrence but not zero, vs quality of life is the real issue. I have a number of women like you who are using estrogen. To date, I have seen no recurrences in my own patient population.

    Dr Barb on

  • I was on HRT with progesterone, (patches and micronized progesterone) since menopause-age 51-and, now just had a total hysterectomy for uterine cancer, which was stage 1A, grade 1, non-invasive adeno-carcinoma. I’m now age 72. It was done robotically by a very fine surgeon. I’m off estrogen and the hot flashes are miserable but my greatest concern are my bones, bladder and vaginal thinness. What is your opinion? I’m researching articles but there are no definitive reports on the safety of taking estrogen after this surgery and diagnosis. My doc is afraid of any errant cells that are estrogen stimulated.

    Judith on

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