Estrogen Replacement Therapy for Osteoporosis

Written by Medical experts of the National HRT Clinic - November 26, 2015

Osteoporosis is a vital topic for all adults as one in three women, and one in five men will experience osteoporotic fractures in their lifetime. The use of estrogen replacement therapy for osteoporosis is a treatment worthy of discussion due to estrogen’s effects on bones.

Various hormones influence bone growth. While you may think that bones stop growing after puberty, they are in a continual state of renewal throughout your life. Skeletal turnover is about 10% each year meaning that after ten years, all the bones cells in your body will be different than they were ten years prior. Estrogen, testosterone, growth hormone, and insulin growth factor 1 all play a significant role in maintaining bone mineral density.

Why should you consider estrogen for prevention of osteoporosis rather than some of the other treatments?

Hormone replacement is more about dealing with a particular deficiency rather than treating a symptom. Blood analysis measures various hormone levels to determine what type of treatment will be beneficial. A person who has low estrogen levels and is concerned about brittle bones can then benefit from the use of estrogen for osteoporosis treatment.

What Is Osteoporosis?

Osteoporosis is a condition that occurs when the bones become brittle and weak. The term means porous bone which happens as bone turnover occurs faster than new bone growth. Osteoporosis risk increases with aging. The precursor to osteoporosis is osteopenia. When a person is diagnosed with osteopenia, they can then take the necessary steps to strengthen their bones.

Bones are made up of living tissue – tissue that continuously changes with the death and birth of each new bone cell. Peak bone density is during a person’s early twenties. That is also when many critical hormone levels are at their highest point. By age thirty, not only are hormone levels in decline but so is peak bone mass.

One benefit of estrogen replacement therapy for osteoporosis is that it helps reduce the speed at which the body resorbs old bone. If the dying bone cells are resorbed by the body before other cells are ready to take their place, then the bones will weaken.

The process of bone growth and resorption is called remodeling. The old bone cells die off and dissolve the bone matrix. New bone cell growth is vital to prevent the bones from becoming porous and brittle. If that occurs, the bones become susceptible to fractures.

Should I take estrogen for osteoporosis if that is a concern?

Estrogen therapy is not always prescribed for osteoporosis. A person who tests positive for normal estrogen levels will likely not benefit from estrogen replacement therapy. Because multiple hormone levels may be influencing the decline of bone density, a different approach to treatment may be necessary. For many, that treatment is HGH therapy. Other individuals may benefit from testosterone replacement to help improve bone mineral density. Each of these hormones has a specific usefulness for the bones. Growth hormone is the body’s stimulator of new cells.

What Are the Causes of Osteoporosis?

As we continue our examination of estrogen replacement therapy for osteoporosis, we next look at potential causes of weakening bones. Bone resorption is an ongoing process that happens every day. Without the balancing of new bone cells to replace those the body resorbs you will begin to experience a general weakening of the bones that can lead to them becoming brittle and susceptible to fractures.

Here are some of the potential causes of osteoporosis:

• Corticosteroid use in earlier years can weaken the bones, increasing the risk of osteopenia which can later become osteoporosis.
• Prior gastrointestinal surgery to the stomach or intestines can reduce nutrient absorption crucial for supplying the bones with calcium.
• Low intake of dietary calcium throughout life can lead to reduced bone density and early bone loss.
• An overactive thyroid that supplies too much thyroid hormone can lead to bone loss. The same applies to taking too much thyroid hormone medication if you have an underactive thyroid.
• Early menopause which reduces estrogen and testosterone levels is another cause of brittle bones.
• Excessive alcohol consumption and smoking can increase osteoporosis risk.

The following medical conditions can also increase the risk of osteoporosis:

• Cancer
• Celiac disease
• Chron’s disease
• Colitis
• Kidney disease
• Liver disease
• Lupus
• Multiple myeloma
• Rheumatoid arthritis

Another cause of osteoporosis is growth hormone deficiency. Growth hormone is responsible for the body’s cell regeneration. When GH enters the bloodstream, some of it goes to the liver where it influences the secretion of insulin growth factor 1, the mediator of many of growth hormone’s functions. Together, GH and IGF-1 help the body produce the many cells needed to replace those that die off – including bone cells. That is why a person who has growth hormone deficiency would do better receiving HGH therapy rather than estrogen replacement for osteoporosis.

Osteoblasts are the bone cells that lay down the critical new bone material that maintains bone density. Osteoclasts are the bone resorbing cells. Bone formation is a longer process than bone resorption, which is why it is crucial to have adequate estrogen to slow down the resorption while maintaining growth hormone levels to speed up osteoblast formation.

Testosterone is another hormone crucial to the maintenance of bone mineral density, although at a lesser level than estrogen. As an androgen hormone, testosterone helps to decrease osteoblast apoptosis (early cellular death). Because testosterone is the precursor hormone to estrogen, it can help increase estrogen levels while also providing its own benefits to bone growth.

Osteoporosis is a silent condition – most people have no idea they have it until they experience a fracture. However, some warning signs can lead you to seek testing for bone density:

Osteoporosis Symptoms

• Height shrinkage
• Stooped posture
• Back pain associated with a collapsed or fractured vertebra
• Bone fractures

We also recommend speaking with a hormone specialist or orthopedic doctor if you experience joint pains that have no underlying cause.

What Does Estrogen Have to Do with Osteoporosis?

The connection between estrogen and osteoporosis is well established. Estrogen works directly on both osteoblasts and osteoclasts, as shown below:

• The effects of estrogen on the bone cells

Estrogen works with receptors on the surface of both osteoclasts and osteoblasts. Estrogen binds with estrogen receptor alpha (ERa) cellular receptors on the surface of osteoblasts to then enter the nucleus where it can turn on specific genes critical for bone formation. Sex hormone-binding globulin (SHBG) which transports testosterone through the bloodstream may play a role in facilitating the entry of estrogen into the cells.

The usefulness of estrogen replacement therapy for osteoporosis is beneficial when estrogen deficiency is one of the causes of overall weakening. Estrogen slows down the remodeling process which is crucial because the inside of the cortical layer of the bone contains vital minerals. If the remodeling occurs faster than new bone cells appear, the loss of these minerals will lead to a widening of the bone cavity due to loss of trabecular bone. What we sometimes see is added minerals on the outside of the cortical layer to make up for the internal loss. However, that does not increase bone density; it only makes the bones slightly thicker, but no stronger.

Who Should I Have a Bone Mineral Density Test?

A bone mineral density test, also called a dual energy X-ray absorptiometry (DXA) measures minerals such as calcium in your bones. If you are concerned about estrogen deficiency, osteoporosis, or osteopenia, you should have this test.

Because any person can suffer from weakening bones, we recommend that everyone get this test by age 65. Of course, if you have a higher risk factor for osteoporosis, you should undergo testing at a much earlier age. It helps to get a baseline test even if you are a young adult with severe risk factors from the list above.

Before starting estrogen replacement therapy for osteoporosis, your doctor will require you to undergo the bone mineral density test. You should also consider getting tested at an earlier age if you fall into any of the following categories:

1. Entered menopause at an early age
2. A history of fractures when you were young
3. Prior or current eating disorder causing low body weight
4. Sedentary lifestyle with minimal weight bearing activity

According to the National Institutes of Health, here are the guidelines for the bone mineral density test scores:

• Normal bone mass: between 1 and -1
• Low bone mass: -1 to -2.5
• Osteoporosis: -2.5 or lower
• Severe osteoporosis: -2.5 or lower with subsequent bone fractures

What Can I Do for My Osteoporosis?

There are many ways you can help strengthen your bones, including the use of bioidentical estrogen for osteoporosis. The first thing you want to do is look at how lifestyle factors may be influencing your bone density. Engaging in regular exercise using weights can help strengthen your bones. What you do not want to do if you have osteoporosis is participate in exercises that increase fracture risk such as jumping rope, running, hiking, and climbing. Stick with low-impact and weight-bearing exercises for maximum benefit.

Increasing vitamin D and calcium intake may also be beneficial. Dairy, enriched grains, dark green and leafy vegetables can help. Women under age 50 and men under age 70 should get 1,000 milligrams of calcium each day. After that, the number increases to 1,200 mg of calcium. All adults under 70 should aim for 600 international units of vitamin D per day with the number increasing to 800 IU after age 70.

There are some medications that the doctor may prescribe for osteoporosis, including bisphosphonates such as Fosamax, Boniva, Actonel, and Reclast. Another medication called Prolia is an antibody that slows the breakdown of bone while maintaining bone density.

Next up are the hormone medications that can help strengthen the bones, including calcitonin, parathyroid hormones, testosterone, growth hormone, and estrogen.

When is estrogen good for osteoporosis and when is it not recommended?

National HRT recommends consulting with a hormone specialist before starting any type of hormone replacement therapy. HRT should only be used to treat hormone deficiencies – not as a direct treatment for osteoporosis if no deficiency is present.

It is best to begin estrogen therapy early in menopause, although even more than ten years later, treatments may still provide benefits.

We also do not recommend estrogen replacement therapy for osteoporosis diagnosed after age 60. That can be a problem if you wait until then to have your initial bone mineral density test. It is not recommended for women over age 6o to use estrogen, except when absolutely necessary. Since there is a likelihood of having a testosterone or growth hormone deficiency by this age, especially for people with osteoporosis, those two treatments are a better option.

Treatment with estrogen hormone therapy for osteoporosis in younger women can be beneficial. Estrogen can reduce the incidence of hip and vertebral fractures by as much as 50 percent. However, estrogen therapy only works if you use it long-term. Rapid bone deterioration occurs after the withdrawal of short-term estrogen therapy.

What Are the Options for Estrogen Therapy for Osteoporosis?

Options for estrogen replacement therapy for osteoporosis include transdermal skin patches or oral pills. If you choose the estrogen patch, you will likely replace it once or twice a week.

Because oral estrogen carries more risk factors than the estrogen patch for osteoporosis, you may find that your doctor prefers to go with that option. Research has shown that one to two years of transdermal estrogen therapy can increase and preserve bone mineral density.

We do recommend comparing the pros and cons of testosterone, estrogen, and growth hormone therapy for osteoporosis with a qualified hormone specialist. It is essential to select the best possible treatment that will provide the maximum results.

Potential Risks of Estrogen Therapy for Osteoporosis

All medical treatments carry potential risks which is why it is crucial to weigh the benefits vs. the concerns. Every person is different, and health issues could alter the safety of a particular treatment. For many people, the use of estrogen replacement therapy for osteoporosis will be safe. Women over age 60 should not use estrogen therapy. The maximum time of using estrogen should be up to 5 years.

After age 60, the risks of receiving an estrogen dosage for osteoporosis increases for cardiovascular disease, venous thrombosis, breast cancer, and stroke. At this time, it is better to consider other treatments depending on blood test results. It is always advisable to take the lowest dosage possible of any hormone therapy or medication.

Medically reviewed by   National HRT Staff - Updated on November 21, 2023

Please note that the information provided in this article is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

References

References

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6. American Journal of Obstetrics Gynecology
7. Annals of Internal Medicine
8. The role of estrogen replacement therapy in the prevention of osteoporosis May 1989Volume 160, Issue 5, Part 2, Pages 1306–1310
9. Better Bones

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