Hormonal Decline and Osteoporosis in Men and Women - Part 1

Hormonal Therapy

Osteoporosis is a common post-menopausal disease that has a substantial impact on the quality of life in women and is associated with significant morbidity and mortality.  Estrogen therapy (in hysterectomized women) and estrogen/progestin therapy (in non-hysterectomized women) are the most effective treatments available for the relief of vasomotor and urogenital symptoms in post-menopausal women and provide significant protection against osteoporotic fractures or loss of bone mineral density (BMD).

Every medical study has confirmed that estrogens are the most effective way of increasing bone mineral density to prevent osteoporotic fractures even in low-risk women.  This treatment has been found to be safe when started in women under the age of 60.  It is more effective and beneficial than biphosphonates that are frequently used by physicians as first choice or by general practitioners unsure about the safety of estrogen therapy.

Hormonal therapy should be considered as a first-line therapy in preventing bone loss and fractures.  Certain selective estrogen receptor modulators are known to reduce bone loss and help prevent vertebral fractures without endometrial or breast stimulation.  Future therapies are likely to include selective estrogen receptor modulators and the appropriate hormonal therapies.  Interestingly, biphosphonates and other non-hormonal treatments for low bone mineral density do not have the same beneficial effect upon intervertebral disc structure. 

Some believe that these non-hormonal drugs with their considerable long-term complications should have no immediate place in maintaining bone mineral density in women under the age of 60.  Women receiving estrogen therapy for climacteric symptoms such as flushes, sweats, or vaginal dryness, experience a considerable increase in BMD, up to 15% in 10 years, to the extent that osteoporotic fractures 20 years later are much less likely to occur.

One significant benefit is that hormone replacement therapy also is known to protect intervertebral discs.  Several studies have conclusively shown that estrogen could prevent collagen being lost from intervertebral discs, thus maintaining their strength and function.  As discs make up one-quarter of the length of the spinal column and act as cushions preventing crush injuries of the vertebral bodies, the maintenance of these structures is paramount.  Compression fractures lead to loss of vertebral height and lordosis of the thoracic spine (Dowager's hump) can occur.  This is an important benefit to the use of estrogen and testosterone. 

It has been found that women with low bone density, even without typical menopausal symptoms, should use estrogen as a first-choice therapy.  For those younger women with severe osteopenia or osteoporosis due to premature menopause, early hysterectomy and oophorectomy or anorexia with amenorrhea, estrogens are an essential long-term treatment. 

In one particular study the effects of hormonal therapy on bone mineral density was evaluated.  Participants in this study who participated in the placebo group lost an average of 1.8% of spine BMD and 1.7% of hip BMD by the 36-month visit, while those assigned to active hormonal supplementation gained BMD at both sites ranging from 3.5% to 5%. 

Of all the women, women with low initial BMD, and those with no previous hormonal use, gain significantly more bone than younger women, women with higher BMD, and those who had used hormones previously.

In conclusion, postmenopausal women assigned to the placebo demonstrated decreased BMD at the spine and hip, whereas women assigned to estrogen therapy increased BMD during the following 36-month period.

For more information or to read Part 2 of the series, please visit us at the Southwest Age Intervention Institute blog.