Osteoporosis- What is the role of Hormone Therapy?

What is Osteoporosis?

Osteoporosis, which literally translates to, porous bone is a disease that develops due to a loss of calcium in your bones. It becomes more prevalent as you get older but can occur at any age, particularly around the time of menopause. It is characterised by a reduction in the strength and density of our bones and results in changes to the structure of our skeleton. The reduction in bone density increases the likelihood of fractures developing as well as unwanted falls, which further increases the risk of bone breakages and fractures. (2)

Although Osteoporosis is a disease that is associated with the aging process, it does not mean that each one of us is going to develop it. It is one of the most preventable and curable diseases, if detected in time. (2)

Any bone can be affected by Osteoporosis however, the most common ones are the hip, spine and wrist. (1)

Osteoporosis is often referred to as the silent disease of people over 50.  Reason being, our bones can deteriorate and become weakened without causing any symptoms until a bone fracture or break occurs.  (2)

Some signs of Osteoporosis may include:

• Reduction in height
• Fracture of bones that occurs spontaneously without any trauma
• Bone pain
• Tooth loss
• Curvature of the spine

There are known risk factors that correlate to the development of Osteoporosis and these include:

• Gender- Women are more likely to develop Osteoporosis when compared to men. This is due to women naturally having less bone mass to start with, and due to a faster deterioration of bone strength as a result of fluctuations in hormone levels that occur throughout life. An example of this is a reduction in Oestrogen during menopause. (1,2)
• Age- The older we are the thinner and more porous our bones become. (1,2)
• Weight- Underweight individuals are more at risk due to potential reduction in nutrient intake (1,2)
• Ethnicity- Research has suggested that Asian and Caucasian, together with African Americans and Hispanics are at higher risk than other populations (1,2)
• Genetics- Those who’s parents have experienced fractures are more likely to have lower bone mass and therefore may be at risk for fracture development themselves (1,2)
• Hormones- An absence of a menstrual period, low hormone levels especially Oestrogen (females) and Testosterone (males) can contribute to Osteoporosis (1,2)
• Calcium and Vitamin D deficiency- Deficiencies in these 2 nutrients increase the risk of Osteoporosis development (1,2)
• Medication- Long term use of corticosteroids and some anticonvulsants can lead to a reduction in bone density (1,2)
• Lifestyle- Inactivity increases the risk of Osteoporosis developing (1,2)

The Statistics:

Alarmingly, recent statistics from the International Osteoporosis Foundation has found that worldwide, 1 in 3 women and 1 in 5 men, over the age of 50 will develop Osteoporotic fractures in their lifetime. Unfortunately, once one fracture develops, it increases the risk of further fractures developing. (1)

An analysis conducted by the Australian Government has found that 4.74 million Australians over the age of 50, a percentage of 66% of that age group, have poor bone health. Of this, 22% have Osteoporosis and 78% have Osteopenia (prelude to Osteoporosis). (3)

It is estimated that by 2022, 6.2 million Australians over the age of 50 will have either Osteoporosis or Osteopenia. This is scary considering it is a 31% increase from the 2012 statistics. (3)

Prevention and Treatment:

Although the statistics are alarming, there are a multitude of strategies that can be implemented to prevent the occurrence and progression of Osteoporosis, and one important strategy is hormone replacement!

If you are reading this article, you may likely be a woman suffering from the dreaded menopause! Your hormones are either fluctuating all over the place or extremely low, contributing to a plethora of symptoms that are potentially reducing your quality of life. We know that hormones can aid with the classic perimenopausal and menopausal symptoms, but can they really help with your bone health? The simple answer is, thankfully, yes!

There have been several studies conducted to determine the specific role of 17-beta Oestradiol and micronized Progesterone on bone health, and the results are positive!

Summation of the research indicates that low dose Oestrogen, even as low as 0.014mg per day, which is much lower than what most patients are prescribed, has been found to increase bone mineral density and decreased certain markers that break down bone. (4) When compared to synthetic equine Oestrogens, 17-beta Oestradiol was just as successful at improving bone density and no differences in effectiveness were found. (5,7)

Further to this, 17-Beta Oestradiol (at a dose of 0.014mg/day) applied to the skin, was compared to Raloxifene 60mg/day (an anti-osteoporosis medication) in treating Osteoporosis over 2 years. This study found that both forms of treatment were virtually comparable in improving bone density and strength in the lumbar spine (2.4% improvement in the Oestrogen group and 3% improvement in Raloxifene group). The Oestrogen was also well tolerated by the study participants. (6)

How do hormones help with bone health?

The role of bone formation and bone turnover is a complex process that can at times, be quite difficult to understand, and many nutrients, cells and hormones are involved.  Simply put, from a hormonal perspective, Oestrogen slows down the process as to which cells, called Osteoclasts, break down the tissue in bone. Progesterone, on the other hand, has been shown to stimulate cells called Osteoblasts which aid in building the tissue that forms bones. So, both hormones have a positive influence on bone density and therefore, osteoporosis prevention. (8,9)

The health of our bones is determined by our dietary and lifestyle habits from childhood through to adolescents and beyond. If you’re over 50 and are concerned about your bone health and future osteoporosis, please speak to one of our doctors.

1. Zoen T, Ozisik L, Basaran N. An Overview and management of Osteoporosis. Eur J Rheumatol. 2017 4(1): 46-56
2. NIH Osteoporosis and Related Bone Diseases National Resource Centre 2018 https://www.bones.nih.gov/sites/bones/files/pdfs/osteopoverview-508.pdf
3. Osteoporosis costing all Australians: A burden of disease analysis- 2012-2022 https://www.osteoporosis.org.au/sites/default/files/files/BofD_Exec_Sum_for_print.pdf
4. Ettinger B et al. Effects of ultralow-dose transdermal estradiol on bone mineral density: a randomised clinical trial. Obstet Gynecol. 2004 Sept; 104 (3): 443-51
5. Farr J, Khosla S, Miyabara Y, Miller V, Kearns A. Effects of Oestrogen with micronized progesterone cortical and trabecular bone mass and microstructure in recently postmenopausal women. J Clin Endocrin and Metabolism. Jan 2013; 98(2): E249-57
6. Schaefers M, Muysers C, Alexandersen P, Christiansen C. Effect of microdose transdermal 17beta-estradiol compared with raloxifene in the prevention of bone loss in healthy postmenopausal women: a 2 year, randomised double blind trial. Menopause. 2009 May-June; 16(3): 559-65
7. Von Mach-Szcypinski J, Stanosz S, Kosciuszkiewicz J, Safranow K. New aspects of postmenopausal osteoporosis treatment with micronized estradiol and progesterone. Ginekol Pol. 2016; 87(11): 739-44
8. Seifert-Klauss V, Prior J. Progesterone and bone: actions promoting bone health in women. J Osteoporos. 2010 Oct 31; 2010.
9. Prior J. Progesterone for prevention and treatment of osteoporosis in women. Climacteric. 2018. 21 (4). 366-74