Hormones and the Fight Against Osteoporosis
Hormones and the Fight Against Osteoporosis
Many women going through menopause experience very apparent and uncomfortable symptoms such as hot flashes, anxiety, depressed mood, and sleep disturbances1. But there are other less obvious symptions associated with declining hormone levels such as bone loss, also referred to as osteoporosis. Declining hormone levels during menopause puts a woman at risk of osteoporosis, a systemic bone disease manifested as decreased bone mass, destruction of bone microstructure, and increased bone fragility2. It is more prevalent in women than in men (24.8% vs 5.6%), and women who are past menopause are especially at high risk3. In the first 10 years after menopause, a woman would have lost 2/3 of her entire bone mass, with the most significant loss occuring the first 1 to 3 years4.
Osteoporosis is when the building of bone is slower than the breaking down of bone5. Osteoporosis can make the bones so brittle that a fall or even mild stresses such as bending or coughing can cause fracture. Common sites of fracture include the spine, hip, forearm and proximal humerus6. One of the more serious of these is hip fracture which incur the greatest morbidity and mortality. Hip fractures reduce quality of life and shortens life expectancy. Studies have found that 25% of elderly people with hip fracture die within 6 months.
Estrogen receptors are ubiquitous throughout the human body and are involved in a variety of vital physiological functions that range from the development and maintenance of reproductive organs to the regulation of cardiovascular, musculoskeletal, immune, and central nervous systems. So it is no surprise that low estrogen levels strongly correlate with increased risk for osteoporosis. Studies show that elderly women and men with the lowest estrogen levels had the lowest bone density and highest risk of fractures. In one study done by McKane and colleagues, bone resorptions markers of three different groups of women were analyzed: a premenopausal group (age 32 years), an untreated postmenopausal group, and an estrogen-treated postmenopasul group. They found that bone-resorption markers were similar between premenopausal and estrogen-treated groups but were significantly increased in the untreated postmenopausal group. This suggests that bone health is more dependent on estrogen levels than age. In another study by Martin-Millan, et al, just 6 weeks of estrogen deprivation caused a significant loss of cortical bone, the dense outer surface of bone that forms a protective layer around the internal cavity, suggesting that cortical bone is highly regulated by estrogen levels7,8.
Progesterone also works synergistically with Estradiol in bone metabolism. Endogenous estradiol slows bone resorption and prevents bone loss while progesterone increases bone formation. In a meta-analysis in postmenopausal women, there was a further 0.4% increase in bone mineral density when women were treated with both progesterone and estrogen together as opposed to estrogen alone9. An article by JC Prior states that for optimal progesterone-related bone formation to occur, the ovulatory cycle needs a luteal phase length of 10-14 days by quantitative basal temperature or 12-16 days by Luteal Hormone peak. In a one-year prospective, observational study of 66 women between the ages of 20-42, those who had one or more short luteal phases or any anovulatory cycles lost bone mineral density at rates of 4-6% per year, whereas those who had normal ovulatory cycles or only one short luteal cycle per year did not lose bone mineral density. In a meta-analysis of randomized controlled trials in menopausal women, a combined therapy of estrogen and progesterone increased spinal bone mineral density by 2/3 of a percentage than estrogen therapy alone. All of these results strongly imply the importance of progesterone and estradiol in bone mineral density and suggest that hormone replacement therapy may help prevent osteoporosis.
Because osteoporosis is often asymptomatic, it is important to take preventative measures before fractures occur. With declining hormone levels playing such a big part in bone metabolism, you can start right now with hormone replacement therapy. Initiating hormone replacement therapy early in women may not only help maintain strong bones and prevent fractures, but also improve quality of life and expand life expectancy.
At Harbor Compounding Pharmacy, we compound various formulations of bioidentical estradiol and progesterone that are easily adjustable to find the right dose for you. Our compounds can be used for both static- or biorhythmic-dosing schedules (like Wiley Protocol) for hormone replacement needs. Harbor Compounding Pharmacy is a licensed, PCAB-accredited compounding pharmacy servicing patients all over California to Las Vegas, Nevada, Washington, Colorado, Pennsylvania, Missouri, New York, and Illinois. If you have a prescription for a compounded medication or have any questions, please fill out the form on our site to get the appropriate health solution for you.
- Thurston RC, Maki PM, Derby CA, Sejdic E, Aizenstein HJ. Menopausal hot flashes and the default mode network. Fertil Steril. 2015;103(6):1572-1578 e1571.
- Xu L, Liu B, Li P, et al. Correlations of Serum Hormones and Bone Mineral Density with Fracture and Balance Ability of Postmenopausal Patients and Effects of Calcitriol. Med Sci Monit. 2018;24:7309-7315.
- Centers for Disease Control and Prevention. FastStats-Osteoporosis. National Center for Health Statistics. https://www.cdc.gov/nchs/fastats/osteoporosis.htm. Updated Aug 17, 2016. Accessed Aug 4, 2019)
- Zuo H, Sun A, Gao L, et al. Effect of Menopausal Hormone Therapy on Bone Mineral Density in Chinese Women: A 2-Year, Prospective, Open-Label, Randomized-Controlled Trial. Med Sci Monit. 2019;25:819-826.
- Mayo Clinic. Osteoporosis-Symptoms and Causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968. Updated June 29, 2019. Accessed Aug 4, 2019)
- WHO SCIENTIFIC GROUP ON THE ASSESSMENT OF OSTEOPOROSIS AT PRIMARY HEALTH CARE LEVEL. Presented at World Health Organization meeting. May, 2004. Brussels, Belgium. https://www.who.int/chp/topics/Osteoporosis.pdf. Accessed Aug 4, 2019)
- Martin-Millan M, Almeida M, Ambrogini E, et al. The estrogen receptor-alpha in osteoclasts mediates the protective effects of estrogens on cancellous but not cortical bone. Mol Endocrinol. 2010;24(2):323-334.
- Veritas Health. Cortical Bone Definition. Spine-Health. https://www.spine-health.com/glossary/cortical-bone. 2019. Accessed Aug 4, 2019)
- Seifert-Klauss V, Schmidmayr M, Hobmaier E, Wimmer T. Progesterone and bone: a closer link than previously realized. Climacteric. 2012;15 Suppl 1:26-31.