Osteoporosis Hrt

A hormone deficiency may result in the reduction of calcium stores in the bones. Hormone replacement therapy (HRT) is the use of supplemental hormones to replace the naturally occurring hormones in the body that have become deficient due to aging or illness.

During menopause, a woman’s level of estrogen naturally begins to decline with the loss of ovarian function. Hormone replacement therapy aids not only in reducing common symptoms of menopause, such as hot flashes, heart palpitations and sweating, but also helps to maintain strong bones. Estrogen has been shown to increase skeletal mass and reduce the incidence of bone fractures.

Despite these benefits, certain health risks are associated with hormone replacement therapy. If you are considering HRT, a careful discussion with your doctor is warranted. Your doctor’s supervision and counsel is indispensable with any hormone therapy program, natural or synthetic, given the impact that such substances can have on other body systems.

Natural and Synthetic HRT

While hormone replacement therapy won’t make osteoporosis go away, it can reverse some of its effects and slow its progression.

“Natural” hormone replacement involves the use of hormones identical to those produced by the human body. Examples of this are estrogen and progesterone. These are normally derived from plants (such as soybeans) and altered to be identical to the human hormone. Doctors sometimes prescribe estrogen and progesterone to relieve the symptoms of menopause.

Synthetic hormone replacement uses hormones and chemicals that are not identical to the hormones produced in the body. Progestins, synthetic forms of progesterone, are often used in hormone replacement therapy. Normally, many of the synthetic forms of the hormones have been altered to be more potent, so be aware of any possible side effects. For example, if estrogen is used without progesterone or progestin, the possibility of developing endometrial cancer increases greatly.

Hormone Replacement Therapy: Supplements and Foods

The use of herbal and natural supplements has risen dramatically in the last decade. Herbal supplements such as red clover, dong quai, evening primrose oil, ginseng and black cohosh are all sold under the pretence of alleviating hot flashes. Some documentation indicates that the use of tropical wild yam is effective against hot flashes. While some of these natural remedies may provide relief from menopause symptoms, none have yet proven to be effective in strengthening bones or preventing bone loss.

Soya drinks, tofu, and other soy products provide a natural supply of isoflavones, which are structurally similar to the hormone estrogen and thus can be utilized by the body as estrogen. Research has proven that isoflavone-rich soy supplements can reduce bone loss in some patients (Alekel et al., 2000).

Soy products are a valuable resource to vegetarians and the lactose-intolerant who are at risk for low calcium intakes. In addition to providing isoflavones, they are commonly enriched with calcium during processing, thereby making this important anti-osteoporotic mineral available. Because soy products are not naturally high in calcium, check the package label carefully for calcium content.

Other Hormonal Drugs

A new class of hormonal drugs called selective estrogen receptor modulators (SERMs), such as raloxifene (Evista®), may provide superior clinical effects by selectively enhancing bones while minimizing other adverse health effects associated with HRT.

The effects of parathyroid hormone (PTH) on bone are currently being studied. Early results have shown an increase in bone mass in patients treated with PTH as compared to placebo.

Other classes of drugs include calcitonin and bisphosphonates which both act to inhibit the breakdown of bones.

When to Switch to HRT

Many women ask when they should switch from oral contraceptives to hormone replacement therapy.

The answer is not a simple one for most women. If a woman is not sexually active, she can switch at any time without risk of pregnancy. Meanwhile, women who are currently partnered should speak to their doctor to confirm that they are experiencing menopause, since oral contraceptives often cause menstruation-like bleeding even though ovulation is no longer occurring.

Women can have their hormone levels tested for follicle-stimulating hormone (FSH), and estrogen to determine if menopause has occurred. This test is best performed after the woman has discontinued oral contraceptives for twelve to fourteen days (and, as a precaution, also discontinued unprotected sexual intercourse with her male partner).

If decreased levels of FSH and estrogen are confirmed, then she may safely switch to hormone replacement therapy and calcium supplements to avert bone loss.

If FSH levels show that the woman is still ovulating, she should continue with oral contraceptives or other birth control means, if she wishes to avoid a pregnancy. Remember though that osteoporosis risks should still be discussed with a physician, as should any type of natural or synthetic hormone therapy, or herbal supplementation.

Resources

Alekel, D.L., Germain, A.S., Perterson, C.T., Hanson, K.B.