Estrogen Therapy for Osteoporosis Osteoporosis does not just happen to women, nor is estrogen therapy for osteoporosis a female-only treatment. Men have a one in five chance of dealing with an osteoporotic fracture as they age compared to a woman who faces one in three odds. That is why discovering if you are at risk for osteoporosis as early in life as possible is important. The sooner you can take preventative measures, the better off you will be. The use of both synthetic and bioidentical estrogen for osteoporosis can help improve bone density. Bioidentical hormones are always a better option for any type of hormone replacement therapy as they have the same properties as the naturally produced hormone. Although synthetic hormones carry out the same functions, they vary slightly in make-up. The body must alter them before use, and there is more of a risk of potential side effects with synthetic hormones. Estrogen is not the only hormone to influence bone density. Growth hormone (somatotropin), testosterone, insulin growth factor 1, and other hormones play various roles in maintaining bone strength throughout life. Determining the best option for the treatment of osteoporosis depends on what the body needs. Hormone specialists run blood tests that measure a variety of blood levels, including hormone levels that tend to decline with age. The results will let the doctor know if hormone replacement therapy can benefit the body and reduce the risk of osteoporosis.
Finding the right treatment for osteoporosis is important. Estrogen therapy will benefit some people if they have an estrogen deficiency.

What Is Osteoporosis and Why Does It Occur?

Osteoporosis is a word no one wants to hear. It can lead to potentially debilitating fractures in later years of one’s life. Hip fractures can have fatal consequences as research shows that two out of every five hip fracture patients will not make it to the twelve-month mark following their injury. For adults with estrogen deficiency, osteoporosis is a very real possibility. Osteoporosis occurs when bone turnover exceeds new bone development. The human skeleton is in a continual state of remodeling. Old bone cells die, and new ones take their place. However, it is not as simple a process as it sounds. The older you get, the slower the production and development of new cells. Unfortunately, the resorption of old cells is a shorter process. If not enough new bone cells are ready to take the place of those that die off and get resorbed by the body, the bones become porous and brittle and lose bone mass. We talk about using estrogen therapy for osteoporosis because of the impact estrogen has on bone formation. Each of the hormones mentioned in the previous section contributes to the ongoing growth of new bone cells. Growth hormone and insulin growth factor 1 promote cellular regeneration – the process that helps create new cells. Testosterone helps stimulate the proliferation of preosteoblasts – the cells that go on to form new bone cells. Estrogen also plays a role in that process. Both estrogen and testosterone are crucial for bone formation, but only estrogen can help slow bone resorption. That is the primary reason for the connection between estrogen and osteoporosis. Estrogen helps to slow down bone turnover while increasing the growth of new bone cells. Within a ten-year period, all bone cells in the body will turnover. Each year, we see approximately ten percent of the old bone cells undergoing resorption.
Osteoporosis occurs when old bone cells turnover faster than new bone cells can take their place.

What Impact Does Estrogen Have on the Bones?

There are two primary ways estrogen effects osteoporosis:
  • Influencing osteoblasts
  • Influencing osteoclasts
Osteoblasts are the bone-forming new cells. Estrogen exerts its influence directly on osteoblasts by binding with estrogen receptor alpha (ERa) receptors on the surface of the osteoblasts. The hormone SHBG (sex hormone-binding globulin) transports both estrogen and testosterone through the bloodstream. The binding of estrogen to SHBG is not as tight as with testosterone so that the estrogen can separate more readily to enter the nucleus of the cell. SHBG also helps the estrogen enter the cells so that it can activate the genes used in bone formation. The use of estrogen therapy for osteoporosis not only helps with osteoblast formation, but it also influences osteoclasts by slowing down the remodeling process. Estrogen helps to maintain the minerals inside the cortical layer of bone. People with osteoporosis lose these minerals which then attach themselves to the outside of the bone. While that has no bearing on bone density, it can slightly thicken the bones. Inside the bones, we find that the loss of trabecular bone causes a widening of the bone cavity. Estrogen helps promote osteoblast production while slowing down osteoclast activity on bone resorption.

How Can Estrogen Help Osteoporosis?

Estrogen is crucial for maintaining bone density and reducing the risk of osteoporosis. Women are especially vulnerable to osteoporosis because their estrogen, testosterone, and progesterone levels all drop rapidly at the onset of menopause. The loss of these hormones takes an immediate toll on a woman’s bone density. That is where estrogen therapy for osteoporosis can help. Men do not experience the rapid decline of menopause. While they may develop andropause, it is a much slower process. Until around age 70, women have a higher risk of osteoporosis and fractures. However, by age 70, the level of bone decline evens out, leaving both genders susceptible to osteoporosis. That is also why some men can benefit from estrogen replacement for osteoporosis. Of course, there is an alternative of testosterone therapy available for both women and men, depending on their hormone blood test results. Testosterone replacement therapy serves a dual purpose as it increases both testosterone and estrogen levels. The enzyme aromatase converts some of the body’s free testosterone into estradiol, the most abundant form of estrogen. With testosterone therapy, a person can effectively increase both testosterone and estrogen levels to influence osteoblast and osteoclast actions.
Estrogen therapy can help reduce the risk of osteoporosis and fractures.

Who Is a Candidate for Estrogen Therapy for Osteoporosis?

The use of estrogen for prevention of osteoporosis is beneficial if you have estrogen deficiency. A doctor – preferably a hormone specialist – will determine if you are a candidate following the review of your comprehensive blood tests and physical examination reports. Estrogen therapy is only recommended for women under age sixty. After that, the risk of developing conditions such as cardiovascular disease, stroke, breast cancer, and venous thrombosis increases. Should I take estrogen for osteoporosis if I have had breast cancer, or have a family risk factor for the disease? No, estrogen therapy for osteoporosis should not be used by anyone with risk factors that would make menopausal treatment with estrogen unsafe. However, testosterone is a safer alternative because the doctor can include an aromatase blocker to inhibit testosterone conversion into estradiol. That way, if you have a testosterone deficiency, as well, you can still get the benefits of osteoblast stimulation.
Estrogen hormone replacement therapy should only be given to those individuals with estrogen deficiency.

What Type of Estrogen Therapy Is Best for Osteoporosis?

The use of an estrogen patch for osteoporosis is the best option for many individuals. Oral hormones can affect the liver. In studies, transdermal estrogen skin patches used for one to two years significantly increased and preserved bone mineral density. The transdermal patch estrogen dosage for osteoporosis makes it easy to use this option by replacing the patch one to two times a week, depending on your need. A hormone specialist is the best person to determine hormone treatments. At HT Medical Center, we recommend having a full hormone blood panel workup before beginning estrogen therapy for osteoporosis. Some people may have a hormone deficiency that causes estrogen dominance. When that occurs, elevated estrogen levels due to testosterone and progesterone decline can cause weight gain and other health issues. Increasing estrogen levels at that time is not wise. That is why we never prescribe any hormone treatments without first running complete diagnostic blood tests.
If estrogen therapy is deemed beneficial for the treatment of osteoporosis, then transdermal patches may be the best option.

When Should You Begin Estrogen Therapy for Osteoporosis?

There is no set time to begin estrogen hormone therapy for osteoporosis. All forms of hormone replacement are individualized for each person. Hormone therapy only works when there is a deficiency in that hormone in the body. Menopause is a time when estrogen levels in women drop rapidly. If there is a concern over decreased bone density, the use of estrogen therapy for osteoporosis can begin early into the start of menopause. Is estrogen good for osteoporosis for all women? No, women with breast cancer risks should not use estrogen therapy. Also, no female over age sixty should use estrogen replacement therapy. Testosterone would be a better choice, especially if increasing estrogen levels is important. Your doctor may recommend other medications to treat osteoporosis depending on your risks and hormone levels.
The sooner you can begin estrogen therapy when and if it is needed, the better the outcome.

How Do You Get Estrogen Therapy for Osteoporosis?

You may be tempted to ask your doctor to prescribe estrogen for osteoporosis treatment. However, we caution against it. Any form of hormone replacement is best handled by a specialist. The balancing of hormone levels requires advanced training that general physicians do not have. Many women consider asking their gynecologists for estrogen therapy, but, again, that is not always the best option. Many gynecologists focus more on the obstetrics side of their practice. They may not have the training necessary to prescribe personalized hormone replacement therapy to older women. Never accept hormone treatment without first checking blood hormone levels. To get estrogen therapy for osteoporosis, or to find out what type of hormone treatment is best for you, please contact HT Medical Center for a free telephone consultation. The call is confidential, and your privacy is as important to us as it is to you. We offer convenient, local testing facilities and fast, superior service. Let us help you improve your bone density and overall well-being.
Contact HT Medical Center to learn more about treating osteoporosis and hormonal imbalance.