Helping The Bones

BENEFITS OF HRT:

HELPING THE BONES

What HRT can do for you…

Osteoporosis is the fourth leading cause of death in women – after heart disease, cancer, and stroke. The weakened bones of osteoporosis cause 80-90% of all fractures in postmenopausal women.

Estrogen has been clearly shown to slow bone loss; its use results in a significant reduction in the amount of fractures in the elderly. In addition, it has an effect on the body’s ability to utilize calcium and vitamin D, which results in increased bone mineral density.

Although oral micronized progesterone may have some beneficial effects on the bones, the benefits are not as significant as some books may lead you to believe. Most osteoporosis experts believe progesterone has much less of an effect on bone density than estrogen.

There is little evidence to support the claims that over-the-counter progesterone creams have a significant beneficial effect on bone density. There is one very good ongoing study regarding the use of high-dose oral micronized progesterone and bone density that unfortunately won’t be completed until 2003.

Testosterone supplementation can be beneficial to the bone. However, the dose must be adjusted on an individual basis to prevent the side effects associated with higher doses.

What are your needs?

Ask yourself:

Do you have a family history of osteoporosis?

Are you thin with a small frame?

Have you ever used steroids (like prednisone or cortisone) long term?

Do you have a sedentary lifestyle?

Do you have a diet low in calcium or high in caffeine or alcohol?

Do you smoke?

If you answered "yes" to any these, a bone density test might be useful. Discuss this with your primary care provider. The test can help to determine what course of action you should take. If you have low to moderate bone loss, you may be able to protect yourself with lifestyle changes such as diet and weight-bearing exercise. More severe bone loss would indicate the need for additional medication.

Additions/alternatives to HRT

Simple steps for prevention-

Calcium

Most people don’t get enough of it. Dairy products are the most concentrated natural form of calcium, but an increasing amount of fortified foods, like orange juice, are now available. Supplements are very useful, and the most cost effective is calcium carbonate. Calcium citrate is a good choice for those people on acid-reducing medications like Prilosec and Zantac. You should take the calcium with added vitamin D, preferably at mealtime.

Weight bearing exercise

Something as simple as walking provides benefits. There is an increasing amount of evidence that training with weights is important for women of all ages. It is also very useful in controlling weight.

Dietary changes

Excessive use of alcohol and caffeine can contribute to bone loss. Although the data is not conclusive, soy protein may be beneficial for bone health
.
Other medications

Evista (a SERM - see the estrogen section), Miacalcin, Fosamax and Actonel are all approved medications that help with bone loss when used alone or in combination with HRT. The most profound effect on the bones is seen with the drugs like Fosamax and Actonel. Both of these drugs are available in a once a week dosage. Actonel seems to cause less stomach upset.

Benefit to Risk

The initial results of the Women's Health Initiative study (July 2002) have questioned the benefit to risk ratio of Prempro (equine estrogen and synthetic progestin) for bone health. Until further studies are available, many feel that drugs like Fosamax or Actonel would be more appropriate than Prempro for those at high risk of osteoporosis. Other studies indicate that for the postmenopausal treatment of osteoporosis the benefit of HRT (other than Prempro) may be greater than the risk for women who have no increased risk of breast cancer and fall into one of the following four categories.

AGE	bone mineral density t score (femur)	additional risk factors	history of osteoporotic fractures
1. under 65	at or below - 2.0	none
2. under 65	at of below - 1.5	one
3. over 65	at or below -2.5		none
4. over 65			yes

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