Hormones can help to strengthen and protect your bones during perimenopause and menopause
• Bones become weaker during perimenopause and menopause
• Oestradiol (oestrogen) HRT is licensed as a treatment to prevent osteoporosis
• Evidence shows testosterone is also associated with increased bone strength
As you get older, you may worry more about the thought of breaking a bone. This is because the amount of bone tissue you have (known as bone density) decreases with increasing age and especially during perimenopause and menopause. Bone density matters because it is a measure of how strong and healthy your bones are.
RELATED: Hormones and bone health
Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is usually only diagnosed when a fall or low impact causes a bone to break (fracture). When your bone health has deteriorated to this point, fractures can occur from relatively minor bumps and falls which can lead to impaired mobility and other serious complications.
Women are more likely to have osteoporosis than men, and half of women over the age of 50 will experience a fragility fracture in their lifetime (compared to 20.7% of men) [1]. Studies have shown that significant proportion of those at high fracture risk do not receive therapy for osteoporosis, known as the treatment gap [2]. In the UK, the treatment gap amongst women is 66% [3].
Women who have had an early menopause, who have premature ovarian insufficiency (POI) or who’ve had their ovaries removed are at increased risk of osteoporosis [4]. This is because they have more time without their hormones. The lack of hormones – oestradiol, progesterone and testosterone – can cause your bones to lose their density at a faster rate than new bone tissue grows. A DEXA scan can measure how dense your bones are and is a useful way to measure changes in bone strength over the years.
RELATED: Bone health during menopause
Can HRT help prevent osteoporosis and increase bone density?
Many studies have shown that HRT is an effective treatment to prevent and repair bone loss and it can reduce the risk of fractures by 50% [5, 6, 7, 8]. Oestradiol slows down the rate of bone loss and even promotes new bone growth which helps keep bones stronger for longer [9]. Progesterone collaborates with oestradiol and helps bone formation and prevents bone loss [10, 11].
A meta-analysis of 57 studies showed HRT can increase bone density by 7% on average over two years and reduce spinal fractures by a third [12].
For perimenopausal and postmenopausal women, NICE recommends HRT as a treatment for osteoporosis [13]. A study of 25,389 women aged 50-79 found HRT reduces fracture risk [8].
RELATED: Osteoporosis: how to protect your bones during menopause and beyond
Can testosterone help prevent osteoporosis and increase bone density?
While the association between oestradiol and progesterone deficiency and osteoporosis is well recognised, more and more evidence has emerged regarding the positive association between testosterone and bone mineral density. Numerous studies have recognised that testosterone play an important role in maintaining bone mineral density and bone health among men [14, 15, 16].
Studies have also shown that testosterone has a statistically significant association with bone mineral density in older women (over 65 years) [17] and in younger women (age 40-60) [18], suggesting that lower testosterone increases the risk of osteoporosis.
It’s also been found that in menopausal women, treatment with both testosterone and oestradiol, is more effective in increasing bone mineral density than oestradiol alone [19].
RELATED: The importance of testosterone for women
How else can I keep my bones healthy?
If you want to maintain healthy bones, it is important to keep your muscles, joints and ligaments strong too. The best way to do this is through exercising regularly but this can be difficult if you lack energy and motivation, and if you have achy muscles and joints. Many women find that once they start HRT and get relief from their symptoms, that exercise becomes more possible.
Exercise should ideally be weight-bearing with impact through your joints such as running, tennis, dancing, aerobics or even jumping up and down. Resistance exercise is also important such as press ups, lifting weights, or using a resistance band.
The right nutrition is vital for maintaining healthy bones. You need 700mg a day of calcium and vitamin D helps your body absorb calcium – you may need to consider a supplement to ensure the necessary intake. Smoking and alcohol also increase your risk of osteoporosis. Read more in our article How can I keep my bones strong?
The most common treatment for osteoporosis is a group of medications called bisphosphonates. Although they are effective at maintaining your bone density, they come with side effects such as heartburn and indigestion and many people stop taking them for this reason.
Bisphosphonates have also been associated with increased risk of major adverse cardiovascular events [20] and a meta-analysis of 12 studies found that treatment with bisphosphonates may be associated with an increased risk of atrial fibrillation [21].
RELATED: Recognising and reversing osteoporosis with Dr Taher Mahmud
What’s the bottom line?
There is clear and strong evidence that taking hormones reduces your risk of osteoporosis and bone fractures. It can be prescribed a first line treatment choice for women to prevent and treat osteoporosis. Testosterone has also been shown to improve mineral density.
Your healthcare professional should be able to advise you on the right dose and type of HRT for you.
