Osteoporosis is a common and undertreated skeletal disorder especially effecting postmenopausal women. It leads to pain, morbidity, and increased mortality as a result of fractures. Characterized by low bone mass, osteoporosis is the result of decreasing levels of certain hormones – particularly the estrogens – as a part of the natural process of aging. Between 2005-2008, as many as 30% of women > 50 years old were diagnosed with osteoporosis. Luckily, with a solid understanding of the condition, access to competent and engaging health care professionals, and knowledge of existing preventive treatments, osteoporosis can be managed successfully and gracefully.
Diagnosis and treatment of osteoporosis is often personalized considering a number of patient specific factors like age, medical conditions, medications, menstrual status, family history of osteoporosis, and personal history of fractures. Diagnostic tools like the T-Score and FRAX probability score also aid providers in determining which treatment is approach is best. Based on this information a wide variety of treatments may be implemented. These include lifestyle adjustments like weight bearing exercise, supplementation with calcium and vitamin D, or trials of medications such as the bisphosphonates (Fosamax, Actonel, etc…) and estrogen replacement therapy. Often, the best results involve a combination of interventions. Let’s take a closer look at estrogen replacement therapy as it’s the most nuanced but may provide the best protection for many patients.
Estrogen replacement therapy is an effective bone-protecting strategy that improves bone mineral density and offers fracture risk reduction. And it’s no wonder! In young women, estrogens exert a tonic or balancing effect on bone building and breakdown. The estrogens also increase the amount of vitamin D our bodies absorb and increase bone building growth factors. However, as estrogen levels decline – as they do following menopause – the balancing effect of estrogens is lost, and the process favors bone breakdown. The result is a 50 % reduction in trabecular bone (bone making up the spinal column, the pelvis, and the femur), and 30% reduction in cortical bone (bone making up the peripheral skeleton) in the first 20 years following menopause.
The good news is that with estrogen replacement therapy, a decrease in fractures as high as 60% can be expected! This reduction can be expected in patients taking estrogen for more than 5 years. There is a caveat to estrogen replacement therapy for osteoporosis which requires careful attention. For maximal protection, estrogens need to be used continually and long term. This means a discussion and plan should be put in place for the safe and effective use of estrogens in the years following menopause and beyond. For safe use of estrogens long-term, I recommend a bioidentical low dose of estrogens in a transdermal formulation after careful and continual assessment of risk factors for breast cancer and cardiovascular disease. At Maida Pharmacy Compounding and Wellness, our Hormone Wellness Program is where we have these conversations with patient and their providers!
As eluted to earlier, a combination of treatment’s is most beneficial. A healthy diet, weight bearing exercise, and appropriate intake of calcium and vitamin D cannot be stressed enough. These interventions alongside estrogen replacement therapy, have been shown to be more beneficial than either alone. If you are concerned with your bone health, act today! Talk to a health care provider about your baseline bone mineral density, your personal risk factors, and reasonable goals to maintain bone health. Our consulting pharmacists are happy to discuss personalized treatment options. Schedule a complimentary consult to learn more about estrogen replacement therapy.
Angelo Maida, PharmD
Compounding Pharmacist at Maida Pharmacy Compounding and Wellness