Osteoporosis and Menopausal Hormone Therapy

Menopause significantly accelerates bone loss, increasing the risk of osteoporosis—a condition affecting 1 in 2 postmenopausal women globally. During menopause, declining estrogen levels disrupt the bone remodeling process, where osteoclasts (bone-resorbing cells) outpace osteoblasts (bone-forming cells). This imbalance leads to rapid bone density reduction, with up to 20% of bone loss occurring in the first decade after menopause. Like any problem, prevention is always better than treatment and osteoporosis is no different. 

Estrogen's Protective Role and Therapy

Estrogen maintains bone density by suppressing osteoclast activity and regulating calcium absorption. The Study of Women's Health Across the Nation demonstrated that bone mineral density (BMD) declines most rapidly during menopausal transition. Transdermal estrogen therapy has shown promise in counteracting this loss: a 2017 meta-analysis found it increases lumbar spine BMD by 3.4-3.7% within 1-2 years. Although it is not the only benefit of menopausal hormone therapy, we can make a significant impact on a woman's bone health and risk of fracture as they age.

Management Strategies

Menopausal hormone therapy can make a significant difference in preserving bone and preventing decreases in a patient's bone health.

Medications by themselves or in addition to menopausal hormone therapy can be very helpful in preventing further bone loss and fracture. It's important to understand the risks and benefits with any drug you are considering in this realm. 

Exercise provides dual protection and should be a focus not just for bone health but for fall prevention and mobility in general. 

If you have a diagnosis of low bone density, osteoporosis, or have risk factors and would like to prevent osteoporosis please reach out to us, we can help. Dr Cassleman works with individuals through hormone therapy to relieve menopausal symptoms but also improve patients bone health. Dr Cassleman can guide you through your options if you are considering a medication to help protect your bones. The Onero program at Mission Metabolic Health can be a wonderful help to those trying to prevent and reverse low bone density and osteoporosis through exercise. Understanding your options and choosing which are right for you is important, give us a call at 5862004265 to set up your appointment.