Bones are living things just like your heart and muscles, they are not the same as they were last week or even last year. Osteoporosis in later years affects men and women but the risks are higher among white and Asian women, women who are very thin, and women who enter menopause early.
Bone Density vs Bone Resilience
The flexible internal framework of the bone is called the osteoid. Calcium is deposited in and on the osteoid, creating the outer shell of the bone. Increased calcium and other minerals increases the stiffness and supportive strength of the bone but decrease its flexibility. As you age, the thick, elastic collagen fibers inside the bone become thinner and more brittle.
The first doctor to advocate for estrogen treatment to prevent osteoporosis was Fuller Albright in 1940. Over time some doctors began to conflate osteoporosis and osteomalacia (known as rickets in children) which led to the widespread but incorrect belief that if women just took enough calcium and vitamin D, they could stave off osteoporosis. Although calcium is crucial for developing strong ones, once bones are formed, additional calcium neither prevents nor treats bone loss. The reason calcium supplements do not reduce the risk of hip fractures is that they do not affect the interior architecture of the bone.
The Women’s Health Initiative investigators acknowledged the benefits of estrogen and bone health as early as 2002. However, for estrogen to reduce the risk of fractures that occur ten to thirty years after menopause, postmenopausal women must be on HRT for at least 10 years, and possibly the rest of their lives.
How About Alternatives
Exercise is the most popular recommendation for bone strength. Studies have shown the exercise may improve bone strength and resistance to fracture in pre-menopausal women, however, it does not improve bone strength or resistance to fracture in post-menopausal women who are not on HRT.
Bone density can be measured in a DXA scan but bone tensile strength cannot. That’s the measurement of the flexibility of your bones. The term osteopenia has no medical meaning. It is not the precursor to osteoporosis.
Prescriptions for bisphosphonates, seen as an alternative to HRT to ward off bone loss have skyrocketed. Side effects to these drugs are be unpleasant and some way worse than those of HRT. The most common is abdominal discomfort, muscle and joint pain, fever and flulike symptoms and insomnia. About 70 Percent of women stop the medication within a year due to the side effects. The medications are taken for long periods and they have been associated with an increased risk of atypical hip fractures.
The Take Home
- Currently HRT is the most effective intervention with the fewest unpleasant or dire side effects for preventing or diminishing the development of osteoporosis.
- Exercise is good no mater your age, but it won’t improve bone density in postmenopausal women not on HRT.
- Calcium supplements are ineffective in preventing postmenopausal osteoporosis or fractures because they do not affect bone resilience.
- Frequently prescribed bisphosphonates are associated with gastrointestinal discomfort, fatigue and insomnia, with an increased risk of atypical femoral fractures if taken for a long time.
If you’d like to read more about the studies and current findings on this, pages 105-125 in Estrogen Matters by Avrum Bluming, MD and Carol Tavris, PhD is where all this information comes from.
It’s important to understand how to help your health and improve your bones. If you have questions about HRT, please read my other posts about the safety, as well as benefits for heart health using HRT. You get to make the choices for your health that feel most comfortable to you. Looking at the current and updated research on HRT can help you.
If you have any questions, or need help, I’m here to support you.
Have a great week. Donna
