Estrogen and the Skeletal System
Osteoporosis leads to fractures, sometimes occurring with minimal or no trauma. The bones most commonly affected are the femur (hip), the vertebra (bones in the spine) and the radius (forearm). Half of women above age 50 will have a fracture related to osteoporosis. Hip fractures can be debilitating and even life-threatening. The mortality rate for women resulting from hip fractures means that one out of five will not live more than one year. A much higher percentage of women are debilitated, as it is often an event that leads to placement in a skilled nursing facility. The risk of hip fracture is equal to the combined risk of getting breast, uterine or ovarian cancer combined. The risk of dying from a hip fracture is greater than the risk of dying from any of those three cancers.
The conventional treatments for osteoporosis have limited efficacy and significant side effects. The most common class of drugs used is bisphosphonates. This includes Fosamax (alendronate), Boniva (ibandronate), Actonel (risedronate) and Reclast (zoledronic acid), among others. These drugs don’t help grow bone; rather they slow the rate of bone loss. Many patients have difficulty tolerating these drugs due to gastrointestinal side effects including reflux. If they are able to tolerate this, there may be long-term side effects, including osteonecrosis (wearing away) of the jaw, esophageal cancer and a femur fracture at the mid-shaft. Prolia (denosumab) is another commonly used drug for osteoporosis. It has the advantage that there can be some bone growth, but with significant side effects including bone, muscle and joint pain and increased risk of fracture in the spine after stopping Prolia or missing a dose. Similar to bisphosphonates, jaw osteonecrosis and femur fracture can occur.
Taking estrogen as part of a bioidentical hormone replacement program is a great strategy for treating osteoporosis. In contrast to the bisphosphonates that slow the rate of bone loss, estradiol can actually increase bone density—the bones gain mass and thus become stronger. The stronger the bone, the less likely there will be a fracture. Another benefit of estrogen is that the tensile strength of bone is increased.
In contrast to bisphosphonates, estradiol has many other benefits. For instance, with estradiol, the risk of heart disease, which is the leading cause of death of older women, is reduced by about 60 percent. Another potential cause of death of older women is Alzheimer’s disease, and estradiol significantly reduces the risk. Women that take advantage of the benefits of bioidentical hormone replacement typically feel more energy, have increased libido and have better mood and sleep. While bisphosphonates can cause erosion of the jaw, estradiol increases bone strength in the mouth so women will have healthier teeth and gums, with decreased loss of teeth.
Throughout life, there is an ongoing balance between bone formation and bone destruction. When women lose estrogen at menopause, bone destruction far outpaces bone formation, thus there is a decline in bone density. Until a fracture occurs, osteoporosis is painless. Bone density can be measured with a DEXA scan. Using a small amount of radiation, bone density is measured and compared to women of the same age and to 20-year-old women. When the bone density declines to more than 2.5 standard deviations of the bone density of a young woman, osteoporosis is diagnosed.
An0ther useful diagnostic test is measuring N-telopeptide, a metabolite that is produced when bone is broken down, in the urine or blood. It is measured as a ratio to creatinine called NTX. Because this is a better measure of bone physiology, it can be detected sooner.
Other lifestyle changes can help improve bone health. Weight-bearing exercises such as walking and running will be a positive factor that promotes bone strengthening. Supplements such as vitamins and minerals can also promote bone health. Vitamin D can promote bone health. When taken with vitamin K, the effect on the bone is magnified. Strontium has also been shown to promote bone health. If someone has an adequate level of vitamin D, they will usually have enough calcium so that additional calcium supplementation is not necessary. While all these measures should be part of a healthy lifestyle, when osteoporosis is already developed, these lifestyle changes are not enough to reverse the condition and estradiol is needed.
Warren Slaten, M.D., a wellness physician specializing in regenerative pain treatments and lifestyle counseling, is certified in advanced bioidentical hormone replacement. For more information, visit HormonesNJ.com.
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