In this post I will discuss the relationship between hormones and osteoporosis, as well as the role hormones plays in bone health during all stages of life — including puberty, pre-menopause and post-menopause. I will also cover, in detail, bioidentical hormone replacement therapy (HRT) for osteoporosis. Specifically, I will cover how to find a hormone replacement therapy doctor, the costs of bioidentical hormone replacement therapy, and my personal experiences with HRT.
Hormones and Osteoporosis • Agenda
- Bioidentical Hormone Replacement Therapy.
- Benefits of Bioidentical Hormone Replacement Therapy.
- Bioidentical Hormone Replacement Therapy Doctors.
- Hormone Replacement Therapy Cost.
Please note that the term “bioidentical hormone replacement therapy” is interchangeable with “hormone replacement therapy” in this blog post.
There are, in general, four variables that affect the health of your bones:
- Your genetic makeup. Have you inherited strong bones from your parents? Unfortunately, you cannot control these one so you have to learn to live with the skeleton that you were given. The good news is that you can influence the remaining three variables.
- Your nutrition. In past blog posts, I have spoken about different nutrition topics including: vitamin K2 for osteoporosis, milk for osteoporosis, nitrate rich foods, calcium and osteoporosis, prunes for osteoporosis, sodium and osteoporosis, omega 3, and protein and bone health. I have provided a diet plan for osteoporosis that you can follow.
- Your osteoporosis exercise program and specifically how you load and weight bear on bones. There are over 100 blog posts on osteoporosis exercise on this site. For most readers, a good place to start is Exercise for Better Bones.
- Your hormones and specifically hormone replacement therapy for osteoporosis. The balance of this blog post is dedicated to hormones and osteoporosis.
Studies that examine bone formation during puberty, pre-menopause, and post-menopause demonstrate that there is a strong relationship between bone health, hormones and osteoporosis.
Hormones and Osteoporosis: Puberty and Bone Health
Over a quarter of the bone that a person will build in their entire life happens during the two years surrounding the start of puberty. (1) By the end of adolescence an individual’s skeletal mass has almost doubled. (2)
In addition, sex steroids play an important role in the optimal development of muscle and bone. (3) Unfavourable body composition during sexual maturation results in sub-optimal bone mass and strength in both early adulthood and later life. As a result, it is important that young people attend to their bone health.
Hormones and Osteoporosis: Premenopausal and Postmenopausal Women
Studies show postmenopausal women who experience a depletion of estrogen are never able to build bone as effectively as postmenopausal women who have a healthy estrogen levels.
The postmenopausal women can exercise just as hard as the premenopausal women, and follow the same nutrition plan, but they do not have the hormones that the premenopausal women have to help support the growth of the bone.
When you think about hormones and osteoporosis, you need to consider your stage of life and your hormonal level.
As we mentioned above, puberty is an important time in bone formation. Young women need to pay attention to when they start their menstrual cycle.
Activities such as ballet, gymnastics or may keep their percent body fat very low and delaying the onset of menarche. This is not good for bone health since it restricts the critical time during puberty when bone formation is rapid.
Unless these young people are considering a lifetime career in athletics or ballet, you may want to help them understand the importance of having sufficient amount of body fat in order to allow the body to feel that it’s surviving well enough that it can actually start having a regular menstrual cycle.
Finally, the regular occurrence of a menstrual cycle is a very good indicator that bones are being well supported by hormones.
Depo Provera and Osteoporosis
Is there a relationship between Depo Provera and osteoporosis? It turns out that there is.
Certain birth control choices, such as Depo Provera, can stop menstrual cycles from occurring. This may be practical for young athletes but it has been shown that it can be detrimental to bone at an important time in life to build bone.
Young women in puberty and women close to menopause have limited time to rebuild bone. Depo Provera can rob them of this critical time.
Transgendered Youth, Estrogen, Testosterone and Osteoporosis
Transgendered youth who are either given estrogen or testosterone during sex change can lose bone. It is important that they work closely with their physician and they stay on their hormonal prescriptions that they are given. These hormones will have a really significant impact on their bones.
In the article, Hormone Therapy for Transgender Patients, Unger states: “Bone and cardiovascular health are important considerations in transgender patients on long-term hormones, and care should be taken to monitor certain metabolic indices while patients are on cross-sex hormone therapy.” (4)
Can hormone replacement therapy alone improve osteoporosis? Do you need to supplement the bioidentical hormone replacement therapy with other things?
Bone quality, bone density and consequently, bone strength, are all products of hormonal balance, exercise, diet and good genetics. If one is lacking or weak, it impacts the effect of all the others to be able to build bone to it’s optimum level.
By taking bioidentical hormone replacement therapy, you are trying to reduce the effect of your own hormonal decline. At the same time, it becomes more important to optimize your nutrition and exercise. They all play an important role.
During the first seven to ten years of menopause, your body is adapting to the loss of hormones. This is why women lose the most bone during this period. Without hormones, it is very difficult to build bone. Your goal should be to maintain bone — and if you are “maintaining” you are “gaining”.
Bioidentical hormone replacement therapy can be an important treatment option for women with osteoporosis or osteopenia. A review by three American Gynaecologists, published in March, 2018, proposes that hormone therapy (HT) “should be considered for the primary prevention and treatment of osteoporosis in appropriate candidates. Hormone therapy (HT) should be individualized and the once ‘lowest dose for shortest period of time’ concept should no longer be used. ” (5)
The decision to take hormone replacement therapy is an important one and can be very complex. You need to work closely with a bioidentical hormone replacement therapy doctor skilled in this treatment before you commit to this path.
I have been on bioidentical hormones for a number of years. There are four main benefits of bioidentical hormone replacement therapy:
- Increase in Strength
- Better Bone Quality
- Better Sex
- Improved Sleep
Benefit #1: I Feel Stronger
One of the main reasons why I started bioidentical hormones was to maintain the strength of my bones and muscles and reduce my risk of osteoporosis. I found that once I hit menopause, I was not able to lift as hard and I did not recover as well from my workouts.
Tests showed that my bone loss was at a very high rate because of my genetics, my petite stature, and my race (Caucasian). We know that, in general, women will lose bone between 1 and 5% a year. I was losing 5% a year. That was way too fast for me. And I had a lot of years left ahead of me.
Since starting the bioidentical hormone replacement therapy, I feel much stronger. My stamina, particularly when I exercise, has improved. My bone density scores have stopped declining.
Benefit #2: Better Bone Quality
A study of menopausal hormone replacement therapy (MHRT) by Dr. Georgios Papadakis at Lausanne University Hospital shows that not only does it have a positive affect on bone mineral density (BMD) but that it also preserves bone microarchitecture. The positive effect on bone microarchitecture and BMD was maintained even two years after stopping MHRT. (6) In other words, bone quality is maintained with this treatment option.
In the study, Dr. Papadakis points out that “drugs used to prevent fragility fractures in women with osteoporosis really should improve both BMD as well as bone microarchitecture. However, so far current drugs used to treat osteoporosis actually have less of an effect on bone microarchitecture than they do on bone mineral density (BMD).”
Should you avoid pharmaceutical intervention and, instead, opt for menopausal hormone replacement therapy for your osteoporosis? Dr. Papdakis speculates that treatments such as HRT that “favourably influence bone microarchitecture may well have advantages over those that do not.” However, this is still speculation and has not been proven.
According to a MedScape review of the study (7), Dr. Papadakis maintains “the idea is not to prescribe HRT to all women and I don’t think HRT should be prescribed indefinitely, either.”
“But at least in young postmenopausal women at increased risk of osteoporosis, HRT can be a very effective first-line treatment, provided the woman has no contraindications and it can be continued for at least 5 and maybe even 10 years.”
Benefit #3: Better Sex
Sex was the second motivation. I’ve had a great marriage for over 30 years and sex has been a really important part of that marriage. (Hope my kids aren’t listening!)
I wanted sex to continue to be an important part of our relationship. However, having sex without hormones was like having sex with a big blanket between us. I couldn’t feel a whole lot of anything and I thought, “Well, that is not going to work very well for the next few decades of my life.” That needed to change!
Since starting the bioidentical hormone replacement therapy, I feel much engaged and sensations during sex.
Benefit #4: Improved Sleep
The third benefit of bioidentical hormone replacement therapy was improved sleep. A really important part of having good health is having a good restorative sleep. I have always been a good sleeper, but with menopause and hot flashes, I wasn’t sleeping as soundly as I was used to, or as I wanted to.
Since starting the bioidentical hormone replacement therapy, my sleep is back to what it was before menopause set it. I sleep much deeper and my sleep is uninterrupted through the night.
Exercise Recommendations for Osteoporosis
Exercise is vital to bone health and osteoporosis. But what exercises should you do and which ones should you avoid?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on your bone health — one lesson each day. You can look at the videos at anytime.
To register for this free email course, simply click on the image of the couple or click here and provide your email address.
I cover important topics related to osteoporosis exercise including:
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Once I decided that I wanted to start hormone therapy, my biggest challenge was locating bioidentical hormone replacement therapy doctors close to where I live and then choosing one. I had to find a doctor comfortable with bioidentical hormone replacement therapy who could determine the type of hormones and quantity that I should take.
Bioidentical Hormone Replacement Therapy Physicians
Before locating a bioidentical hormone replacement therapy doctor, I read books (take a look at my review of The Hormone Cure) and did research on bioidentical hormone replacement therapy.
Once I had an understanding of HRT, my first thought was to consult with my general physician (GP). I approached him with my concerns. To no surprise, he did not have a lot of knowledge in bioidentical hormone replacement therapy for osteoporosis.
He was, however, sympathetic to my concerns. He was willing to do a hormone blood test on me and look at my testosterone, estrogen, and progesterone levels.The tests found that the hormone levels were very low in some areas. However, when the test results came in, he was not too sure about the next steps.
Naturopathic Hormone Balance
I approached a naturopathic doctor who I knew had experience in naturopathic hormone balance. Because we live in Canada, she cannot prescribe hormones. However, she wrote up recommendations for my doctor to follow.
My doctor would prescribe a couple of hormones and I would start feeling a little bit better. However, I didn’t know if I was at my optimum level.
When I asked him if he would do another blood test, he would ask, “Are you feeling better?”
I would say, “Yes.”
But I never knew if I was feeling at my optimum or if my hormones levels were at their optimum. Eventually, he wasn’t willing to do another blood test.
That was too erratic for me and, in the end, did not work. I didn’t feel like I was moving in the right direction and I wanted to move on to another approach
Found: A Bioidentical Hormone Replacement Therapy Physician!
With the encouragement of my husband, we started looking outside of Ottawa for a bioidentical hormone replacement therapy physician. With some work we found a doctor who specialized in bioidentical hormone replacement therapy in Toronto.
It has meant a four hour train trip to Toronto, but it working with him has made all the difference in the world and the long train rides have been well worthwhile.
Evaluating Bioidentical Hormone Replacement Therapy Doctors
Here are some guidelines and tips on evaluating bioidentical hormone replacement therapy doctors. When it comes to your final choice, you will need to evaluate the following:
- Do they have experience in bioidentical hormone replacement therapy? Not all physicians do. In fact, limited time is spent in medical school on hormones and hormone therapy. Find one who has several years of experience in this treatment area.
- Are they knowledgeable in osteoporosis? The medical specialties most often familiar with hormones and osteoporosis are endocrinologists and gynaecologists. My experience has been that gynaecologists are the most comfortable with hormone replacement therapy; probably because they deal with women’s health issues on a regular basis.
- Are they willing to perform repeated tests to determine your optimal hormone level? I found it took several test cycles before the physician achieved the optimal balance for me.
- Are they comfortable with bioidentical hormone replacement therapy? Hormones can be quite complex and hard to understand. You want to be with someone who understands the chemistry and potentials interactions with your body. It takes some skill and knowledge to know the types of hormones and the proper levels to prescribe to arrive at the optimal level for you.
My advice is to invest the time to find a physician who has experience with bioidentical hormone replacement therapy and I caution you to avoid a general physician not skilled in this area of therapy.
Before I started down this path, I did not realize the cost of bioidentical hormone replacement therapy. The costs include the hormone treatments, the testing (and retesting), and the cost of the bioidentical hormone replacement therapy doctor.
My prescription includes six different hormone treatments:
One of the compounding pharmacies I used made it difficult to figure out exactly how much medication I was supposed to take because the way they dispensed the medication. Thankfully, I eventually found a compounding pharmacy that delivered a better experience and results.
Depending on where you live, some of the pharmacies will deliver at your doorstep. Some require that you to show up in person.
The lab test costs were modest at less than a $100 (Canadian) in the first year. The cost of the bioidentical hormone replacement therapy doctor was also manageable at around $300 (Canadian) per year.
Hormones and Osteoporosis Conclusion
The benefits of bioidentical hormone replacement therapy are improved strength, better sex and richer, deeper sleep.
A bioidentical hormone replacement therapy treatment was not a straight forward process. My General Physician was not comfortable with them, it was frustrating to find a doctor who knew bioidentical hormone replacement therapy, I had some troubles dealing with compounding pharmacies, and the out-of-pocket costs for bioidentical hormone replacement therapy are too high for many people.
Ultimately, the decision is yours and it has be right for you. I hope that this helps you with your decision.
- Bailey, DA et al. A six year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: The University of Saskatchewan Bone Mineral Accrual Study. J Bone Miner Res 1999: 14(10):1672-1679
- Saggese G, Baroncelli GI, Bertelloni S, Puberty and bone development. Best Pract Res Clin Endocrinol Metab. 2002 Mar;16(1):53-64
- Carson JA, Manolagas SC, Effect of sex steroids on bones and muscles: similarities, parallels, and putative interactions in health and disease. Bone. 2015 Nov;80: 67-78
- Unger CA, Hormone therapy for transgender patients. Trans Androl Urol. 2016 Dec;5(6):877-884.
- Levin VA, Jiang X, Kagan R. Estrogen therapy for osteoporosis in the modern era. Osteoporos Int. 2018 Mar 8.
- The Benefit of Menopausal Hormone Therapy on Bone Density and Microarchitecture Persists After its Withdrawal. Papadakis G., et al. J Clin Endocrinol Metab, 2016 Dec;101(12): Epub 2016 Nov 17
- Menopausal Hormone Therapy Promotes Bone Health. A MedScape review by Laurie Barclay, MD.
For more information, check out my Osteoporosis Guidelines.