Osteoporosis, bone health, menopause, HRT and the confusing messages of medicine
Convincing menopausal women that HRT is good for bone health has become common practice. It’s what you’ll likely hear from your doctor and also if you catch a menopause expert in the media listing the perceived benefits of HRT. But is it true?
The North American Menopause Society (NAMS) 2022 hormone therapy position statement states in its abstract: “Hormone therapy . . . has been shown to prevent bone loss and fracture.”
The British Menopause Society’s (BMS) Vision for menopause care in the UK (revised in October 2020) states: “HRT can improve bone health and reduce the risk of osteoporosis and fractures in later life.”
Yet, further down in the NAMS position statement (for those who take the time to read the whole document) it states: “The BMD [bone mineral density] benefits of preventing bone loss persist as long as [hormone] therapy is continued but abate rapidly when treatment is discontinued.” (Bold added.)
Dig into the NICE guidelines for menopause care, found on the BMS website, and likewise you’ll find the following statement: “HRT reduces the risk of osteoporotic fracture, the benefit being maintained while HRT is taken.” (Bold added.)
Women who take HRT usually start it in their 40s or 50s and stop within seven years, to avoid the increased risks of side-effects that arise from prolonged use. Meanwhile, most women who experience osteoporosis and fractures usually do so decades later when any HRT that they had taken around midlife would no longer have an impact on bone density. So is HRT good for bone health?
While the FDA deemed estrogen supplementation as an “effective therapy” for osteoporosis in 1986, this recommendation was based on studies carried out on women who had entered surgically induced menopause following the removal of their ovaries.
Ovary removal can cause a significant and rapid drop in bone density, which can be reversed with estrogen therapies. However, most women go through natural menopause. Concluding that women who journey through natural menopause require the same therapies as women who've had their ovaries removed is absurd, but HRT has been marketed as a bone health promoter to ALL women for decades.
Our bones (just like our hormones) have become another part of the human body that medicine wants us to believe is destined to malfunction. While rejecting the notion that the body might just have a plan of how best to age, tried and tested by evolution, medicine has equated bone health to bone density, and determined that all norms of female bone density should be based the average bone density of a 30-year-old woman.
What a body needs at 60, 70 and 80 is not what a body needs at 30, and yet a whole industry has developed around bone density testing, medicines and supplements, as if at every age the human body is designed to operate like a 30-year-old. What we actually need, regardless of age, are strong bones, which do not necessarily equal dense bones.
In the case of a fall, strong bones behave more like wood, as opposed to very dense bones, which behave more like glass. Prolonged estrogen supplementation can indeed make bones denser, but if a woman’s bones become denser like glass, they are more likely to shatter.
Charles Dodds, who first published the formula to create synthetic estrogen in 1938, had throughout his career recommended caution in administering hormone therapies to women passing through natural menopause. He recognized the disruptive power of such therapies and was aware that hormones “could alter the metabolism in every cell and organ of the body.” Dodds knew that estrogen stimulates growth, in bone cells and cancer cells, and that there is a relationship between estrogen, bone density and cancer which was (and still is) widely ignored: women and other mammals get more female cancers when their bone density is relatively high, and less when it’s relatively low. It seems that society’s fixation on bone density, rather than bone strength, is indeed misguided.
It makes good business for pharmaceutical companies if women believe that bone health must be preserved by an external medical “fix.” Yet, what if common-sense lifestyle practices are a safer and more effective route? It turns out that time spent outdoors, a clean diet, exercise and caring for our mental wellbeing all contribute to preserving bone strength, and good health in general.
Luckily, we don’t need to fear our bones; we just need to care for them as we care for our whole being.
Inspiration for this post came from the following sources, which offer additional references for further research:
The Better Bones website by Dr. Susan Brown
The Greatest Experiment Ever Performed on Women by Barbara Seaman (2003)