Hormone therapy may increase bone mineral density

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A study suggests hormone therapy may help protect bone health in postmenopausal women. Halfpoint/Getty Images
  • Researchers investigated the link between hormone therapy and bone mineral density in postmenopausal women.
  • They found that multiple modes of hormone therapy increase bone mineral density, and effects remain even after treatment withdrawal.
  • Further studies are needed to confirm the results.

Bone remodeling is a process in which old bone is resorbed and replaced by new healthy bone.

During menopause, when estrogen levels fall, bone resorption occurs faster than new bone can form, leading to bone loss and structural deterioration.

Low bone mineral density is indicative of osteoporosis, a condition characterized by reduced bone strength and increased fracture risk.

An estimated 10.2 million people in the United States aged 50 and over live with the condition, while another 43.3 million people have low bone mass.

Hormone therapy is widely used to prevent and manage osteoporosis. However, studies focusing on the withdrawal effects of hormonal therapy on bone mineral density have produced conflicted results.

While some studies report that the protective effects of hormone therapy persist after hormone therapy withdrawal, others suggest that stopping hormone therapy leads to bone loss.

Knowing more about the effects of withdrawal from hormone therapy on bone mineral density could inform treatment options and trajectories.

Recently, researchers analyzed healthcare data to understand the effects of hormone therapy on bone mineral density over time.

From their dataset, they found that increased in lumbar spine bone mineral density persists even after discontinuation of hormone therapy. The lumbar spine consists of the five bones, or vertebrae, in the lower back.

The study’s findings appear in Menopause.

For the study, the researchers analyzed data from 6,031 postmenopausal women aged between 50 and 89 years old. Among them:

  • 33% were unexposed to hormone therapy
  • 32% had used or were using combined contraceptive pills
  • 10% had used or were using estrogen-only pills
  • 1% had used or were using estrogen/progestin combo pills
  • 0.4% had used or were using estrogen-only patches
  • 0.07% had used or were using estrogen/progestin patches

About 19% of women used two kinds of hormone therapy, and 3.7% used more than three kinds at once.

“Hormone therapy with estrogen slows the rate of bone resorption restoring the balance between bone resorption and bone formation and thus preventing the progression to osteoporosis,” Dr. Melanie Meister, urogynecologist at The University of Kansas Health System, not involved in the study, told MedicalNewsToday.

The researchers further found that all hormone therapy methods, aside from estrogen-only patches, had a protective effect against osteopenia. Osteopenia refers to bone mineral density loss that has not yet reached the threshold to be considered osteoporosis.

The researchers noted that none of the hormonal therapy types were linked to osteoporosis prevalence.

MNT spoke with Dr. Peter Whang, an orthopedic surgeon specializing in spine conditions at Yale Medicine, was not involved in the study, about its limitations.

Dr. Whang noted that as the study analyzed survey data and not a randomized trial, it is not possible to draw conclusions about the results.

Dr. Neil Paulvin, board certified Family Medicine & Regenerative Medicine Doctor, not involved in the study, also told MNT: “To safely extrapolate the study’s findings to all women, it needs to be repeated with various patients. They should also evaluate other profiles such as women with a history of gynecological cancer.”

Dr. Meister added: “Lumbar bone mineral density, is important, but the reason we follow bone mineral density is to evaluate for osteoporosis, and more importantly, risk of fracture, which can result in significant morbidity and even mortality in older adults.”

“Unfortunately, this study could not evaluate the association between hormone therapy and fracture risk. We do not know from these findings whether hormone therapy use decreases the chance that postmenopausal women will experience an osteoporotic fracture,” Dr. Meister explained.

She further noted that the researchers evaluated patients at one ‘snapshot’ in time as opposed to longer periods, which limits the conclusions that can be drawn.

“Women with a history of hormone therapy use also demonstrated higher lumbar bone mineral density and lower rates of osteopenia compared to women who had never used hormone therapy. However, it is unknown when these women stopped hormone therapy in relation to the time their data was collected for the study, so we do not know how long the beneficial effects of hormone therapy last after discontinuing it,” she noted.

“These findings imply we can increase the use of hormone therapy in the treatment of osteopenia and osteoporosis,” said Dr. Paulvin,[Hormone therapy could] also be studied further for women in menopause.”

“It is important to remember that low bone mineral density is not the only risk factor for fractures, and some risk factors are modifiable including smoking and excessive alcohol intake,” added Dr. Meisters.

“Not everyone is a candidate for hormone therapy depending on other medical conditions. Additionally, we do not recommend beginning hormone therapy in women who are more than 10 years past menopause because there is some concern about cardiovascular risks in these women. It is important to discuss the use of hormone therapy with your doctor,” she concluded.

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