Years ago when HRT was launched, alongside the potential for symptomatic relief, we were sold HRT as being “good for protecting you against osteoporosis”. Still today, in practice I find patients afraid of taking HRT because of the side-effects and afraid not to in terms of their long term bone health. In this post I aim to help you explore HRT and Osteoporosis and if HRT really is good for your bone health.
What You Need to Know About HRT and Osteoporosis
1. What is Your Actual Level of Risk for Osteoporosis?
Some might explain the increase in the incidence of osteoporosis as being caused by us living longer, as an inevitable consequence of the menopause for women, and aging in general for us all. Whilst there are certainly changes that take place as we get older it may also be that there are other factors we need to consider regarding our long term bone health.
A study published in The Lancet in 1993 compared the rate of bone loss in the skeletal remains of women aged between 15 and 89 who lived two centuries ago, to that of present day women. They found that the rate of bone loss in modern-day women is significantly greater [1], [2].
The rate of osteoporosis is increasing, and it is important to assess if you need to take extra steps towards looking after your bone health because you do actually have genuine risk factors. Or it may be that you are not especially at risk and taking sensible measures to look after your general health will also support your bones.
Risk Factors for Osteoporosis:
- Family history of osteoporosis
- History of an eating disorder
- Being underweight
- Irregular periods
- Smoking
- Sedentary lifestyle with low levels of exercise
- Excessively high levels of exercise
- Digestive problems that affect absorption (e.g. low hydrochloric acid levels, coeliac disease)
- An early menopause
- Being European or Asian
- Medications – steroids, laxatives, diuretics, some thyroid medications, drugs for blood thinning such as Heparin
Some of these are things that we cannot change, like our family history. But there are also many lifestyle factors that can have a very positive influence on our bone health. For many women, following the broad dietary advice, taking good quality supplements, avoiding smoking and excessive alcohol, and more active lifestyles can be helpful in avoiding the worry of osteoporosis. For those with a strong family history, a current condition or a number of risk factors there is also a great deal of additional positive support that can be offered.
2. HRT and Osteoporosis – Your Long Term Bone Health
There is a strong argument that modern life is contributing towards the increased incidence of osteoporosis. HRT (hormone replacement therapy) was offered as a way to protect against this but I believe that it is an incomplete and flawed plan.
Although taking HRT over a long period of time may possibly increase bone density there are three important practical points that need to be considered.
1. Is the effect sustained after stopping the HRT?
No – once the HRT is stopped, no matter for how many years it has been taken, bone density can rapidly begin to drop again. [3]. The International Osteoporosis Foundation website page on Hormone Replacement Therapy (HRT) states that “discontinuation of HRT results in acceleration of bone turnover, decrease in bone mineral density (BMD) and eventual loss of anti-fracture efficacy” [4]. Ground gained is lost.
2. Does bone density equate to bone strength and health, and a reduction in the risk of fracture?
Do we know if increasing bone density is the best way to optimise bone strength? In Japan bone density is significantly lower than in the USA, but the incidence of hip fracture is two and a half times less, even though the Japanese consume less calcium [5].
3. Is it safe to take HRT for the length of time needed to confer any benefits?
No – if you follow the “take HRT to look after your bones” plan you therefore need to take it forever and run the increased risk of serious side effects such as cancer and stroke [6].
We are most at risk of hip fracture in our late 70’s and beyond. If you were sold HRT to protect you bones and you took or take it now during your 40s, 50s or 60s, even if it worked, no matter how long you take it for, when you stop the protection you hoped you were accruing would be fading at the point at which you are most at risk of a hip fracture and other bone health issues.
Meanwhile, the longer you are on it, the more at risk you are of the serious side effects such as cancer and heart disease.
Moreover, HRT also increases our own natural Cortisol levels. This is important because Cortisol is a steroid based hormone and there are problems if levels are elevated over a long period of time. We naturally produce another steroid hormone called Dehydroepiandrosterone (DHEA). DHEA helps to reverse cortisol’s immunosuppressant effect and has a number of health promoting actions, including the protection and increase of bone density. DHEA and Cortisol are inversely related, so when taking HRT our normal levels of Cortisol is raised, which can be problematic, and levels of health promoting DHEA lowered [5], [7].
3. HRT the Risks: “Mocking Ourselves with Falsehood”
Blessed sister, holy mother,
spirit of the fountain, spirit of the garden,
Suffer us not to mock ourselves with falsehood
From Ash Wednesday by T.S.Eliot
Clearly ahead of his time, I do believe that in this beautiful poem, T.S. Eliot was imploring women to consider the wider issues around taking HRT! Hopefully this and my previous posts HRT – the Devil and the Deep Blue Sea [6] and Natural Remedies for Menopause [8] have given you enough factual information about HRT should you feel that you need more than poetry!
How often are women led to believe that without surgery or drugs they will fall into state of decrepitude? When “HRT Nurses” were in vogue some years back, before results from Women’s Health Initiative Study gave us pause to think, women used to see me and tell me that they had been informed that they had no oestrogen. From my various posts and my handbook ‘Menopause: A Heroine’s Journey, Powerful Help for Women’ [9] you will know this is not true. We have an additional form of oestrogen to that which we make in our ovaries. There is a Plan B!
I am often shocked at the how little women have been told by their nurses, doctors and surgeons. How incomplete and negative the information often is. And how hard at that point it can be for many women to uncover what they need to ask to ensure they do not just find themselves on a conveyor belt heading for surgery and/or drugs.
With side effects that have been repeatedly highlighted and the overly optimistic suggestions around the supposed protective benefits unravelled, I am surprised that doctors still wish to prescribe it in any instance. Risk is categorised and explained away as only an issue for a minority. So if you do decide to take HRT just make sure you are not in that minority.
The next step pharmaceutically is Bio-Identical HRT but I have not seen long-term trials that convince me of its safety. It is brought to you by the very same industry that sold both the public and the medical profession standard HRT. The chemicals may be “identical” to your own hormones but they are still steroids prepared industrially and not by your body. They are in smaller doses compared to standard HRT, but they are safe or have they just assumed they are because the dose is lower? Is this sounding familiar? If it doesn’t you might find part 3 of my previous post Natural Remedies for Menopause [8] useful to refer to.
And of course there will be periodic announcements that HRT will prevent or cure all manner of ailments. Just listen out for them – they pop up at intervals. What we need to ask is simple – is it safe and does it actually deliver what is being suggested? Or is this another case of jam tomorrow?
And for those with osteoporosis or assessed as being at risk, they may well be running the additional risk of awful side effects from taking Bisphosphonate drugs like Fosamax. Sold to prevent or treat osteoporosis, their side effects may mean that people taking these could be at risk of osteonecrosis (deterioration) of the jawbone and femur fractures (thigh bone breaks). You can find out more by visiting Drugwatch – Fosamax and Recall Report – Fosamax Overview [10, 11].
You don’t have to be a guinea pig and take these kinds of risks with your health – you have choices.
4. HRT and Osteoporosis – Lifestyle and Choices
I believe there is a huge amount we can do to support ourselves and our long term health. We can draw upon a vast range of remedies, helpful herbs, dietary measures and good quality supplements. Considering how to support with lifestyle measures such as exercise, how we deal with stress, explore relaxation and creativity. Depending upon you and what feels right for you, even just taking small steps towards healthier choices can have a huge impact on your health and happiness.
Improving your diet can help towards giving your body what it needs to be healthy in the longer run What Foods to Eat During Menopause [12]. You will probably have read and been told how important it is to eat lots of calcium-rich foods like milk, cheese, yogurts. Whilst they have their potential benefits, they need to be seen within the context of an overall healthy diet for that particular individual. What is a healthy and balanced diet for you?
Calcium is important but there are other pieces of the jigsaw that are also crucial for your health. Nutritionally they take the shape of all the other nutrients your body needs to make use of the Calcium to build bone such as Magnesium, Vitamins D and K, Boron and Silica, etc.
As always, the key is balance. The article on Wellness Mama [13] gives some interesting information around that balance and non-dairy sources of calcium. In the western world, for most of us it is probably quite hard to be deficient in Calcium but easier to lack some of the other key nutrients. Granny was right – eating your greens is a good idea!
Also of key importance is finding good quality supplements. Ones made with an intelligent combination of what is needed to support general and bone health, sourced from ingredients that are able to be recognised and used by the body. There are many different makes out there, I often use Higher Nature for these reasons.
For me there is a major practical difference between taking a natural and a drug-based approach in that you are giving yourself the opportunity to strengthen and support your overall and bone health in the longer run instead of taking drugs that have the potential to undermine your health.
The good news is that you actually have a great many different ways in which you can support your health to choose from. As I write this I am drawing upon my experience as a practitioner, and there is a wealth of support out there for you. I am always happy to meet and discuss health strategies and options for women at this stage in our lives. I often find women are delighted to find out more about how our hormonal systems work and adapt, and what options they have beyond taking steroids like HRT.
Menopause and some of the health challenges that can arise around this time offer us the opportunity to reassess how we live and look after ourselves. To reclaim our health and choices for ourselves. Often there are changes women want to make, have been waiting to make but have not yet given themselves permission to do so, or felt able to. My hope is that these posts give you more information about practical steps you can take, choices and support that are there for you.
I hope you have found this to be helpful, especially if you are having a difficult time with menopause at the moment. If you have any questions about finding support at menopause and would like to book a free initial meeting, please do contact me.
References and Resources:
[1] Differences in proximal femur bone density over two centuries http://www.thelancet.com/journals/lancet/article/PII0140-6736(93)90433-H/abstract
[2] New Natural Alternatives to HRT, Marilyn Glenville
[3] What Doctors Don’t Tell You, Lynne McTaggart, 1996/ New England Journal of Medicine, 1993:329 (16): 1141-6.
[4] International Osteoporosis Foundation – Hormone Replacement Therapy (HRT) https://www.iofbonehealth.org/hormone-replacement-therapy-hrt
[5] The Wisdom of Menopause, Dr Christiane Northrup, 2001/Fujita et al, 1992, Comparison of osteoporosis and calcium intake between Japan and the United States. Proc. Soc. Experimental Biology & Medicine, 200 (2), 149-152.
[6] HRT – the Devil and the Deep Blue Sea
[7] Sexual Chemistry, Understanding Our Hormones, The Pill and HRT, Dr Ellen Grant
[8] Natural Remedies for Menopause
[9] My handbook ‘Menopause: A Heroine’s Journey, Powerful Help for Women’
[10] Drugwatch – Fosamax
[11] Recall Report – Fosamax Overview
[12] What Foods to Eat During Menopause
[13] Wellness Mama Calcium Without Dairy
[14] Higher Nature