Does HRT really keep my bones strong?

Menopause demystified: looking at the scene behind common menopause questions

HRT is used as a treatment for the bone weakening disease osteoporosis [1].

But if your bones are healthy, does taking HRT reduce your chance of developing osteoporosis in the future?

Let’s see what the science has to say about HRT and bone protection.

About osteoporosis

Your bone tissue is made up of cells and blood vessels that help bone grow and repair itself. The amount of bone tissue you have is known as bone density, and is a measure of how strong and healthy your bones are.

Osteoporosis is a health condition that weakens bones, making them fragile and more likely to break. It develops slowly over several years and is often only diagnosed when a fall or sudden impact causes a bone to break (fracture).

When your bone health has deteriorated to this point, fractures can occur from relatively minor bumps and falls which can lead to impaired mobility and other serious complications [2].

Women are more likely to have osteoporosis than men, especially after an early menopause or if their ovaries have been removed [3], as the lack of oestrogen causes bones to lose their density at a faster rate than new bone tissue grows.

A DEXA scan can measure how dense your bones are and is a useful way to measure changes in bone strength over the years.

What does the evidence say about HRT as a treatment for osteoporosis?

Many studies have shown that HRT is an effective treatment to prevent and repair bone loss and it can reduce the risk of fractures by 50% [4]. The oestrogen in HRT slows down the rate of bone loss and even promotes new bone growth which helps keep bones stronger for longer [5].

If you want to maintain healthy bones, you can’t ignore the structures that support your bones so you will want to keep your muscles, joints and ligaments strong too. The best way to do this is through exercising regularly but this can be difficult if you lack energy and motivation, and if you have achy muscles and joints.

The most common treatment for osteoporosis is a group of medications called bisphosphonates. Although they are effective at maintaining your bone density, they come with side effects like heartburn and indigestion and many people stop taking them for this reason.

For perimenopausal and postmenopausal women within ten years of menopause, HRT is a suitable first choice due to the additional health benefits (cardiovascular and others) and the symptom relief it can offer.

Other ways to keep your bones healthy

The right nutrition and type of exercise is vital for maintaining healthy bones.

You need 700mg a day of calcium; leafy green veg, dried fruit and dairy are rich sources of calcium. Vitamin D helps your body absorb calcium.

You should also consider taking a vitamin D supplement

as it can be difficult to obtain vitamin D from diet alone
during the autumn and winter months
or if your skin is not regularly exposed to sunshine.

Smoking and alcohol also increase your risk of osteoporosis [3].

Exercise needs to be weight-bearing with impact through your joints such as running, tennis, dancing, aerobics or even jumping up and down. Resistance exercise is also important such as press ups, lifting weights, or using a resistance band.

What’s the bottom line?

There is clear and strong evidence that oestrogen as part of HRT reduces your risk of osteoporosis and bone fractures. It can be considered a first line treatment choice for women with osteoporosis and for those wanting to protect the health of their bones as they age. HRT should be taken alongside a healthy diet rich in calcium and vitamin D, and within a routine of regular exercise that is weight bearing and impacts through your joints.

References:

National Institute for Health and Care Excellence (2015), Menopause: diagnosis and management, www.nice.org.uk/guidance/ng23
https://www.osteoporosis.foundation/facts-statistics/epidemiology-of-osteoporosis-and-fragility-fractures
https://www.nhs.uk/conditions/osteoporosis/
Gambacciani M, Levancini M. Hormone replacement therapy and the prevention of postmenopausal osteoporosis. Prz Menopauzalny. 2014 Sep;13(4):213-20. doi: 10.5114/pm.2014.44996. Epub 2014 Sep 9. PMID: 26327857; PMCID: PMC4520366. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520366/
Gosch M, Roth T, Kammerlander C, Joosten-Gstrein B, Benvenuti-Falger U, Blauth M, Lechleitner M. Treatment of osteoporosis in postmenopausal hip fracture patients after geriatric rehabilitation: changes over the last decade. Z Gerontol Geriatr. 2011 Dec;44(6):381-6. doi: 10.1007/s00391-011-0254-6. Epub 2011 Dec 14. PMID: 22159832. https://pubmed.ncbi.nlm.nih.gov/22159832/