HRT and Osteoporosis


by John R. Lee, M.D. and Virginia Hopkins

Should You Take Hormone Replacement Therapy to Prevent

There is a misperception that osteoporosis begins at
menopause. In reality, bone mass begins declining in most women in their
mid-thirties, accelerates for 3-5 years around the time of menopause, and then
continues to decline at the rate of about 1-1.5% per year. Because bone loss
accelerates at menopause, and because estrogen levels decline at menopause,
conventional medicine has adopted the belief that osteoporosis is an estrogen
deficiency disease that can be cured with estrogen replacement therapy. This is
only partly true. The missing piece of this puzzle is diet and lifestyle, plus
the bone-building hormone progesterone, which drops much more precipitously at
menopause than estrogen does. (When I refer to progesterone, I mean the natural
hormone, not the synthetic progestins. Read my books for details on the

There is no question that estrogen can slow bone loss around
the time of menopause, but the scientific evidence is very clear that after 5-6
years, bone loss continues at the same rate, with or without estrogen. A very
large study published in the New England Journal of Medicine in 1995,
studying risk factors for hip fractures in white women, which followed over
9500 women for eight years, found no benefit in estrogen supplementation in
women over the age of 65. If estrogen was the only known treatment for
osteoporosis, it might be worth taking it to get the small saving in bone
density, despite all the risks and side effects. But since it's clear that
progesterone, combined with proper diet and exercise, steadily increases bone
density regardless of age, there are very few women who should ever need
to take estrogen for osteoporosis.

Women who need estrogen tend to be those who are petite,
slim and small-boned. After menopause, a woman’s fat cells make estrogen,
but a slim woman may not be making enough to keep up with bone loss. Those
women may need a very low dose of estradiol.

There are a number of pharmaceutical drugs being used to
treat osteoporosis, none of which work very well, and all of which have
unpleasant side effects. One of the best known is fosamax, a biphosphonate drug
that can slow bone loss. Unfortunately, the old bone which is saved by using
fosamax is eventually structurally unsound, and after three or four years it
has no benefit, and I suspect it tends to increase the rate of hip
fracture after about five years. For awhile fluoride was being touted as an
osteoporosis drug, but like fosamax, it only slows bone loss temporarily, and
the long term consequence is an increased rate of hip fracture due to
structurally unsound bone. Another conventional medicine osteoporosis drug is
called Calcitonin-salmon (Calcimar). This is a hormone made by the thyroid
gland that can temporarily slow bone loss. Again, the long term side effects
are not well known, and its effectiveness diminishes rapidly after a few

Progesterone and Osteoporosis

One of the most important factors in osteoporosis is a lack
of progesterone, which causes a decrease in new bone formation. Years of
clinical experience giving women progesterone showed me that using a natural
progesterone cream will actively increase bone mass and density and can
reverse osteoporosis. These patients consistently show as much as a 29
percent increase in bone mineral density in three years or less of progesterone
therapy. After treating hundreds of patients with osteoporosis over a period of
15 years, I found that those women with the lowest bone densities experienced
the greatest relative improvement, and those who had good bone density to begin
with, maintained their strong bones.

Postmenopausal women using a transdermal (on the skin)
progesterone cream or oil should use the equivalent of 15-20 mg daily for three
weeks out of the month, with a week off each month to maintain the sensitivity
of the progesterone receptors. You can read the book
What Your Doctor May Not Tell You
About Menopause for details on how to use progesterone cream.

Exercise for Strong Bones: Use 'Em Or Lose 'Em

Lack of exercise is one of the primary causes of
osteoporosis. Using your bones keeps them strong and healthy. Weight-bearing
exercise is the only thing besides progesterone found to actually
increase bone density in older women. By weight-bearing I mean exercise
that uses your bones. Brisk walking counts as weight-bearing exercise, but add
some hand-held weights and it's even better. Pushing a vacuum cleaner or lawn
mower, gardening, dancing, and aerobic exercise also qualify.

Your exercise plan should include a minimum of 20 minutes of
weight bearing exercise three to four times a week. An hour is even better. In
contrast to women who exercise, those who don't continue to lose bone,
regardless of what else they are doing. Studies of elderly people who fall and
break a bone show that these people had poor flexibility, poor leg strength,
instability when first standing, and difficulty getting up and down in a chair.
Exercise can help increase flexibility, strength, and coordination. A weight
lifting program of just half an hour three to four times a week can
significantly improve bone density. You don't need to go to the gym to do a
weight lifting program. You can lift a can of peas or a small carton of milk.
Women with advanced osteoporosis should work with a physical therapist to
create a safe, effective program to reduce the risk of fracture. The Asian
movement exercises such as yoga, tai chi and chi kung can also be excellent for
improving strength, flexibility and coordination.

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