Preventing Bone Loss with HRT

Woman in Vrksasana PoseOur bones are living growing tissue. The body is constantly building and breaking down the bone to keep them healthy and strong. Before the age of 30 the bones are at their peak strength, then we start to lose bone mass faster than the body replaces it. Overall risk for osteoporosis varies among individuals and depends on factors such as genetics, food intake, exercise, alcohol, smoking, and the use of certain medications. However, for women specifically, estrogen has been shown to play an important role in bone health.

The ovaries slowly decrease the production of estrogen as women approach menopause. Her monthly periods become less regular and she reaches menopause once she has not had a period for at least one year. Bone loss speeds up when the estrogen starts to decline and the greatest loss occurs during the first four to eight years of menopause, even up to 20 percent! Research has shown that estrogen replacement may be able to slow down this rapid bone loss and help prevent osteoporosis.

There has been a lot of misconception and confusion about hormone replacement since the Women’s Health Initiative study in which oral Premarin and Progestin use increased risk of heart disease and uterine cancer.  More recent studies are taking a broader view of HRT.

  • Using a different method of estrogen administration such as patch or cream,
  • Choosing 17Beta-Estradiol, which is the bio-identical hormone, instead of  Premarin, which is made from horse urine and is not identical to human estrogen. .
  • Prescribing a decreased dose of estrogen

With these changes, physicians are feeling much more comfortable prescribing a low-dose estradiol patch or vaginal cream to help combat bone loss in menopausal women.

A research study was performed in 2004 with 400 women, ages ranging from 60–80 years old. The study lasted two years. Half of the participants were put on a low dose estradiol patch of 0.014mg per day and the other on a placebo. The results were impressive. For women on the patch, bone mass density of the spine increased fourfold and bone turnover markers were improved. Only one woman in the estradiol group showed signs of increased abnormal endometrial lining, but cleared soon after short-term treatment with progestin.

These findings suggest that low-dose estrogen can slow the bone loss in menopausal women and reduce risk of developing osteoporosis. This may be a great alternative for women who cannot tolerate the side effects of osteoporosis drugs such as bisphosphonates which can cause stomach and esophageal erosions as well as muscle, joint and bone pain.

Although it is important to note that estrogen replacement still has its fair share of unknown risks. Be sure to work with a qualified and experienced bio identical hormone provider to determine what is right for you. Find a provider near you.

By Haylee Nye NCNM Naturopathic Medicine Program Edited by Dr Elise Schroeder


“New Releases.” Ultra-low Dose Estrogen Patch Improves Bone, Appears Safe for the Uterus. Harvard Health, n.d. Web. 18 July 2014.

Hormones and Healthy Bones. National Osteoporosis Foundation. Web. 17 July 2014.