For decades, estrogen replacement therapy (ERT) was considered the only preventive measure for osteoporosis. Unfortunately, it was only available for women, some of whom were soon excluded as the risk of uterine cancer became known.
Still estrogen may play a role in the prevention of bone loss in men. Of all risk factors, the postmenopausal avalanche of bone loss experienced by almost all women is the most dramatic. It outweighs most other risk factors except for severe illness like poliomyletis or perhaps the accumulated effects of long term corticosteroid therapy.
Addressing other factors such as lifestyle and exercise may help to slow bone loss, but the effectiveness of this approach varies from one individual to another. Lifestyle changes made in youth or early adulthood may help you reach peak bone mass at a later age, giving you more bone to lose before complications set in, but menopause will still make significant inroads into your skeletal stores of calcium.
Under no circumstances should any woman ignore the importance of preventive measures before, during, and after menopause. Still, even those who do not begin ERT promptly as long as they begin within a few years of menopause can still benefit.
Estrogen production virtually stops with natural menopause, at which point the rate of bone turnover speeds up significantly. Osteoblasts begin to create new bone at an unprecedented rate, but the osteoclasts are even more aggressive and the overall result is a continuous net drain of calcium from bone.
For estrogen replacenTlent therapy to prevent or slow this metabolic change, it must be maintained throughout the normal period of menopause. When therapy is discontinued and bone loss picks up again, it is not at the accelerated postmenopausal pace. It is generally closer to the more moderate rate of loss taking place when therapy began.
There are, therefore, two advantages to hormone replacement therapy: First, it diminishes bone loss and maintains a stronger skeleton. Second, it alleviates many other common, unpleasant effects of menopause. Therapy is usually begun at menopause and maintained for seven to ten years. Studies have shown that hormone replacement reduces the risk of osteoporotic fractures of the hip and forearm by about one third, and fractures of the spine by more than a half.
Hormone replacement therapy is not a cure for osteoporosis, nor will it completely arrest bone loss. But if it is taken for this period, it removes a potent risk factor that otherwise leads most women down a dangerous path of bone loss and a toward a prognosis of early osteoporosis.
The ideal time to begin hormone replacement is when the ovaries stop working and your natural supplies of estrogen begin to dwindle. Overall bone loss begins at menopause but is slowed dramatically by the use of estrogen drugs. The sooner you take it, the less bone you’ll lose. It can even be taken up a year or two after the onset of menopause, although some bone loss has already taken place and a late start is not recommended.
Remember, estrogen therapy prevents or slows bone loss but does not rebuild bone already lost. In earlier times, osteoporosis was but one of many signs of age related degeneration. However, global life expectancy has risen dramatically since 1950 to its present sixty six years, so most women worldwide live long beyond menopause.
In highly industrialized countries many women reach menopause with more than one third of their lives yet to be lived. Consider also that 55 percent of people over sixty and 65 percent of eighty year old are women, and that by 2050 one fifth of the world’s population will be over sixty. Osteoporosis often makes those years difficult and painful, and the cost to society is increasing dramatically as people live longer. However, it can be easily prevented in most cases.