Estrogen Replacement Therapy for Osteoporosis

Benefits and Risks of Estrogen Treatment

If you're approaching menopause, your body will likely alert you to the sudden drop in estrogen with physical signs (such as hot flashes) and psychological changes (including mood swings). The effect on your bones won't be as obvious, but the loss of estrogen will certainly affect them. If you have a high risk for osteoporosis and are approaching or have already reached menopause, estrogen replacement therapy may be a good osteoporosis treatment or preventative measure.

Estrogen is a sex hormone that is essential to female bone health because it promotes the activity of osteoblasts, which are cells that produce bone. When estrogen levels drop during menopause, the osteoblasts aren't able to effectively produce bone.

Estrogen replacement therapy used to be the only FDA-approved treatment to prevent osteoporosis. There are now many other drugs and medications for osteoporosis, but estrogen remains a fairly common treatment to conserve bone mass and prevent osteoporosis-related fractures in post-menopausal women.

Who is a Good Candidate?
Estrogen replacement therapy is appropriate for most women, but it should not be used if if you have:

  • Breast or uterine cancer
  • Poor liver function or liver disease
  • A recent history of blood clots

Also, estrogen replacement therapy is not for pre-menopausal women or for men.

In most cases, you will also take progesterone hormones along with estrogen. This is because taking estrogen alone increases your risk for uterine cancer, while the combination of estrogen and progesterone greatly reduces this risk. However, if you have had a hysterectomy, involving the removal of your uterus, or were born without a uterus, you can safely take estrogen alone because you have no risk for developing uterine cancer.

When to Start Estrogen Replacement Therapy
The ideal time to begin estrogen replacement therapy is during early menopause. But many endocrinologists believe that the bone-preserving benefits of estrogen therapy can still be achieved even if started more than a decade after menopause.

How to Use Estrogen Replacement Therapy
Depending on what brand of estrogen your doctor recommends, estrogen can be given as a transdermal (skin) patch or a pill.

Your doctor may recommend you take estrogen daily, with progesterone for about 14 days each month. You could also take estrogen and progesterone each day, or simply take estrogen each day.

If you're using a patch, you'll likely change the patch twice a week or weekly.

Potential Risks
Though estrogen replacement therapy was once the only approved osteoporosis medication, it is not as widely used today. Part of the reason for this is because the therapy has been connected to increased risks of uterine cancer, breast cancer, stroke, heart attacks, blood clots, and even mental decline.

Despite these potential side effects, estrogen replacement therapy is effective at protecting post-menopausal women from bone loss. If you and your doctor believe estrogen replacement therapy is the right treatment course for you, it will most likely be used in the lowest possible dose for the shortest amount of time.