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The dilemma of HRT and osteoporosis: Is it worth the risk?

May 4, 2011
By Mary Lou Williams, M. Ed.

The FDA has approved hormone replacement therapy for two uses: to treat the symptoms of menopause (hot flashes, night sweats, vaginal dryness) and to prevent or treat the bone-thinning disease, osteoporosis.

A study published on October 1, 2003, in the Journal of the American Medical Association has recommended that HRT no longer be prescribed for the second of these purposes, the prevention or treatment of osteoporosis. Why? The recommendation was based on an analysis of a landmark government study. The Women’s Health Initiative, whose major findings were published in July 2002. This study did not find that HRT had a negative effect on bones. Indeed, it found that hormones do prevent broken bones in postmenopausal women. However, it also found an increased rate of heart disease, strokes, blood clots in the legs and lungs, breast cancer, and a doubling of the risk of Alzheimer’s disease.

Three new studies have added to this list of negative effects: findings from the European Prospective Investigation into Cancer and Nutrition found that women on postmenopausal hormone therapy had a 29 percent greater risk of ovarian cancer, compared with those who did not use hormones. A study reported in the October 11, 2010, issue of The Archives of Internal Medicine indicated that estrogen therapy increases the risk of kidney stones in healthy postmenopausal women. Finally, a study in the October 20, 2010, issue of the Journal of the American Medical Association found that prolonged use of hormone replacement therapy not only raises the risk of breast cancer, but it also ups the risk for more severe forms of the disease and increases a woman’s chances of dying.

Short-term HRT and the risk of osteoporosis

Hormone therapy can delay the risk of osteoporosis and fractures as long as a woman is on it. Once estrogen is stopped, considerable bone loss can occur rapidly. According to Dr. J. Christopher Gallagher, an osteoporosis expert at Creighton University, once a woman discontinues estrogen, she will lose everything she gained within two to three years. A study published in the New England Journal of Medicine in October 1993, found that the bone benefits seen with short-term estrogen use are, in the long run, minimal to nonexistent. Taking estrogen for less than seven years had no net protective effect on women’s bones by the time they reached age 75. For long-term preservation of bone mineral density, women would have to take estrogen for at least seven years after menopause. The study found that even this duration of therapy had little residual effect on bone density among women 75 years of age and older, who have the highest risk of fracture. In women who had taken estrogen for seven to 10 years, the net benefit by age 75 was about three percent more bone mass than in women who never took the hormone - not enough to be considered significant.

Long-term HRT and the risk of breast cancer

In a study reported in the Journal of the American Medical Association in 1991, estrogen replacement therapy was consistently shown to increase the risk of breast cancer by four percent per year. When multiplied by 15 years, the risk is 60 percent! Therefore, if a woman began estrogen therapy at 50 and continued until age 65, she would have a 60 percent increased risk of breast cancer.

In a Swedish study published in the New England Journal of Medicine in August 1989, the breast cancer rate among women who took estrogen alone was double that of women who took no hormones. Among women who took the combination therapy of progestin as well as estrogen for four or more years, the rate of breast cancer was four times as high as the rate among women who took no hormones at all.

Because of the increased rates of breast cancer with long-term use of HRT as well as the increased rates of heart disease, strokes, blood clots and Alzheimer’s disease, the researchers of the 2003 study concluded that the benefit of HRT on bone density is not worth the risks.

The alternatives

What then can be done to prevent or reverse osteoporosis? What do we do about our bones, especially our hipbones? Are there non-drug, natural ways to prevent or reverse this bone thinning disease?

The answer is yes; they involve removing toxins from the diet that weaken bones and adding nutrients that strengthen them. And unlike HRT, they can be used by men, who also are subject to osteoporosis as they age, as well as by women. These substances will be the topics of subsequent articles.

Mary Lou Williams, M. Ed., is a writer and lecturer in the field of nutrition. She welcomes inquiries. She can be reached at 267-6480.



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