Estrogen plays an important role in maintaining bone structure. Low estrogen levels can lead to porous, weakened bones and osteoporosis.
Our bones consist of living, growing tissue. The body is constantly breaking down old bone and growing new bone to take its place.
If a person has osteoporosis, their body makes too little new bone, loses too much bone, or both.
Menopause is a natural process and causes levels of certain hormones, including estrogen, to decrease. This can lead to osteoporosis.
Below, learn how estrogen influences osteoporosis, how to prevent the condition, and what the treatments entail.
Estrogen is one of the hormones that regulate bone metabolism. It is essential to bone health because it promotes the activity of osteoblasts, which are the cells that make new bone.
During a person’s life, their bone density increases until around the age of 30. After this point, it slowly begins to decline.
Low estrogen can accelerate this process, which is why people going through menopause experience a faster loss of bone density than males.
Osteoporosis is a condition where bones have become more porous due to a loss of minerals. This porosity weakens the bones and makes them more likely to fracture.
When estrogen levels drop, a person may lose bone density. Experts do not understand exactly how this happens, but according to a 2022 review, several factors may play a role:
- Reduced cell formation: Low estrogen reduces the activity of osteoblasts, which are cells that make new bone.
- Increased turnover: Estrogen influences the amount of cell turnover, meaning the body loses more bone cells than it can replace.
- Changes in body composition: Scientists have observed that during menopause, people tend to gain more visceral fat around the abdomen as bone mineral density decreases. There may be an interaction between these changes.
- Microbiome changes: Some researchers have suggested that changes in gut flora could influence bone density. Estrogen plays a role in regulating gut flora, and changes in estrogen may lead to unfavorable changes in the microbiome that affect the absorption of calcium or inflammation levels. An imbalanced microbiome may also lead to less estrogen. However, this is still an area of ongoing research.
There are various ways to prevent bone loss, including:
- eating foods rich in calcium and vitamin D
- taking calcium and vitamin D supplements
- regularly performing weight-bearing exercises, such as walking, jogging, skipping rope
- doing resistance exercises, such as weight training or push-ups
- avoiding smoking and excessive alcohol consumption, if applicable
- absorbing vitamin D through small amounts of sun exposure
Some doctors prescribe hormone therapy to prevent or reverse osteoporosis. This involves taking estrogen, or estrogen and progesterone, to slow the decline of bone density.
Doctors may recommend hormone therapy to people who have gone through menopause or undergone ovary removal. The treatment can also improve menopause symptoms, such as insomnia and hot flashes.
Hormone therapy can come in the form of a pill or skin patch. A doctor may suggest taking a pill daily or using a skin patch twice weekly.
Risks and considerations
According to a 2022 review, there has been some controversy around whether doctors should still use hormone therapy as a first-line treatment for osteoporosis.
However, the review authors emphasize this technique is safe and effective for osteoporosis, particularly for those experiencing symptoms or who are under the age of 60.
The National Health Service (NHS) in the United Kingdom summarizes some of the potential risks:
- Breast cancer: There is a small increased risk of breast cancer for people who take combined hormone therapy long term, but there is little or no risk from estrogen-only hormone therapy.
- Blood clots: Hormone therapy pills can increase the risk of blood clots, though the overall risk is still low. That said, this does not apply to patches, gels, or sprays.
- Stroke: Hormone therapy pills may also slightly increase the risk of stroke. However, this only applies to pills, and the risk for those under 60 is still very low.
If a doctor suggests hormone therapy, they will likely recommend the lowest effective dosage for individuals.
Some may be able to take hormone therapy long term to slow bone loss. Others may consider hormone therapy a temporary solution for managing the menopause transition and look to other medications for osteoporosis later on.
Osteoporosis does not typically cause symptoms, and a person may not realize that they have it until they fracture a bone.
To detect bone loss early, the National Osteoporosis Foundation recommends contacting a doctor about a bone density test. People can ask about this if they:
- have chronic back pain
- are going through menopause
- are over 50 years old and have fractured or broken a bone
- are female and over 65 years old
- are a male and over 70 years old
- have lost more than half an inch of height in 1 year
Certain underlying conditions, dietary restrictions or deficiencies, and medications can also affect bone health. People with any concerns can ask a doctor about their risk.
Estrogen is a key part of metabolism that promotes the activity of osteoblasts, which are cells that make bone.
When a person has low levels of estrogen, they have an increased risk of osteoporosis and fractures. People can prevent bone loss with lifestyle changes and, if appropriate, with medication.