Osteoporosis is a “silent” disease that effects millions of adults worldwide. All too often the first sign of the disease is a catastrophic fracture with potentially serious consequences. Half of adult Americans over fifty are at risk of breaking a bone due to osteoporosis! For women the risk of having a fracture is higher than the risk of having a heart attack, stroke or developing breast cancer combined. Men aren’t spared entirely either. While their risk of fracture is lower than women their risk of dying during the recovery is higher. Preventing osteoporotic fractures should be a priority for everyone at risk but sadly most with osteoporosis don’t know they have it and many that do have been told that there is not much they can do other than take medications that hopefully slow the course of the disease. Read on to learn how sex hormones in both men and women play a role in bone health and can be used as a tool to not only reduce the risk of fracture but to actually reverse bone loss.
There are three primary sex hormones in men and women. Estrogen, progesterone and testosterone play many roles in the body but each play an important role in bone health and preventing fracture. Estrogen is the most frequently recognized hormone effecting bone. Research dating back for decades has demonstrated that women on estrogen replacement after menopause had a lower risk of fracture. More recent literature paints and even more impressive picture with well designed studies showing reduction in the risk of hip fracture and spine fracture by 60% and 90% respectively. When estrogen is present it will slow down the process of bone loss. It does this through two mechanisms. First, it improves intestinal calcium absorption and secondly, suppresses bone resorption. Without estrogen for any reason including menopause bone loss increases rapidly.
Progesterone, the yin to estrogen’s yang, also has a receptor in bone. As happens elsewhere in the body progesterone acts to balance the function of estrogen in bone. Interestingly though in bone they act synergistically to both improve bone quality through different mechanisms. When progesterone is present it increases bone rebuilding. In premenopausal women progesterone rises during the luteal phase of the menstrual cycle when estrogen levels drop. This back and forth cycling is what helps to build bone to peak mass in early adulthood. Without normal cycles this production of bone fails. In post menopausal women both estrogen and progesterone levels fall to nearly zero. In premenopausal women with dysfunctional or very short cycles the progesterone effect may also be lost. Replacing estrogen when it’s lost will help slow bone loss but adding progesterone is required to help BUILD bone and can be done at any point in adulthood.
Lastly, testosterone shouldn’t be ignored here. While it does not have a direct receptor in bone deficiency IS associated with fracture. This occurs for two clear reasons. First, in both men and women testosterone is converted to estrogen. This is exclusively where men get estrogen from and this conversion should be preserved for men to maintain their bone quality. Testosterone does have a direct impact on lean muscle mass though and maintenance of muscle is critical to preventing falls and supporting longevity. When looking at testosterone levels in both men and women it MUST be measured with estrogen to monitor how much conversion is occurring. There is a sweet spot for estrogen in both sexes. Frequently men are given both testosterone and a drug to prevent the conversion to estrogen. This practice will help increase testosterone levels but may overly suppress estrogen levels and have negative consequences. Testosterone without conversion to estrogen dose NOT protect bone.
Bone health is a rarely talked about problem that effects millions of Americans. Preventing bone loss is a complex topic but understanding the role that sex hormones play in preventing and treating osteoporosis can help guide a discussion around how to best optimize hormones in men, premenopausal and post menopausal women. Nobody is immune to bone loss and in a world of worsening health, increasing toxins and failing nutrition policies more and more people are finding themselves with poor bone quality and at risk for fracture.