The loss of estrogen production by the ovaries at menopause can have profound effects on skeletal health. Low estrogen levels in women are directly associated with lower bone mineral density and increased risk for fractures. Doctors have known this for years and in fact hormone replacement therapy (HRT) in the form of estrogen and progestin used to be the treatment of choice for postmenopausal osteoporosis. Then in 2002 the Women’s Health Initiative (WHI) study was terminated abruptly when it was discovered that HRT increased the risk of heart attack, stroke, venous blood clots, and breast cancer. With the release of these findings, patients and doctors alike became nervous about HRT and it’s use dropped significantly. In fact, the meteoric rise in bisphosphonate use in the early 2000’s owes its launch to the WHI findings.

I frequently see patients who I think would benefit from HRT. I suggest that they speak with their medical provider about low dose or ultra low dose estrogen because research indicates it is both effective and safe (unlike the higher doses used in the WHI study) for preserving bone density. If you want to learn more about HRT, I explain its use in my book, The Whole-Body Approach to Osteoporosis. Also, a review article by Sandra Sacco and Wendy Ward is certainly worth the read. Don’t let the findings of the WHI sway you from estrogen therapy (low dose, transdermal) if it is indicated.

Sandra M. Sacco and Wendy E. Ward, Revisiting estrogen: efficacy and safety for postmenopausal bone health. Journal of Osteoporosis Vol 2010, Article ID 708931.