HRT and bone density

[LetThereBeLove]

An excellent article about lack of bone density in menopausal women in yesterday's Observer https://www.theguardian.com/society/2024/oct/27/feel-it-in-your-bones-taking-the-pain-out-of-osteoporosis

That’s a great article OP - thanks for sharing.

I’ve had to learn quite a lot about osteoporosis over the last year having being unexpectedly diagnosed at 55.

That article is one of the simplest summaries I’ve seen.

Bump

Really good article - thanks for sharing OP. I like the well balanced focus (and evidence based) on both HRT and strength training.

Many women don’t realise they have osteoporosis until it’s too late. This combined with the fact the risks of HRT were overstated means many women are at risk of fractures and breaking bones.

It was a good article. What it made me wonder is whether you actually have to have some sort of fracture before you can get a Dexa scan? I shattered my ankle 7 years ago, really did maximum damage- it was hill walking, but even so; it was all screwed back together but nobody offered me any sort of scan or even mentioned bone density. Can you just ask for one (If you can get any contact with a GP for a start)?

I was offered a dexa scan after falling and fracturing my humerus. Normal thankfully

Can you just ask for one

@Bideshi I asked my GP when I was in my late 50s and they were happy to refer me for a dexa scan. I found that I had osteopenia (not quite osteoporosis but on the way) and started taking HRT and other supplements . A subsequent x-ray on my ankle found that I had osteoarthritis and I believe the two conditions are linked.

No you don't have to have had a fracture before having a dexa scan. If you are perimenopausal or already in the midst of the menopause, whatever your age, badger your GP for one if necessary. You should have been offered one when you shattered your ankle :-( Good luck.

womananddog I also had osteopenia and began taking HRT then my GP got infected with the scare over breast cancer and persuaded me to stop. I was under the care of the menopause clinic at Chelsea & Westminster Hospital so I had a dexa which showed my bone density had worsened in the meantime to full osteoporosis. They put me back onto HRT and the next dexa showed my bones had improved.

I got one after my dentist found reduced bone density in my jaw, GP was happy enough to order it.
Of course the hospital then lost it and I have no idea what it says!🙄

Thank you, useful article. I had some blood tests done, i wonder if bone profile:protein, calcium etc.. is useful too?

Good article

I got a Dexa scan when I was 40 after being diagnosed with early menopause. It showed moderate osteopenia and I started taking HRT.

10 years later I thought I should have a repeat scan to see if my bones had got weaker. I asked my GP and was told 'no, you won't get another scan unless you have a fracture'. I paid to get one privately. It showed the osteopenia was worse now. The necks of my femurs were -1.9 and -2.2. Osteoporosis starts at -2.6.

So I am still on the HRT and trying to use vitamins, diet and trying to build bone in the gym but after reading that article I don't think I am doing high enough weights.

I do think we need to lift heavy weights - so ones that you can only lift about 7 reps of. I had a stress reaction in my femur (I run and overdid it a bit but not loads!) and I’ve been advised to lift much heavier weights. If the muscles attached to the bones are strong then that helps strengthen them.

Also had calcium and vitamin D checked but they were fine. I’m pushing for a Dexa scan so will see what that says.

I am not sure if every council does this, but I have been referred by my GP and now have very subsidised gym membership for a year. It includes some 1:1 guidance from a PT - my PT seems quite knowledgeable about osteoporosis and exercise

Bone density increases in your 20s and 30s with good diet and weight bearing exercise. Bone density measurement (DEXA scan)is compared against average 30 yr old so if you have built up good bone density then it takes longer for osteoporosis to develop
what we need to be doing is encouraging young women to optimise their bone density by exercising regularly ( weight bearing) so their natural bone density loss that happens from mid 30s has a much higher starting point.
All the treatments are really closing the stable door after the horse has bolted.
In addition poor diet and restrictive diets affect bone density. Most individuals with eating disorders may already be osteopenic in their early 20s
We are targeting the wrong age groups.

Interesting article, thanks for sharing.

It's notable that the article reflects the relevance of testosterone when the only NHS prescribing criteria is lack of libido 🙄

Thanks for sharing OP. This is one of the best articles I’ve read about this topic and useful to have the link to the risk checker too.

Slightly related question - i’ve just had a “low calcium” result from a general blood-test. Would this be related to an increased bone density risk? My mum has bad osteoarthritis, but i’m not quite a candidate for HRT yet so keen to stay on top of it.
(yes, obvs i’m going to speak to a doctor, but not for 4 weeks, so curious).

I would like to have a dexa scan at some point (am 49 now) as my dad had osteoporosis in his 60s and he always lifted weights and was fit, though my mum hasn't had it at all and is 85 now. I do lift weights and am fit, but take more after my dad with low resting heart rate and low BP, and muscular limbs (even as a kid, long before I did weights) He also had low thyroid, I've had mine checked and it was normal.

I do already take oestrogen and progesterone in the combined pill, but will switch to HRT next year.

Thanks. I've been going to the gym for 30 years - but then so did my dad from his teens and lifted heavy and he still had osteoporosis in his 60s.

There are also some drugs that cause osteoporosis. Currently men who are put onto oral steroids are now given bisphosphates routinely. Hormone blockers used in prostate cancer can also cause bone loss. There are plenty of chronic diseases that cause bone loss along with drugs and dietary problems.
But also there is a lot of evidence that osteoporosis has a genetic component. The aging process is genetically determined, we age at different rates despite environmental factors.
Osteoporosis in men is not as common as in women, HRT ( oestrogen & progesterone ) would be inappropriate in men and probably ineffective. Testosterone is more appropriate but like HRT in women it may not be possible if HR+ prostate cancer is a risk.