Why is HRT not prescribed for early osteoarthritis?

[Ziggazigahhh]

As title question. I am 43. Potentially have early osteoarthritis in hands, feet… currently being investigated. If early osteoarthritis is linked to low oestrogen, why is HRT not considered treatment?
genuine question. Dr said this briefly in my appointment and it’s only after I reflected this afterwards did I wonder why!

@Ziggazigahhh Are you confusing osteoarthritis and osteoporosis?

(Some of the posts here are.)

HRT is a prescribed treatment for the prevention or treatment of osteoporosis.
It is not a treatment for wear and tear of osteoarthritis.

If you need HRT for other symptoms, any benefit to joint pain is a bonus but it's not prescribed primarily for that.

@WearyAuldWumman OP is talking about osteo ARTHRITIS

Not osteoporosis.

Your GP is quite able to offer treatment for osteoporosis if it's been diagnosed.
They should offer HRT as it's the preferred treatment for women under 60.

Maybe see another GP or, if you can afford it, see a private specialist. A year is too long to wait . You can't delay treatment for a year- are you in England?

Its not nonsense at all, I gained significant weight on oral HRT, and lost as soon as I switched to the patches.
The risk of breast cancer is usually overstated though.

This has been my experience, and several of my friends.
I just had to keep trying different GPs.

Because there isn't consistent evidence that it helps.
www.tandfonline.com/doi/full/10.1177/20533691251403087

the word heterogeneity =~ inconsistent

Yes, I know. I was responding to the comments about medical practitioners being reluctant to prescribe HRT.

The additional sentence was there to explain why I'm taking it.

The UK is extremely behind on this and you dont usually get to see a rheumatologist in you have broken a bone by which time a lot of the harm has been done.

The Royal Osteoparosis society have good advice as do the official medical body websites in other jurisdictions. HRT is a good shout.

Thank you for your reply 😊. Yes, I'm in England, so it's an NHS GP.
The explanation for nothing being prescribed was my fracture risk being on the lower side (relatively).

I can't fund private healthcare immediately, but will research potential costs and see if £££ could be set aside for treatment.

EDIT: Noted I've misread "osteoarthritis" as "osteoporosis" 🙃

@Meteorite87 The British Menopause Society has info on their website which says that HRT is the preferred treatment for osteoporosis if they are under 60. T

I don't understand your GP saying you have a low risk.

If you have had a diagnosis of osteoporosis, you are at risk of a fracture.
Osteoporosis is a T-score of -2.5, or below. There is no such thing as low risk if you have osteoporosis.

Your bone density can/ will often drop by 3-5% annually.
That is a significant amount.

An appt with a private rheumatologist or menopause specialist will be around £250- put it on your credit card if possible rather than wait a year. You can then go back to your GP for recommended treatment.

Yes T scores were mentioned. It seems mine are a danger if I fall over, but not poor enough for "high risk" spontaneous fractures. I was told that when I asked about being prescribed alendronic acid tablets.

That price you mentioned is less than I'd estimated. I'll see about follow up costs and hopefully visit a private Dr within a few months.

Thanks so much for this

I will revisit this evening when I have some headspace. It’s not conclusive and is ‘just’ a review of existing studies…

they do list some reasons for the inconclusive data…

That seems negligent. You don't want to break a hip at 47!

The thinking now is that for someone your age, HRT is better than other drugs.

Here you are- useful info.
https://thebms.org.uk/publications/consensus-statements/prevention-and-treatment-of-osteoporosis-in-women/

Summary practice points

• Provision of adequate dietary calcium and supplemental vitamin D is usually considered a part of osteoporosis management.

• The effects of calcium and vitamin D supplements alone on fracture reduction are however not proven.

• HRT reduces the risk of both spine and hip as well as other osteoporotic fractures.

• Estrogen remains the treatment of choice for osteoporosis prevention in younger women experiencing menopause. It is especially important in those with premature ovarian insufficiency and early menopause. It should also be considered for osteoporosis prevention in women over the age of 60 who continue to benefit from HRT in terms of menopause symptom relief.

• Bisphosphonates are effective for treatment of established osteoporosis, reducing both spine and hip fractures.

• Bisphosphonates have a very long skeletal retention time and hence should be used with caution in younger postmenopausal women (e.g. those aged below 65 years).

• Denosumab is an effective treatment for reducing spine and hip fractures in osteoporotic women.

• Denosumab should be avoided in women with increased susceptibility to infections. There may be an increased risk of fractures after denosumab discontinuation. Specialist support is recommended as alternative therapies will be needed for ongoing management to avoid the risk of vertebral fracture.

• PTH, PTH receptor agonists and Romozosumab all increase bone density and result in fracture reduction but their high costs limit widespread use.

This is a good article https://www.orthopedicsri.com/blog-items/menopause-and-joint-pain-an-orthopedic-perspective/

Also - is this for real…. (From article)
Soy products: Edamame, tofu, and tempeh are all foods high in isoflavones. These mimic estrogen and may reduce menopausal joint pain symptoms.

@JinglingSpringbells Yes was not a good response by my GP.
Ah, I need to update my knowledge.
Thank you for the info + link 😊 I'll study the details tomorrow morning 🌞

@Ziggazigahhh Thank you for the shared link, I'll read all the info tomorrow too.