From the Guidelines
Estrogen therapy is not recommended for the treatment of osteoporosis in women due to its association with serious harms and lack of evidence showing a reduction in fracture risk in postmenopausal women with established osteoporosis. According to the American College of Physicians guideline update 1, moderate-quality evidence showed that menopausal estrogen treatment did not reduce fracture risk in postmenopausal women with established osteoporosis. The guideline strongly recommends against using menopausal estrogen therapy or menopausal estrogen plus progestogen therapy for the treatment of osteoporosis in women (Grade: strong recommendation; moderate-quality evidence) 1.
Instead, other treatment options such as bisphosphonates (alendronate, risedronate, zoledronic acid) or denosumab are recommended to reduce the risk of hip and vertebral fractures in women with known osteoporosis 1. These medications have been shown to be effective in reducing fracture risk and have a better safety profile compared to estrogen therapy.
Key points to consider when treating osteoporosis include:
- Assessing the patient's fracture risk profile and individualizing treatment decisions based on age, fracture risk, and other health conditions
- Considering the use of calcium and vitamin D supplements as part of the treatment regimen, while being mindful of the potential risks of excess dosing
- Monitoring for potential adverse events associated with osteoporosis treatments, such as atypical subtrochanteric fracture, osteonecrosis of the jaw, and cardiovascular events.
Overall, the decision to use estrogen for osteoporosis should be made with caution and only after considering the potential benefits and harms, as well as alternative treatment options that may be more effective and safer.
From the Research
Estrogen and Osteoporosis
- Estrogen has been shown to have a positive effect on bone mineral density (BMD) in postmenopausal women, which can help prevent osteoporosis 2, 3, 4.
- Hormone replacement therapy (HRT), which includes estrogen, is a common treatment for osteoporosis in postmenopausal women 2, 3, 5.
- Studies have shown that combining HRT with other antiresorptive agents, such as bisphosphonates, can increase BMD and reduce the risk of fractures more effectively than HRT alone 2, 4.
Combination Therapies
- Combination therapies, such as HRT with bisphosphonates or calcitonin, have been shown to be more effective in increasing BMD and reducing fracture risk than single-agent therapies 2, 4.
- The addition of testosterone to estrogen therapy has also been shown to increase BMD and prevent decreases in markers of bone formation in early postmenopausal women 2.
- However, not all combination therapies have been shown to be effective, and some may have no added benefits or even lose efficacy when coadministered 2.
Other Treatment Options
- Other treatment options for osteoporosis include selective estrogen receptor modulators (SERMs), such as raloxifene, which can increase BMD and reduce fracture risk 3, 6, 5.
- Bisphosphonates, such as alendronate and risedronate, are also effective in increasing BMD and reducing fracture risk 3, 6, 5.
- Teriparatide, a recombinant human formulation of parathyroid hormone, has been shown to have a strong anabolic effect and increase BMD and reduce fracture risk 6.
- Strontium ranelate, a new divalent strontium salt, has been shown to have both anti-catabolic and anabolic effects and increase BMD and reduce fracture risk 6.