One unquestionable benefit of hormone replacement is the preservation and restoration of bone density. Studies have shown that it is possible for most patients to raise and improve bone density with the use of specific supplements and hormones. Both estrogen and testosterone improve bone density. Higher doses have greater effect, but lower doses will still be effective. Spinal bone density tends to improve more rapidly than hip bone density. Bisphosphonate drugs such as Fosamax, Boniva, and Actonel may increase bone density on bone scans but the quality and strength of retaining older, denser bone does not equate to stronger bone and may even increase the risk of fractures, destruction of the jawbone, and esophageal problems including trouble swallowing.
By far the most effective method of hormone replacement for increasing bone density is implantation of hormone pellets. This is because the pellets release a constant amount of hormone throughout the day, every day, for several months. There is no significant fluctuation of hormone levels. In some woman who had previously been using transdermal hormone creams, bone density increased significantly in the lumbar spine after changing to pellets.
DEXA bone density testing is the most accurate way to determine the presence of osteoporosis. It employs very low dose x-ray to assess bone thickness in the hip, lower back, and wrist, the primary areas at risk for fracture. Insurance permits testing every two years after menopause, and every year if osteoporosis is found. A T-score (a correlation with age of maximal bone density) of -2.5 or lower determines that osteoporosis is present. All women should have bone density measurements by the age of 50.
A woman should have bone density measurement at the time of menopause, or earlier if she has a fracture of the hip or spine, premature or surgical menopause, inflammatory bowel disease, treatment with steroids, or a family history of osteoporosis. Very thin women, and light-skinned women, have a higher risk of osteoporosis.
Bone density in men also responds to hormonal changes. All men with osteoporosis, with height loss, or history of vertebral, hip or wrist fracture, should have DEXA bone density testing. If bone density is low or low normal, the testosterone level should be obtained. A total testosterone level below 320 ng/dl justifies treatment with testosterone. Again, pellets are the most effective method of hormone administration, but sublingual, transdermal or intramuscular preparations are still effective. Bone density should be retested every year until a desirable result is achieved, and every two years after that.
Lifestyle factors that lower bone density are:
Nutritional supplements that raise bone density are:
The best exercises to raise bone density are walking, weight-bearing exercises, and resistance training. Bicycle riding seems to be less effective. Lifestyle measures to improve bone density should be first line therapy but hormones should be considered if no improvement is noted on Bone Density Scans.