Estradiol and Osteoporosis

The Female Patient, 2004

The potential lethal consequences of osteoporosis are overwhelming. Estrogen is protective, but only when certain serum levels are maintained.

(which is why I recheck serum levels in all my patients after initiating therapy?)

Fitzpatrick LA. Estrogen and bone health. Female Patient. 2004 Oct;29:40-46.

Maturitas, 2000

Prospective controlled cohort trial: 2016 healthy women aged 45-58 years, all less than two years menopausal. Staying on hormone replacement for 5 years reduced total fracture risk almost 40% (RR=0.61, 95% CI: 0.39-0.97) and forearm fracture risk 76% (RR=0.24, 95% CI: 0.09-0.69)!

Maturitas. 2000 Oct 31;36(3):181-93. Hormonal replacement therapy reduces forearm fracture incidence in recent postmenopausal women ? results of the Danish Osteoporosis Prevention Study.

Journal of the American Medical Association (JAMA), 1996

A 3-year, multicenter, randomized, double-blinded, placebo-controlled clinical trial studied 875 healthy women aged 45 to 64 years:

CONCLUSIONS: Estrogen replacement therapy increases Bone Mineral Density at clinically important sites (hip and spine).

JAMA. 1996 Nov 6;276(17):1389-96. Effects of hormone therapy on bone mineral density: results from the postmenopausal estrogen/progestin interventions (PEPI) trial.

Journal of the American Medical Association (JAMA), 2003

In older women, a dosage of 0.25 mg/d of 17-beta-estradiol increased bone density of the hip, spine, and total body, and reduced bone turnover, with minimal adverse effects.

(Note: 17-beta estradiol is bio-identical estrogen.)

Prestwood KM, Kenny AM, Kleppinger A, Kulldorff M. Ultralow-dose micronized 17beta-estradiol and bone density and bone metabolism in older women: a randomized controlled trial. JAMA. 2003 Aug;290(8):1042-1048.

American Journal of Obstetrics and Gynecology, 1989

Estrogen use by postmenopausal women, especially when started within 3 years of the last menstrual period, prevents bone loss and reduces the risk of osteoporotic fractures.

Withdrawal of estrogen therapy is followed by significant bone loss, suggesting that long-term therapy is needed.

Am J Obstet Gynecol. 1989 Dec;161(6 Pt 2):1842-6. Estrogens in the prevention of osteoporosis in postmenopausal women.