Beyond Bisphosphonates: Estrogen And SERMS

While bisphosphonates—Fosamax, Boniva, Actonel, and Reclast— are the most powerful drugs we have to combat osteoporosis, they come with a host of potential side effects. If you’re unable to deal with those side effects; and/or if your osteoporosis is mild, you may want to consider two other types of osteoporosis treatment: estrogen, and SERMs (selective estrogen receptor modulators).   

Estrogen
There are various forms of estrogen available on the market. The broader class of these drugs, known as hormone replacement therapy drugs (HRT), have been taken by millions of women to deal with the side effects of menopause, one of which is osteoporosis. The most common HRT drugs are Prempro and Premarin.

How does estrogen strengthen your bones? Basically, estrogen hinders osteoclasts, the cells that break bone down; and helps osteoblasts, the cells that build it back up. Estrogen slows the amount of bone osteoclasts can absorb; and it increases the amount of calcium osteoblasts (the “good guys”) can absorb. So bone breakdown is slowed, and the pace of bone buildup is increased.

Sounds good, right? Well, yes and no. Estrogen definitely helps slow/reverse osteoporosis. It’s also been identified as a significant breast cancer and uterine cancer risk factor. So the use of HRT for osteoporosis has declined.

Nevertheless, if you’re at very high risk for osteoporosis, your doctor may determine that the benefits of taking HRT (estrogen) may just outweigh its risks for you.

Premarin (estrogen) and Prempro (estrogen and progestin)
Is it recommended for me?
These drugs are very effective at preventing and treating osteoporosis in postmenopausal women, particularly in the 5 to 10 years just after menopause. However, the FDA does not recommend estrogen for the prevention of osteoporosis in postmenopausal women, unless the woman is at significant risk, and can’t take non-estrogen medications.

Doctors are currently recommending that women take HRT in the lowest possible dose, for the shortest possible amount of time, in order to minimize the risk of cancer. So it’s a tough balancing act: for its full benefit against osteoporosis, HRT should be taken for up to 10 years post-menopause; but taking HRT for that long increases your risk for cancer. The complicated decision to take HRT is made on an individual basis by a woman and her doctor.

How will it help me?
Estrogen builds bones all over your body, by both slowing their breakdown, and speeding their buildup; it offers equally effective protection against hip, spine, wrist, and any other type of fracture. In fact, studies show that women who take estrogen or estrogen/progestin during the first 5 to 10 years after menopause may reduce their risk of hip fracture during that timeframe by up to 50%.

When and how would I take it?
Premarin and Prempro are taken daily, in pill form. There’s no special protocol for taking them, although it’s a helpful memory aide to take them along with your daily vitamins and supplements.