Hormone Therapy Increases Lumbar Spine Bone Mineral Density - Protects Against Bone Loss

As the population continues to age, there is greater focus on bone health and minimizing fractures to maintain mobility. A new study suggests that various types of hormone therapies not only increase lumbar spine bone mineral density (BMD) in postmenopausal women but also protect against bone loss, even after hormones have been discontinued. 

Osteoporosis is a common debilitating condition, with approximately 14 million cases in the United States alone. Characterized by decreased BMD and an increased risk of bone fragility that results in pain, fracture, and disability, it is often associated with estrogen deficiency. This explains why postmenopausal women have a greater risk of developing osteoporosis than older men.

Hormone therapy (HT), including estrogen-only and estrogen-progestogen combinations, is widely used for the prevention and management of osteoporosis, although there have been conflicting studies about the lingering benefits after the hormone use is discontinued.

In this study, which is based on real-world data from more than 6,000 postmenopausal women involved in the national Health and Nutrition Examination Survey, researchers sought to evaluate the associations of various types of hormone preparations with BMD, postmenopausal bone loss (osteopenia), and postmenopausal osteoporosis. They also explored the withdrawal effect of HT. Multiple therapies were studied, including oral contraceptive pills, estrogen-only pills, estrogen-progestogen combination pills, and estrogen-only patches.

On the basis of the results, researchers concluded that all the therapies evaluated increased lumbar spine BMD in postmenopausal women. Except for the estrogen-only patches, all forms of HT additionally provided protection against osteopenia. These benefits persisted even after the hormone preparations were discontinued. No association, however, was found between HT and osteoporosis prevalence.

Abstract

Objectives: This study aimed to evaluate the associations of hormone preparations with lumbar spine bone mineral density (BMD), osteopenia, and osteoporosis in postmenopausal women, and whether these impacts persisted after hormone preparations were discontinued.

Methods: A total of 6,031 postmenopausal women were enrolled and divided into seven groups based on the types of hormone preparations. Among them, 1,996 participants were further divided into a current users (CU) group and a past users (PU) group. Multivariable linear regression models or logistic regression models were used to evaluate the associations of hormone preparation with lumbar spine BMD, osteopenia, and osteoporosis.

Results: Combined oral contraceptive pills, estrogen-only pills, estrogen/progestin combo pills, estrogen-only patches, or the use of more than two kinds of hormone preparations were positively associated with lumbar spine BMD (all P < 0.05). Except for estrogen-only patches, other hormone preparations also had a protective effect against osteopenia (all OR < 1, all P < 0.05), but none of them were associated with osteoporosis prevalence (all P > 0.05). The BMD increased by 0.10 and 0.04 g/cm2 in the CU and PU groups, respectively, compared with the nonusers group (all P < 0.05). In both the CU and PU groups, the risk of osteopenia was reduced (OR, 0.34 and 0.57, respectively)

Conclusions: Hormone preparations increase lumbar spine BMD in postmenopausal women and exert a protective effect against osteopenia. These impacts persisted after hormone preparations were discontinued. Hormone preparations, however, were not associated with osteoporosis prevalence.

Reference

Yiran Wang, Chao Sun. Association of hormone preparations with bone mineral density, osteopenia, and osteoporosis in postmenopausal women: data from National Health and Nutrition Examination Survey 1999-2018. Menopause 2023 May 2 ;doi: 10.1097/GME.0000000000002180. Online ahead of print.

Content created May 2023