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HRT and osteoporosis: 11 natural solutions

Hannah Bailey
Article written by Hannah Bailey

Date published 05 August 2019

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Hormone replacement therapy (HRT) is a commonly prescribed medication that can help manage the symptoms of menopause. Additionally, it has also been approved for the treatment of osteoporosis in women under the age of 60, whether they are going through the menopause, or are postmenopausal.

During perimenopause and menopause, oestrogen and progesterone levels drop, which can lead to hormonal changes, and HRT is prescribed to help relieve those symptoms by allowing the body to function normally again through replenishing those lost hormones. Current science at play suggests that during HRT, the body's bone density can actually increase, which helps to manage osteoporosis. The article further suggests that HRT can decrease the risk of fractures in the hips and spine in particular.

What is osteoporosis?

Osteoporosis is, essentially, brittle bones that are likely to fracture due a decrease of bony tissue. When osteoporotic bones are x-rayed, they have clear holes in them, which cause the weaknesses, and the tendency to fracture can even come from relatively small knocks. The condition is also very painful, and can be debilitating for many.

However, it's the after-effects of HRT where concern starts to creep in, and current knowledge becomes more muddled. There is no conclusive evidence to suggest that HRT continues to support bone health after the course has finished. Additionally, potential long-term side effects, such as a development of ovarian cancer, however how small the risk, are enough to cause stigma around the topic.

From around age 30, bone mineral density (BMD) begins to decrease in women. However, during menopause, the decrease in progesterone and oestrogen can accelerate the BMD decline, putting many women at risk of osteoporosis. Once it starts decreasing, the BMD can actually, however, be increased (although it is hard to show this with scans and x-rays) through treatments such as HRT - therefore, it's important to start working on maintaining your BMD as soon as you can to reduce the risk of osteoporosis. Thankfully, for women not wanting to take HRT, there are some natural solutions that also may aid in reducing that risk:

1. Exercise

Regular exercise and movement is vital in managing osteoporosis. Spending hours in the gym isn't necessary, just moving around more can be enough, for example: standing up more often can make a difference, as can shifting positions whilst lying on the sofa. Load-bearing exercises are thought to be the most beneficial, and these include activities such as: walking and stair climbing, hanging off climbing bars, and some light-weight lifting may be useful to include in your schedule. Essentially though, by keeping the body moving, and the more you keep it supple, the more beneficial it will be to your bone density.

2. Vitamin D

Natural vitamin D intake comes from being outside, therefore 20 minutes a day is considered beneficial. Additionally, if you can supplement those 20 minutes with a walk, it can help keep the body flexible and get your daily exercise done for the day.

3. Vitamin D intake in winter

By taking a vitamin D supplement between October and April, when sun exposure it at its minimum, you can replicate the benefits all year round. However, if you are going to take vitamin D supplement, it is perhaps worth taking it in conjunction with calcium (through dairy products or a calcium supplement): taking both is important for maximum absorption, as they work together within the body.

4. Calcium

Calcium is important for keeping your bones strong and healthy. Calcium-rich foods include dairy products, green leafy vegetables, nuts, and fish where you consume the bones. However, there is little evidence to suggest these aid your body in staving off osteoporosis. Whilst calcium does have important benefits in supporting bone health, it's essential to understand it can also negate the effect of other medication: therefore it is advisable to check with your doctor first should you decide to up your calcium intake via produce or a supplement.

5. Quit smoking

Cutting down on cigarettes may also help to maintain your BMD. A study on the effects smoking causes to bone mineral density found that fracture risk was significantly higher in women who smoked compared to those that didn't. The general perception surrounding smokers and osteoporosis is that smokers tend to have a poorer general health than those who don't. It is this that may be the contributing factor in smokers having an increased risk for osteoporosis.

6. Fizzy drinks

Fizzy drinks can also play a huge role in decreasing bone density. The phosphoric acid causes calcium to leach out of the bones which, in turn, makes them weaker and more susceptible to fractures. Phosphoric acid can also be found in some soft drinks as well, so it's worth checking the label. If in doubt, flavouring your own water with cucumber, mint, lemon, lime, or berries can make a great alternative.

7. Vitamin K

Current research suggests low vitamin K intake can been associated with low bone density. It actually helps to aid, in conjunction with vitamin D, cells that replace old bone with new bone. It's commonly found in dried basil, green leafy veg (kale and Brussel sprouts), chilli powder, olive oil, and dried fruits.

8. Reducing alcohol intake

Reducing your alcohol intake may help to not only improve your overall health, and make menopause easier to handle, but also improve your BMD. A review of evidence relating to alcohol and bone density found that drinking 2 or more drinks a day increased the risk of low bone mineral density. Perhaps the main reason for this is how alcohol can severely decrease the effectiveness of calcium.

Essentially, alcohol has the potential to negate all the natural solutions you are trying to help with osteoporosis: it can decrease oestrogen levels, which research suggests declines naturally during menopause - as oestrogen can help with maintaining bone health, its decrease will only challenge this.

9. Sodium and potassium

Processed foods can have a massive impact on bone health: essentially nutrient-poor foods can contain a disproportionate amount of sodium chloride in comparison to potassium, which can affect the body's metabolic levels. If the proportions of these minerals are continually imbalanced, which may be the case if your diet is poor, the kidneys may try to flush out the excess sodium.

Recent studies shows this, as a result, can also lead to a flushing out of calcium at the same time - which is integral to general bone health. Potassium-rich foods such as fresh fruit, may help to reverse this effect.

10. Caffeine

A high intake of caffeine in the elderly may cause deficiencies in mineral bone density. The reason for this is that caffeine can have a negative effect on the body's ability to absorb calcium. This, similarly to sodium, can cause the body to release calcium through urine.

11. Diet

Nutrition, like exercise, is one the most important natural ways in helping the body support its bone health. By cutting out processed foods, and cooking with a wide variety of different foods (especially vegetables) to increase your overall nutrient intake, you should gain all the natural vitamins you need for bone support.

Whenever you intend to make any lifestyle changes, whether they be dietary or physical, you should always check with your doctor first: increasing your intake of certain minerals and vitamins, whilst normally positive in their effects, may decrease the effectiveness of any additional medication you may be taking. While osteoporosis cannot be cured, as of yet, these are natural steps and changes you can make that can aid in slowing it down, and making it much more manageable.

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Hannah Bailey

About Hannah Bailey

Hannah Bailey BSc is a qualified nutritionist with a BSc in Public Health Nutrition from Sheffield Hallam University and is now studying for a Masters to become a nutritional therapist.