by Jackie Hart, MD
Q: Is there an alternative to estrogen therapy to minimize bone loss after menopause? I already have osteopenia and cannot take hormone replacement due to blood clots.
A: There are several options for women like you who are unable, for medical reasons in particular, to take hormone replacement therapy after menopause. The best measures, in lieu of estrogen therapy, for minimizing bone loss include the following:
Engage in regular strength training. Focus particularly on the upper body to help prevent bone loss at the spine. An excellent guide to initiating and maintaining an exercise program is Strong Women Stay Young by Miriam E. Nelson, PhD.
Avoid use of large amounts of alcohol. Drinking more than two drinks per day may increase the risk of falling and is associated with lower bone density.
Increase your calcium intake. Since you already have signs of bone loss with osteopenia, strive for 1500 milligrams of calcium per day:
Take calcium supplements with magnesium in a ratio of 1:1 or 2:1 in divided doses two to three times per day (for example, 1200 milligrams of calcium and 600 milligrams of magnesium or 1200 milligrams of each). I recommend calcium citrate over calcium carbonate because the former is more readily absorbed.
Increase your dietary calcium intake, specifically from non-dairy foods such as broccoli, Brussels sprouts, salmon, beans, and legumes (particularly soy). The animal protein in dairy products may enhance loss of calcium in the urine.
Take 200 to 400 IU vitamin D per day to increase calcium absorption.
Eat soy products. Soy is rich in isoflavones, a class of phytoestrogens believed to promote bone health (phytoestrogens are natural plant-based compounds with several estrogen-like activities but without many of the risks):
Try to eat two to three servings of soy per day. Choose from tofu, tempeh, miso, soy milk, textured vegetable protein, and fresh soy beans. (Note: although it may have other health-promoting effects, soy sauce does not contain isoflavones).
For now, avoid the synthetic version of isoflavones that are available in supplement form called ipriflavone. Animal and human studies suggest that ipriflavone builds bone, but long-term safety and efficacy have not yet been established. A research trial presently underway in Europe will likely provide more definitive advice in the next couple of years.
Talk to your doctor or health care provider about the risks and benefits of other medications. Your options include:
Bisphosphonates, such as alendronate.
Selective estrogen receptor modulators (SERMs), such as raloxifene. The SERMs, though, cannot be used if you have a history of blood clots.
Calcitonin, which may be indicated if you already have osteoporosis.
Monitor your progress. Discuss with your doctor or health care provider the possibility of using annual bone density studies to evaluate how well your anti-bone loss program is protecting you.
Other less proven measures to consider are a vitamin B complex supplement and magnet therapy. The theory behind magnet therapy for osteopenia or osteoporosis is that electromagnetic fields affect the growth of bone and cartilage. Neither of these methods, however, are as well established as those outlined above.
Q: Is there an alternative to estrogen therapy to minimize bone loss after menopause? I already have osteopenia and cannot take hormone replacement due to blood clots.
A: There are several options for women like you who are unable, for medical reasons in particular, to take hormone replacement therapy after menopause. The best measures, in lieu of estrogen therapy, for minimizing bone loss include the following:
Engage in regular strength training. Focus particularly on the upper body to help prevent bone loss at the spine. An excellent guide to initiating and maintaining an exercise program is Strong Women Stay Young by Miriam E. Nelson, PhD.
Avoid use of large amounts of alcohol. Drinking more than two drinks per day may increase the risk of falling and is associated with lower bone density.
Increase your calcium intake. Since you already have signs of bone loss with osteopenia, strive for 1500 milligrams of calcium per day:
Take calcium supplements with magnesium in a ratio of 1:1 or 2:1 in divided doses two to three times per day (for example, 1200 milligrams of calcium and 600 milligrams of magnesium or 1200 milligrams of each). I recommend calcium citrate over calcium carbonate because the former is more readily absorbed.
Increase your dietary calcium intake, specifically from non-dairy foods such as broccoli, Brussels sprouts, salmon, beans, and legumes (particularly soy). The animal protein in dairy products may enhance loss of calcium in the urine.
Take 200 to 400 IU vitamin D per day to increase calcium absorption.
Eat soy products. Soy is rich in isoflavones, a class of phytoestrogens believed to promote bone health (phytoestrogens are natural plant-based compounds with several estrogen-like activities but without many of the risks):
Try to eat two to three servings of soy per day. Choose from tofu, tempeh, miso, soy milk, textured vegetable protein, and fresh soy beans. (Note: although it may have other health-promoting effects, soy sauce does not contain isoflavones).
For now, avoid the synthetic version of isoflavones that are available in supplement form called ipriflavone. Animal and human studies suggest that ipriflavone builds bone, but long-term safety and efficacy have not yet been established. A research trial presently underway in Europe will likely provide more definitive advice in the next couple of years.
Talk to your doctor or health care provider about the risks and benefits of other medications. Your options include:
Bisphosphonates, such as alendronate.
Selective estrogen receptor modulators (SERMs), such as raloxifene. The SERMs, though, cannot be used if you have a history of blood clots.
Calcitonin, which may be indicated if you already have osteoporosis.
Monitor your progress. Discuss with your doctor or health care provider the possibility of using annual bone density studies to evaluate how well your anti-bone loss program is protecting you.
Other less proven measures to consider are a vitamin B complex supplement and magnet therapy. The theory behind magnet therapy for osteopenia or osteoporosis is that electromagnetic fields affect the growth of bone and cartilage. Neither of these methods, however, are as well established as those outlined above.