Journal / Hormone Replacement Therapy

HRT as an Effective Option For Prevention of Osteoporosis

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

HRT as an Effective Option For Prevention of Osteoporosis

An Overview: Osteoporosis

Our bone strength isn’t something that we typically spend time thinking about, but we should. Osteoporosis is when your bones become brittle and fragile – typically as a result of hormonal changes. Osteoporosis prevention can help with the bone loss that you were able to keep up within your 30s. That’s when you produced bone faster than you lost it, but once you hit 40 you need to work to prevent osteoporosis and think about treatment for osteoporosis.1 

Prevention of osteoporosis is critical because as we age bone breaks can lead to substantial problems. Effective osteoporosis treatment includes hormone replacement therapy (HRT). Doing this early means that when you do lose bone later on in life, you have enough reserve to avoid your bones getting dangerously fragile.

Aging predisposes women to osteoporosis due to declining estrogen levels. By the time you hit perimenopause (the late 30s and 40s), you can expect your bone loss to increase significantly. With age, estrogen continues to drop and that’s why you are more likely to suffer from osteoporosis or other bone-related issues later in life.2 By the time you are postmenopausal if you did not use HRT, you may have significant bone loss. 

Bone fractures at any age are bad, but as we age these breaks can lead to substantial morbidity and mortality and are considered one of the largest public health priorities by the World Health Organization.4 Menopausal women need to receive appropriate guidance for the prevention and management of osteoporosis. This review will focus on the prior and current studies for various HRT formulations used for the prevention and treatment of osteoporosis.

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How to Prevent Bone Loss

There are various forms of effective treatments for osteoporosis. The most effective appears to be HRT. Hormone replacement therapy (HRT) at different doses can rapidly normalize turnover, preserve bone mineral density, and lead to a significant reduction in bone breaks and fractures.2-4

  1. Hormone Replacement Therapy (HRT) to prevent osteoporosis is commonly prescribed. HRT is a medication prescribed to women as they age and start perimenopause. It is also used for women going through menopause to relieve menopausal symptoms, prevent bone loss, and treat osteoporosis.

    In your 30s, estrogen levels decrease with perimenopause and cause many women to develop symptoms like hot flushes and sweats. These are obvious symptoms of perimenopause, but the decrease in estrogen levels also causes bone loss which can lead to osteoporosis. The long-term repercussions of bone loss are far more concerning than sweating with hot flashes.

    You may want to consider taking HRT before the age of 40 when you are starting to lose the protection that estrogen gave your bones at an earlier age. As your bones become less dense, the risk of osteoporosis and broken bones increases. 

    Is HRT Safe?

    The use of HRT depends on your age, weight, medical and family history.  Strokes are a little more common in women who start using HRT when they are over 60.2,3 All the more reason to start HRT early.

    There have been many reports in the media about the risks of HRT and unfortunately, these reports have not been accurate or balanced, causing worry and confusion about long-term health risks. To be clear, HRT is a safe and effective treatment when it’s prescribed by healthcare providers. It is important to discuss the risks and benefits with your healthcare professional.

  2. Exercise: Exercise does a great job of increasing the density of your bones by increasing the amount of bone that is laid down by your body. The more you use your body and expose your bones to weight-bearing, light impact, the more your body will make the bones stronger.1-3 Running, jumping, or dancing are great ways to provide regular weight-based exercise. 

    While swimming and cycling are great for joints and cardiovascular health, especially as we age, they do not create enough impact to improve bone density and don’t prevent osteoporosis.

  3. Calcium and Vitamins D & K:  Calcium (Ca) is stored in our bones and makes our bones strong. Vitamins D and K help with Ca absorption into the blood and helps Ca to the bones. Eating Ca-rich foods and taking supplements can help ensure that you have enough of each of these vitamins and minerals.

  4. Anti-inflammatory Foods: Your body is always working to protect itself. One of the methods it uses to heal itself is inflammation. While it’s natural for your body to trigger inflammation responses, there can also be long-term inflammation due to chronic disease or being overweight. With chronic inflammation, your body isn’t able to keep up with normal bone production and osteoporosis can occur. Eating foods that have anti-inflammatory properties can be helpful. Vitamin E supplements, eating oily fish, as well as fruits and vegetables all, have anti-inflammatory properties. 

  5. Healthy Weight Being overweight can cause inflammation and can disrupt the body’s ability to strengthen bone, and can reduce bone density. Being underweight can also cause loss of bone mineral density. A normal, healthy weight is important in preventing bone loss. 

  6. Reducing Unfriendly Bone Foods  High levels of saturated fat, processed meat, salt, and sugar can cause acidity in the body that can trigger the body to release Ca from bone, and also increase inflammation. One study suggested that unhealthy eating can lead to almost half our skeletal mass of calcium being lost in urine.4,5

  7. Avoid smoking. Smoking reduces the body’s ability to absorb calcium and reduces its ability to make bone from the calcium it does absorb. As soon as smoking is stopped, the body can quickly reverse the losses.2-5


HRT is an effective, safe, and proven osteoporosis prevention and osteoporosis treatment. Prevention of osteoporosis can be found as HRT in the form of tablets, skin patches, and creams. It usually combines bioidentical estrogen and progesterone that is micronized. 

You may want to consider taking treatment for osteoporosis before the age of 40 when you are starting to lose the protection that estrogen gave your bones at an earlier age. 

Prevent osteoporosis by eating a healthy diet full of fruits and vegetables and enough protein. Finally, keep moving! The more you use your bones, the more your body will work to keep them strong. Try to do some form of light impact, weight-bearing exercise five times a week for around 30 minutes.

Menopause is a normal phase of life and there are often chronic symptoms that will appear during this time. We encourage you to look into the benefits of hormone replacement therapy to fight these symptoms. 

Bioidentical hormones as HRT can help you move through this sometimes precarious phase with grace and wellness.  Let the Winona women’s health care experts work with you to replace the missing ingredients to help you feel and stay young and healthy.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”