Question

I am 38 years old and have already gone through the menopause. I am currently on HRT and a calcium supplement. I have had a dexa-scan and I have been rated high risk for osteoporosis. This is why I agreed to go on HRT. Is there any other alternative besides HRT? I am more concerned now with weight gain.

Answer

Given the fact that you have gone through the menopause at 38 years of age and have been told that you are at high risk for osteoporosis I would be very slow to recommend a change in your treatment. Your current treatment would generally be regarded as the treatment of choice for a woman in your situation. If you are really reluctant to continue with conventional HRT you could discuss with your doctor the option of switching to a SERM (selective estrogen receptor modulator), a gonadomimetic or a biphosphonate. All of these three categories of drugs are effective in preventing further reduction in bone mass. Calcium supplements alone are not sufficient to prevent osteoporosis although it is recommended that they be taken along with HRT and the previously mentioned drugs. The key difficulty you face is that the reduction in bone mass accelerates after the menopause. Bone is a living active structure that is constantly undergoing two parallel processes of new bone formation and bone resorption (re-absorption). New bone formation continues at a steady pace after the menopause but the rate of resorption accelerates resulting in a gradual reduction in the bone mass. Approximately 3% of bone mass is lost each year for the first 5 years after the menopause, which means that on average a menopausal woman will lose 15% of her bone mass within 5 years of her periods stopping. The key to reversing this trend is to focus on bone resorption. HRT, SERMs, gonadomimetics and biphosphonates all reduce resorption thereby reducing the risk of developing osteoporosis. Calcium supplements alone have no effect on the process of resorption therefore the rate of reduction in bone mass continues unabated.

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