Bone density is indicator for hormones

ON CALL

May 17, 1994|By Dr. Simeon Margolis | Dr. Simeon Margolis,Special to The Sun

Q: I have just stopped having menstrual periods and my doctor has recommended hormone replacement to reduce my risk of having fractures of my spine and hip. I am hesitant to take hormones because they may increase my chances of developing breast cancer. Is there any way to find out how much the hormones will help me?

A: A bone density measurement may help you to decide whether to begin hormone replacement. Estrogen is the most effective antidote to the rapid bone loss that occurs in the years immediately after the menopause, and you would be especially well served by estrogen replacement if your bone mass is already low. Keep in mind the impressive evidence for the benefits of estrogen on the prevention of coronary heart disease. The danger of breast cancer with hormone replacement is not entirely clear. Some studies have shown a small increase in breast cancer risk; others have shown no increase. On balance, the benefits of hormone replacement on osteoporosis and heart disease appear considerably greater than the risk of breast cancer.

A thinning out of bone mass is the major problem that precedes almost all bone fractures in older individuals, and osteoporosis, marked by fragile and weak bones, is by far the most common cause of the condition in aging. Aging and estrogen deficiency are the two major causes of osteoporosis.

Bone mass, which is about 30 percent greater in men than in women and 10 percent greater in blacks than in whites, peaks around age 35 and then declines slowly but inevitably in the following years in both men and women. The greatest threat in women is the greatly accelerated rate of bone loss after the menopause. Other risk factors for osteoporosis are a family history of osteoporosis, a delicate frame, being underweight, sedentary lifestyle, low calcium intake, high intakes of alcohol, caffeine, animal protein and smoking cigarettes.

Although the presence of one or more of these risk factors may increase a predisposition to osteoporosis, no combination allows an accurate prediction of bone mass. Fortunately, several safe techniques, termed bone densitometry, now make it possible to obtain an accurate measure of your bone mass.

A number of studies have shown that the presence of low bone mass predicts the risk of subsequent fractures.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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