I have been digging to find out about osteoporosis and the conflict I have with continuing an HRT regieme. I'm 51. I was on HRT for 6 years and weaned myself off of it a year ago. My bone scan (dexascan), a few weeks ago, was above normal for my age group. My OB/GYN thinks I should take Fosamax or stay on HRT...I just kinda scratched my head. (Why fix something if it ain't broke? I understand the concept of prevention, but I think the medical community is just too gunho on this). So I've done some reading. Fosamax is hard on the stomach and I'm already taking Prevacid for Gerd.

One of the better books I've seen on the subject is OSTEOPOROSIS-HOW TO MAKE YOUR BONES LAST A LIFETIME, by Wanda S. Lyon and cynthia E. Sutton (notice they aren't doctors...). Checked it out at local library. Copyright 1993.

Some excerpts from my reading:

1. The rate of bone loss, which accelerates during menopause usually levels off to about 1 percent per year six to 10 years after menopause.

2. Researchers believe that one of the crucial ways estrogen benefits bone is that it helps keep the osteoclasts from becoming over industrious and breaking down more bone than the osteoblasts can rebuild. (In our 20's and early 30's we tear down and build at the same rate. It starts falling in our 30's, we don't build as much as we lose).

3. The greatest loss of bone mass occurs in the first four to eight years after the onset of menopause, then the rate of loss begins to decline until it levels off to the normal age-related loss rate.

4. Most osteoporosis experts believe that to maximize its positive effects on bone mass, estrogen replacement therapy should begein at the first signs of the onset of menopause, and should be combined with increased calcium intake. They also indicate that the greatest benefit occurs when estrogen is continued for FIVE YEARS OR MORE, since the greatest amount of bone loss occurs in the first seven years after menopause.

5. However, it has risks (HRT), and should be used ONLY by those women who are most likely to benefit. Bone mass measurement should play an important role in making a decision on treatment. The use of estrogen replacement therapy for reasons other than to reduce bone loss is another issue entirely.

6. Some researchers and other experts on osteoporosis go so far as to state that EXERCISE CAN ACTUALLY INCRASE BONE MASS, although definitive data is still forthcoming.

7. Recent measurements have indicated that muscle mass and bone mass are directly related. It appears that when you exercise, you have the same effect on bone that you do on muscle. ...and that most Americans probably have lower bone mass because of lack of exercise. Exercise increases the bone remodeling rate.

8. 30% of your bone is NEW bone! Less than one year old!

9. ESTROGEN does not replace lost bone mass, it just reduces further bone loss. FOSAMEX (bisphosphonates) can actually improve bone mass. It impairs the the osteoclasts'ability to break down bone. Once absorbed, these crytals (Fosamax) remain in the skeleton for many years. (Is that good or bad..). They are anti-resorptive agents. They allow the bone formation stage to continue, thereby increasing bone mass. How permanent, no one knows yet.

I guess I've come to the conclusion that I have to weigh my risk of getting osteoporosis. I've taken HRT for 6 years, I have better than average bone mass and I still exercise. I do take calcium in food and supplements. No history in my family. I'm medium boned and somewhat overweight (overweight women have more bone mass). My muscles are in good shape-no flab hanging off my arms, and I have always had a solid, muscular body. I am not high risk for this disease at this point in time. I'm going to stay OFF HRT and have another scan in a few years. I question Fosamax. Are we only hearing the good? I guess it's good if you got osteoporosis already...

Just thought I would share what I have gleaned from many books. June Lynn

But I've come to the conclusion, that there's a LOT we don't know. Maybe there's a reason why bone starts reabsorbing more as we age. Are we stopping a process that we shouldn't? Doctor's dont really know the long term effects of hormones for each individual. Especially synthetic hormones. Different groups of doctor's have different opinions, but they are AMA trained and their thinking may be skewed. But by all this I have learned and more research needs to be done.