Welcome to the latest episode of Rena Malik, M.D., where we delved into the crucial role of estrogen in bone and joint health.

can-estrogen-reshape-your-brain

Can Estrogen Reshape your Brain?!

let's talk about bone health now bone health is a serious issue in fact during my career I have seen the most dramatic changes in people's quality of life when they fall but let me share some numbers with you in the United States every year more than 2 million fractures occur every year because of osteoporosis that includes 700,000 vertebral fractures meaning your spine the bone column around your SP 300,000 hip fractures and 400,000 Hospital admissions now most of these fractures occur in older post-menopausal women and in women that risk of osteoporosis that causes fractures increases from 6.8% in your 50s to up to almost 35% in your 80s that's more than one in three now a fracture may not sound that serious but hip fractures are associated with a five to Eightfold increase in mortality that means that if you get a hip fracture you're likely five to eight times more likely to die within 3 months of that hip fracture than somebody else and the risk of mortality after a year is more than 20% so it is not a small thing now estrogen deficiency or loss of estrogen leads to what's called increased bone resorb I meaning that's eating up more bone your body's eating up more bone and not replacing it with osteoblasts so increased bone resorption means that your body is taking up bone and not turning it over fast enough meaning the osteoblast or the cells that create new bone can't keep up with the bone loss and this causes a gradual deterioration of multiple types of bone one is called tacular bone and that's sort of porous bone it's usually found at the ends of long bones and cortical bone which is the strong and compact type of bone that's found on the outer layer of the long bones and so it affects both of those bones and on average women experience an annual loss meaning every year 2% loss of bone mass starting 1 to three years before menopause and Lasting for 5 to 10 years now during the menopause transition that bone loss is significantly more there's an average loss of 10 to 12% in the spine and hip and after that it sort of slows down to about half a percent per year but by the age of 80 the average woman has lost 30% of her Peak bone mass 30% that is a lot of lost bone so when you're thinking about screening for bone health we use a test that measures bone mineral density and it's called a dual energy x-ray absorb deometry and it's generally recommended for all women age greater than or equal to 65 and if you're below 65 60 to 64 for example you want to use something called a fra estimate that would put your risk of a fracture particularly a 10-year risk of fracture at the same age as a 65 year-old so how do you know if you're at risk well you may have had multiple fractures before but essentially talk to your doctor and use this online tool called the fra tool I'll put it in the description below and the show notes specifically it measures the 10year probability of having a fracture particularly in the hip the spine the forearm or the shoulder so there's other things that you might do that actually put you at risk too including smoking and even drinking in fact the relative risk of fracture in a postmenopausal woman who smokes increases by 30% % that's independent of bone mineral density and in terms of alcohol if you consume three servings of alcohol daily that's associated with a 38% risk increase in osteoporotic fractures and 68% increase in Hip fractures generally estrogen therapy is recommended for bone health in terms of prevention so when we looked again at the women's health initiative which is the largest study we have on hormone therapy it has its flaws but we're not going to talk about those today that used estrogen progesterone together so they had reduced vertebral and hip fractures by 34% in the low fracture risk population So based on this and a number of other studies using oral or transdermal meaning patches or gels of estrogen are approved for the prevention of osteoporosis and particularly in young post-menopausal women so the women who are within the first 10 years of going under menopause now systemic estrogen with or without progestin and the reason you take progestin or progesterone is if you have a uterus to protect yourself from endometrial cancer it effectively prevents bone loss and so it's really important to consider this as an option because it really will help you prevent those fractures and those injuries that can be really dramatic and life-changing it's also know if you start hormone therapy and then you go and stop it the benefits of it change rather quickly and in fact the bone loss occurs very fast within one to two years after stopping and your protection from fracture or any other sort of injury stops within that first year so you do need to consider other therapies if you want to help prevent injury all right the next topic is joint health so arthritis as you probably already know is really really common and in fact it is one of the most common reasons that people live with disability for years and arthritis is actually joint based pain swelling and restriction of movement due to the pain and swelling so estrogen receptors are found in all joint tissues that includes the articular cartilage the subchondral bone and the cium those are all parts of the joint so to start off estrogen actually plays an important role in promoting cartilage growth and preventing its breakdown in fact researchers have looked at knee joint MRIs of women who are on hormone therapy and they've actually noticed increased cartilage on their MRIs after going on hormone therapy so that's one way that your joints benefit from estrogen but estrogen also helps to decrease bony changes that are associated with osteoarthritis we've talked about bone health already so this is another way way that bone health is important in your joints another interesting thing about estrogen is that it has anti-inflammatory properties and in arthritis the joint damage occurs because there's inflammatory signaling Pathways that are activated but estrogen actually acts like a natural anti-inflammatory and helps mitigate some of that joint damage when you're thinking about how estrogen reduces pain there's actually a few phys ologic mechanisms first is the estrogen receptors can be found in different parts of the brain and the spinal cord specifically the dorsal root ganglion the hypothalamus the lyic system in neurons or nerve cells as well as joints now Studies have shown that estrogen therapy actually decreases what we call sinovial nerve fiber neurotropins in animal models so what that means is they're actually reducing the amount that those nerves fire and this subsequently actually reduces pain the other interesting thing is that both estrogen and testosterone have the ability to reduce pain and they do this by activating specific pain Pathways in the spinal cord so for example when estrogen levels are low like during the early phase of the menstrual cycle or day one pain and sensitivity can be heightened and menopause is a low estrogen phase so I can actually tell you a story I vividly remember I was getting laser hair treatment and I went in and one day it just hurts so much more than the other days and my doctor said to me it's probably because you're around your menses and I said you know what that's true and so it is certainly possible that menopause or having low estrogen States whether it's through natural menopause or surgical menopause can heighten your sensation of pain also as we've talked about all these changes that occur with low estrogen that include fatigue poor sleep and mood changes that we're going to talk about next can actually also work to amplify the perception of pain are

Dr.

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