7 ms·

This is great. But, the root of the problem for most postmenopausal women is simply the lack of estrogen. You need estrogen to make bone. Men and women do. Men

This is great. But, the root of the problem for most postmenopausal women is simply the lack of estrogen. You need estrogen to make bone. Men and women do. Men are mostly protected from osteoporosis because they convert testosterone to estrogen. Elderly men have more estrogen than postmenopausal women. Their levels go to near zero. It's a tragedy that more doctors don't recommend HRT for older women, at least some level of replacement, maybe not up to peak levels when they were younger. The lack of estrogen causes a lot of suffering.

ravenstine 2y ago
Men are also more likely to do strength training, which also helps build bone density. Women are also more likely to regularly perform cardio/aerobic exercises, which can reduce bone density when done in excess and without adequate nutrition. Lack of estrogen is of course the root, but I think we can't dismiss behavior differences contributing to the effect. In my experience, many women do minimal to no strength training because they're worried that muscle tone will make them look masculine. Maybe this is a really bad idea to live by.
- amelius 2y ago
  > Women are also more likely to regularly perform cardio/aerobic exercises, which can reduce bone density when done in excess and without adequate nutrition. What is the biological mechanism behind this statement?
  - ravenstine 2y ago
    Elevated cortisol (in response to the stress of running or whatever) increases bone resorption and inhibits bone growth. This isn't necessarily an issue for anyone doing lots of cardio, but it's an increase in risk. It also reduces protein synthesis, which is important for both muscle and bone (it isn't just calcium).
    - magicalist 2y ago
      > Elevated cortisol (in response to the stress of running or whatever) increases bone resorption and inhibits bone growth Cortisol is also released during strength training, though. Seems like a real issue is low impact cardio, which isn't negative for bone density (as far as I can tell) but does have a theoretical opportunity cost when you could be doing weight-bearing cardio, which does improve bone density. Agreed with littlestymaar's comment higher up, though, that exercise rates being what they are, the theoretical opportunity cost may be quite theoretical.
      - hprotagonist 2y ago
        > Cortisol is also released during strength training, though. more than compensated for by the compressive loading signals from lifting heavy.
        ambicapter 2y ago
        How do compressive loading signals compensate for cortisol production? Seems like one is a nerve signal and the other is a hormone?
        digdugdirk 2y ago
        The previous post was referring to the overall bone density change. The skeletal loading from strength training is a stronger signal for bone density increase vs the negative impact on bone density from increased cortisol production.
    - ben_w 2y ago
      > Elevated cortisol … increases bone resorption and inhibits bone growth Would that also be true for caffeine consumption? IIRC it increases cortisol levels, but I don't really know much about what else it does, I've only read the Wikipedia page and gone "Wow, I'm really glad I've already cut back".
      - 2y ago
- littlestymaar 2y ago
  This may be true, but it's not really relevant. Most people don't do training at all, especially past 50 yo, where bone density declines in women. (And that's a significant issue in itself)
- piombisallow 2y ago
  Estrogen replacement increases the risk of cancer in women.
  - kridsdale1 2y ago
    This is not accurate and is the result of a misinterpretation of the Women’s Health study of the 2000s. It’s much more complicated. The specific type of molecule matters.
    - bsder 2y ago
      Citation. Breast cancer dropped with a step function when HRT was stopped in general for meopausal women. I haven't seen any studies to the contrary.
      - digdugdirk 2y ago
        Did a quick search and found this one: https://evidence.nihr.ac.uk/alert/risk-of-breast-cancer-with-hrt-depends-therapy-type-and-duration/ https://evidence.nihr.ac.uk/alert/risk-of-breast-cancer-with... Could be worth a look? I didn't dive into the study itself, but it seems decent at a glance.
        bsder 2y ago
        The studies all say that HRT increases the cancer risk, sometimes significantly. Yes, there are differences in type of HRT, but all of them create a signficantly elevated risk. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)14065-2/abstract https://www.thelancet.com/journals/lancet/article/PIIS0140-6... https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Spreading incorrect information about this is bad as HRT is likely to be a difficult choice for a woman. HRT can help alleviate serious menopausal symptoms like depression or mental illness at the cost of an elevated cancer risk. Downplaying the risks is likely to cause a lot of women to make choices that they regret seriously later on.
  - 2y ago
- hyperthesis 2y ago
  Read of a study years ago that had postmenopausal wpmen do weight training - giving a dramatic 40% increase in bone density in 6 weeks IIRC the details. It's not that frail people need to be inactive, but that inactivity causes frailty.
  - alecst 2y ago
    I'd like to see that, the studies I've seen show around 1-5% per year.
    - scott_w 2y ago
      Is that trained or untrained? "Newbie gains" is a real thing, mostly caused by people going from a negative health state to a "normal" health state (or inactivity to basic activity). I can see a rapid increase in untrained people but more marginal increases in trained people because of this.
      - arcticbull 2y ago
        I was under the impression newbie gains were more attributable to better neuromuscular and connective tissue adaptation rather than something that can lead to bone growth. You can gain like 2-4lbs of muscle per month in that phase, and a disproportionate amount of strength. A 40% increase in bone density over 6 weeks sounds like someone’s DEXA scanner is broken. Bones just don’t change that quickly.
        scott_w 2y ago
        Is there a case of bone density being "too low" in some sense that can cause it to go up more quickly? Maybe it's not the bones themselves but something the DEXA scanner picks up that looks like bone growth?
- safety1st 2y ago
  > many women do minimal to no strength training because they're worried that muscle tone will make them look masculine. I've observed this as being a very widespread belief too, and it seems like we need to be giving women a better biology education or something, because holy shit is it wrong. I guess it's more a misconception among the general non weight training public that this stuff is so easy you can basically develop a muscular, masculine body on accident. For all but the youngest and most genetically blessed males it takes years of very specific diet and exercise regimes. Or steroids. Whereas just adding some weighted squats into her routine will have immense health benefits for most women as well as making their body look more feminine and attractive.
  - sapphicsnail 2y ago
    Men could also stop policing women's bodies and activities. I have had my doctor tell me to do load-bearing exercises but I've also heard men mock not just masculine-looking women, but women who are interested in male-coded activities like weight lifting.
    - lupusreal 2y ago
      I wager more men like it than men who mock it. Sports Illustrated is popular for a reason, fit women being considered attractive is very mainstream. There will always be a few assholes that will mock anybody for anything, but what can anybody do about that?
    - erklik 2y ago
      Far more men like women with good-looking fit bodies. It's a statistically insignificant minority that likes "fat women", so "men" overall aren't policing women's bodies to the point of influencing women to not go to the gym. It's largely women who do it to each other.
      - DiscourseFan 2y ago
        >It’s a statistically insignificant minority that likes “far women” Well, I’m not sure if that’s true, many men like “curvy” women, but generally even they are regularly working out. It would be more accurate to say that men dislike unhealthy women. But then you could say the same thing about men.
- throwaway2037 2y ago
  > they're worried that muscle tone will make them look masculine Yes, this is a common concern. It would be good to show women what it looks like to workout hard six days a week for more than one year. (My point: That is an unrealistic weight lifting schedule for 99% of women.) They still won't look very masculine. Very well toned, but not very masculine. My advice when women raise this concern: "If you get too big, just ease off. Maintaining is way easier than growing."
  - Beretta_Vexee 2y ago
    https://brokenclipboard.wordpress.com/2016/02/08/media-coverage-of-female-olympians/ https://brokenclipboard.wordpress.com/2016/02/08/media-cover... It's been done. It doesn't matter that you can't see the abs on 50% of the women on the Olympic team. Some think they'll get the physique of a professional body builder who's been abusing steroids for a decade anyway.
    - cs02rm0 2y ago
      Steroids have a lot to answer for when it comes to perceptions around exercise in general.
    - drakonka 2y ago
      Anecdotally, I have never heard this sentiment from other women I know. That doesn't mean they aren't _thinking_ it, though. Maybe it also depends on location - where I live it is very common for both men and women to do some form of strength training. I've been lifting weights on and off for over a decade and although I do have visible abs, that's more by nature of low body fat percentage than lifting. The point is - no matter how hard I train, I've never even gotten close to what I would consider as "too big" for my preference. Even as your muscle mass increases, the end result just seems to be a more _compact_ and efficient look rather than "bulky" in any sense of the word.
      - Beretta_Vexee 2y ago
        The more you get to know athletes, the more you realize the reality of the physiques of both strength and endurance athletes. The same applies to cardio, where the general population over-estimates the calories burned and imagines that all runners will become skeletons.
apwell23 2y ago
> . It's a tragedy that more doctors don't recommend HRT for older women, at least some level of replacement Once you get on this your only options are 1. use till you die 2. stop and face consequences of suppressed natural estrogen production from HRT. Is that right?
- ambicapter 2y ago
  Is their natural estrogen production not already suppressed from menopause?
  - apwell23 2y ago
    sure but wouldn't HRT suppress whats remanning? Otherwise you are just getting free biological lunch.
    - Auracle 2y ago
      I’m no expert but I don’t believe it’s similar to testosterone in that it could be suppressed for life after doing replacement therapy.
- landryraccoon 2y ago
  "Use it till you die" seems like less and less of a penalty the older you get.
Abishek_Muthian 2y ago
When I was 32 I had a sudden cerebral spine fracture, I was diagnosed as having severe Osteoporosis(I was told my bones were like that of 80 year old); The doctors didn't bother much as I was living with Achondroplasia (Dwarfism) and they attributed everything to it. I'm on bisphosphonate treatment (zoledronic acid), I've already had 5 of those injections and I recently learnt that it could lead to severe side effects and not that effective for treating Osteoporosis. Meanwhile I underwent a genetic testing and the result came out as I have COMP8 mutation which leads to Multiple epiphyseal dysplasia or Pseudo-achondroplasia; Both of which affects bones to different extent and I have symptoms for both. I'm now looking for treatments which can help improve my bone density or at-least prevent further deterioration, CCN3 looks really promising. I even started a project to monitor bone health using BMD (Dexa) reports[1] and to submit reports for research (I'm looking for researchers in this area). 1 in 3 women over the age of 50 years and 1 in 5 men will experience osteoporotic fractures in their lifetime, According to this article more than 200 million people worldwide suffer from osteoporosis but I feel investment in bone health research is not enough. [1] https://bonehealthtracker.com/ https://bonehealthtracker.com/
a2tech 2y ago
I sit in a lot of doctor training sessions and the feelings on hrt have changed a lot in the last 5-10 years. It’s now well thought of and an acceptable risk. Apparently the quality of life improvement is huge compared to the relatively minor risk
- adamc 2y ago
  Although I knew a woman who had breast cancer and a consequence was taking her off HRT. Which she was dreading.
  - mrmuagi 2y ago
    I saw this recent video on a similar topic (prostate cancer and testerone/TRT considerations) [1], and bookmarked it for later. Not knowledgeable to speak further on it though. [1] https://www.youtube.com/watch?v=fiVCsm4dNh0 https://www.youtube.com/watch?v=fiVCsm4dNh0
    - apwell23 2y ago
      If testosterone causes PC then men in their teens and 20s would be the most likely candidates to suffer from it. But PC is almost always a disease of old age .
      - tum92 2y ago
        Estrogen exposure is a significant risk factor for endometrial cancer, which most commonly occurs in post-menopausal women. It’s a cumulative effect, as are many other things. Not a comment on the parent post, just highlighting that biology is not so straight forward.
      - adrianN 2y ago
        It is my understanding that excess testosterone can take prostate cancer from „it grows so slowly you’ll die of something else first“ to something that kills you quickly.

ravenstine 2y ago

Men are also more likely to do strength training, which also helps build bone density. Women are also more likely to regularly perform cardio/aerobic exercises, which can reduce bone density when done in excess and without adequate nutrition. Lack of estrogen is of course the root, but I think we can't dismiss behavior differences contributing to the effect. In my experience, many women do minimal to no strength training because they're worried that muscle tone will make them look masculine. Maybe this is a really bad idea to live by.

amelius 2y ago
> Women are also more likely to regularly perform cardio/aerobic exercises, which can reduce bone density when done in excess and without adequate nutrition. What is the biological mechanism behind this statement?
- ravenstine 2y ago
  Elevated cortisol (in response to the stress of running or whatever) increases bone resorption and inhibits bone growth. This isn't necessarily an issue for anyone doing lots of cardio, but it's an increase in risk. It also reduces protein synthesis, which is important for both muscle and bone (it isn't just calcium).
  - magicalist 2y ago
    > Elevated cortisol (in response to the stress of running or whatever) increases bone resorption and inhibits bone growth Cortisol is also released during strength training, though. Seems like a real issue is low impact cardio, which isn't negative for bone density (as far as I can tell) but does have a theoretical opportunity cost when you could be doing weight-bearing cardio, which does improve bone density. Agreed with littlestymaar's comment higher up, though, that exercise rates being what they are, the theoretical opportunity cost may be quite theoretical.
    - hprotagonist 2y ago
      > Cortisol is also released during strength training, though. more than compensated for by the compressive loading signals from lifting heavy.
      - ambicapter 2y ago
        How do compressive loading signals compensate for cortisol production? Seems like one is a nerve signal and the other is a hormone?
        digdugdirk 2y ago
        The previous post was referring to the overall bone density change. The skeletal loading from strength training is a stronger signal for bone density increase vs the negative impact on bone density from increased cortisol production.
  - ben_w 2y ago
    > Elevated cortisol … increases bone resorption and inhibits bone growth Would that also be true for caffeine consumption? IIRC it increases cortisol levels, but I don't really know much about what else it does, I've only read the Wikipedia page and gone "Wow, I'm really glad I've already cut back".
    - 2y ago
littlestymaar 2y ago
This may be true, but it's not really relevant. Most people don't do training at all, especially past 50 yo, where bone density declines in women. (And that's a significant issue in itself)
piombisallow 2y ago
Estrogen replacement increases the risk of cancer in women.
- kridsdale1 2y ago
  This is not accurate and is the result of a misinterpretation of the Women’s Health study of the 2000s. It’s much more complicated. The specific type of molecule matters.
  - bsder 2y ago
    Citation. Breast cancer dropped with a step function when HRT was stopped in general for meopausal women. I haven't seen any studies to the contrary.
    - digdugdirk 2y ago
      Did a quick search and found this one: https://evidence.nihr.ac.uk/alert/risk-of-breast-cancer-with-hrt-depends-therapy-type-and-duration/ https://evidence.nihr.ac.uk/alert/risk-of-breast-cancer-with... Could be worth a look? I didn't dive into the study itself, but it seems decent at a glance.
      - bsder 2y ago
        The studies all say that HRT increases the cancer risk, sometimes significantly. Yes, there are differences in type of HRT, but all of them create a signficantly elevated risk. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)14065-2/abstract https://www.thelancet.com/journals/lancet/article/PIIS0140-6... https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Spreading incorrect information about this is bad as HRT is likely to be a difficult choice for a woman. HRT can help alleviate serious menopausal symptoms like depression or mental illness at the cost of an elevated cancer risk. Downplaying the risks is likely to cause a lot of women to make choices that they regret seriously later on.
- 2y ago
hyperthesis 2y ago
Read of a study years ago that had postmenopausal wpmen do weight training - giving a dramatic 40% increase in bone density in 6 weeks IIRC the details. It's not that frail people need to be inactive, but that inactivity causes frailty.
- alecst 2y ago
  I'd like to see that, the studies I've seen show around 1-5% per year.
  - scott_w 2y ago
    Is that trained or untrained? "Newbie gains" is a real thing, mostly caused by people going from a negative health state to a "normal" health state (or inactivity to basic activity). I can see a rapid increase in untrained people but more marginal increases in trained people because of this.
    - arcticbull 2y ago
      I was under the impression newbie gains were more attributable to better neuromuscular and connective tissue adaptation rather than something that can lead to bone growth. You can gain like 2-4lbs of muscle per month in that phase, and a disproportionate amount of strength. A 40% increase in bone density over 6 weeks sounds like someone’s DEXA scanner is broken. Bones just don’t change that quickly.
      - scott_w 2y ago
        Is there a case of bone density being "too low" in some sense that can cause it to go up more quickly? Maybe it's not the bones themselves but something the DEXA scanner picks up that looks like bone growth?
safety1st 2y ago
> many women do minimal to no strength training because they're worried that muscle tone will make them look masculine. I've observed this as being a very widespread belief too, and it seems like we need to be giving women a better biology education or something, because holy shit is it wrong. I guess it's more a misconception among the general non weight training public that this stuff is so easy you can basically develop a muscular, masculine body on accident. For all but the youngest and most genetically blessed males it takes years of very specific diet and exercise regimes. Or steroids. Whereas just adding some weighted squats into her routine will have immense health benefits for most women as well as making their body look more feminine and attractive.
- sapphicsnail 2y ago
  Men could also stop policing women's bodies and activities. I have had my doctor tell me to do load-bearing exercises but I've also heard men mock not just masculine-looking women, but women who are interested in male-coded activities like weight lifting.
  - lupusreal 2y ago
    I wager more men like it than men who mock it. Sports Illustrated is popular for a reason, fit women being considered attractive is very mainstream. There will always be a few assholes that will mock anybody for anything, but what can anybody do about that?
  - erklik 2y ago
    Far more men like women with good-looking fit bodies. It's a statistically insignificant minority that likes "fat women", so "men" overall aren't policing women's bodies to the point of influencing women to not go to the gym. It's largely women who do it to each other.
    - DiscourseFan 2y ago
      >It’s a statistically insignificant minority that likes “far women” Well, I’m not sure if that’s true, many men like “curvy” women, but generally even they are regularly working out. It would be more accurate to say that men dislike unhealthy women. But then you could say the same thing about men.
throwaway2037 2y ago
> they're worried that muscle tone will make them look masculine Yes, this is a common concern. It would be good to show women what it looks like to workout hard six days a week for more than one year. (My point: That is an unrealistic weight lifting schedule for 99% of women.) They still won't look very masculine. Very well toned, but not very masculine. My advice when women raise this concern: "If you get too big, just ease off. Maintaining is way easier than growing."
- Beretta_Vexee 2y ago
  https://brokenclipboard.wordpress.com/2016/02/08/media-coverage-of-female-olympians/ https://brokenclipboard.wordpress.com/2016/02/08/media-cover... It's been done. It doesn't matter that you can't see the abs on 50% of the women on the Olympic team. Some think they'll get the physique of a professional body builder who's been abusing steroids for a decade anyway.
  - cs02rm0 2y ago
    Steroids have a lot to answer for when it comes to perceptions around exercise in general.
  - drakonka 2y ago
    Anecdotally, I have never heard this sentiment from other women I know. That doesn't mean they aren't _thinking_ it, though. Maybe it also depends on location - where I live it is very common for both men and women to do some form of strength training. I've been lifting weights on and off for over a decade and although I do have visible abs, that's more by nature of low body fat percentage than lifting. The point is - no matter how hard I train, I've never even gotten close to what I would consider as "too big" for my preference. Even as your muscle mass increases, the end result just seems to be a more _compact_ and efficient look rather than "bulky" in any sense of the word.
    - Beretta_Vexee 2y ago
      The more you get to know athletes, the more you realize the reality of the physiques of both strength and endurance athletes. The same applies to cardio, where the general population over-estimates the calories burned and imagines that all runners will become skeletons.

apwell23 2y ago

> . It's a tragedy that more doctors don't recommend HRT for older women, at least some level of replacement Once you get on this your only options are 1. use till you die 2. stop and face consequences of suppressed natural estrogen production from HRT. Is that right?

ambicapter 2y ago
Is their natural estrogen production not already suppressed from menopause?
- apwell23 2y ago
  sure but wouldn't HRT suppress whats remanning? Otherwise you are just getting free biological lunch.
  - Auracle 2y ago
    I’m no expert but I don’t believe it’s similar to testosterone in that it could be suppressed for life after doing replacement therapy.
landryraccoon 2y ago
"Use it till you die" seems like less and less of a penalty the older you get.

Abishek_Muthian 2y ago

When I was 32 I had a sudden cerebral spine fracture, I was diagnosed as having severe Osteoporosis(I was told my bones were like that of 80 year old); The doctors didn't bother much as I was living with Achondroplasia (Dwarfism) and they attributed everything to it. I'm on bisphosphonate treatment (zoledronic acid), I've already had 5 of those injections and I recently learnt that it could lead to severe side effects and not that effective for treating Osteoporosis. Meanwhile I underwent a genetic testing and the result came out as I have COMP8 mutation which leads to Multiple epiphyseal dysplasia or Pseudo-achondroplasia; Both of which affects bones to different extent and I have symptoms for both. I'm now looking for treatments which can help improve my bone density or at-least prevent further deterioration, CCN3 looks really promising. I even started a project to monitor bone health using BMD (Dexa) reports[1] and to submit reports for research (I'm looking for researchers in this area). 1 in 3 women over the age of 50 years and 1 in 5 men will experience osteoporotic fractures in their lifetime, According to this article more than 200 million people worldwide suffer from osteoporosis but I feel investment in bone health research is not enough. [1] https://bonehealthtracker.com/ https://bonehealthtracker.com/

a2tech 2y ago

I sit in a lot of doctor training sessions and the feelings on hrt have changed a lot in the last 5-10 years. It’s now well thought of and an acceptable risk. Apparently the quality of life improvement is huge compared to the relatively minor risk

adamc 2y ago
Although I knew a woman who had breast cancer and a consequence was taking her off HRT. Which she was dreading.
- mrmuagi 2y ago
  I saw this recent video on a similar topic (prostate cancer and testerone/TRT considerations) [1], and bookmarked it for later. Not knowledgeable to speak further on it though. [1] https://www.youtube.com/watch?v=fiVCsm4dNh0 https://www.youtube.com/watch?v=fiVCsm4dNh0
  - apwell23 2y ago
    If testosterone causes PC then men in their teens and 20s would be the most likely candidates to suffer from it. But PC is almost always a disease of old age .
    - tum92 2y ago
      Estrogen exposure is a significant risk factor for endometrial cancer, which most commonly occurs in post-menopausal women. It’s a cumulative effect, as are many other things. Not a comment on the parent post, just highlighting that biology is not so straight forward.
    - adrianN 2y ago
      It is my understanding that excess testosterone can take prostate cancer from „it grows so slowly you’ll die of something else first“ to something that kills you quickly.