The loss of hormones with menopause leads to a progressive depletion of bone calcium, most rapidly during the five years surrounding menopause. As the vertebrae develop microfractures, often without pain, women shrink and their spines bend. This deformity and loss of height are irreversible, debilitating and demoralizing. They are also unnecessary, because hormone replacement therapy maintains bone density. We have, in fact, measured frequent increases in bone density, even in women in their ninth decade of life, using bioidentical hormones in combination with exercise, dietary changes, and supplemental calcium, magnesium, strontium, vitamin D and vitamin K. Many physicians recommend prescription bisphosphonates. These drugs do increase bone density, but may cause swallowing difficulties and abdominal pain. They may also cause destruction of the jawbone, especially in people with periodontal disease or undergoing dental procedures. There is also some question that the quality of bone produced by bisphosphonates may be defective, and lead to increased fracture risk. We have found that bone density can often be raised in ambulatory women without bisphosphonates.
Loss of estrogen leads to atrophy, thinning and wrinkling of the skin. This makes women look older. Hormones prevent and reduce these changes. Collagen is the main structural component of the skin. Collagen loss in skin is 30% in the first 5 years of menopause.