Sex Hormones and Bone Health

// Christopher Oswald, DC, CNS

Sex Hormones and Bone Health

Healthy hormone balance has a tremendous impact on maintaining bone health throughout the lifespan. This is true for both men and women at every age; from the early years of rapid bone growth and skeletal development, to the adult years in maintaining healthy homeostasis in rates of bone remodeling, and into older age in the continued maintenance of healthy bone remodeling.1,2

Human sex hormones have a dramatic impact upon bone growth, remodeling, and maintenance during each life stageHuman sex hormones have a dramatic impact upon bone growth, remodeling, and maintenance during each life stage. With this understanding and knowledge a clear picture is painted regarding the importance of estrogens and androgens in all ages of men and women for the healthy maintenance of bone. Bone is periodically remodeled by paired osteoclast and osteoblast “teams” and new bone replaces old bone. Estrogens and androgens fundamentally affect the “birth rate” of osteoclasts and osteoblasts from their progenitor cells. While complex, crosstalk between the endocrine system and connective tissues is due to both the transcriptional regulation of genes and through interactions of the ligand-activated receptors with other transcription factors. It seems as though estrogens and androgens shorten the lifespan of osteoclasts and, simultaneously, extend the life of osteoblasts and osteocytes.3

In mouse models researchers have demonstrated the importance of the activation of androgen receptors and estrogen receptors in the healthy formation of trabecular bone and periosteal bone. Results pointed to a major role of the androgen receptor in trabecular bone growth but the healthiest maintenance of periosteal growth was dependent on the activation of both estrogen receptors and androgen receptors.An additional clinical study has identified multiple single nucleotide polymorphism (SNP) signals associated with healthy bone remodeling and growth which are induced by estrogen.These studies point to a key aspect in the duel importance of healthy levels of both estrogens, androgens, and the necessity of aromatization between the two. This highlights the importance of approaching bone health support from the angle of balanced function across multiple hormones and not having a singular focus.

Maintaining appropriate levels of estrogen have been associated with healthy bone density and development for not only women,6 but additionally for female adolescents7 and elderly men.8

When the goal is to maintain healthy bone growth and function throughout the entire lifespan, it is of the utmost importance to remember the vast power the appropriate balance of sex hormones provide. With this understanding there is no better time than now to start focusing on bone health as the rewards of maintaining balance will be reaped for years to come.

Christopher Oswald, DC, CNS

Christopher Oswald is a chiropractor, certified nutrition specialist, and a graduate of Northwestern Health Sciences University.  He practices at Hudson Headache in Wisconsin, focusing on whole body care for those suffering from head and neck pain. In practice he utilizes the combination of functional movement assessment and functional medicine principles to identify the underlying causes, which guides his direction for the appropriate clinical care. Additionally, he is an Advisory Board Member of Nordic Naturals, and the National Association of Nutrition Professionals. 


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[2] Falahati-Nini A, Riggs BL, Atkinson EJ, et al. Relative contributions of testosterone and estrogen in regulating bone resorption and formation in normal elderly men. J. Clin. Invest. 2000; 106:1553–1560.
[3] Manolagas SC, Kousteni S, Jilka RL. Sex steroids and bone. Recent Prog Horm Res. 2002;57:385-409.
[4] Venken, K., De Gendt, K., Boonen, S., et al. Relative impact of androgen and estrogen receptor activation in the effects of androgens on trabecular and cortical bone in growing male mice: a study in the androgen receptor knockout mouse model. Journal of Bone and Mineral Research: The Official Journal of the American Society for Bone and Mineral Research, 2006; 21(4), 576–85. doi:10.1359/jbmr.060103
[5] Liu M, Goss PE, Ingle JN, et al. Aromatase inhibitor-associated bone fractures: a case-cohort GWAS and functional genomics. Mol Endocrinol. 2014;28(10):1740-1751. doi:10.1210/me.2014-1147.
[6] Popat VB, Calis KA, Kalantaridou SN, et al. Bone Mineral Density in Young Women With Primary Ovarian Insufficiency: Results of a Three-Year Randomized Controlled Trial of Physiological Transdermal Estradiol and Testosterone Replacement. The Journal of Clinical Endocrinology and Metabolism. 2014;99(9):3418-3426. doi:10.1210/jc.2013-4145.
[7] Biason TP, Goldberg TBL, Kurokawa CS, et al. Low-dose combined oral contraceptive use is associated with lower bone mineral content variation in adolescents over a 1-year period. BMC Endocrine Disorders. 2015;15:15. doi:10.1186/s12902-015-0012-7.
[8] Ornstrup MJ, Kjær TN, Harsløf T, et al. Adipose tissue, estradiol levels, and bone health in obese men ... Eur J Endocrinol. 2015;172(2):205-216. doi:10.1530/EJE-14-0792.

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