[tbirdny]

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.

[Abishek_Muthian]

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/

[ravenstine]

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.

[safety1st]

> 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]

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.

[safety1st]

No one is "policing bodies and activities" here, sounds to me like you are just being oversensitive and trying to twist the discussion into one that hates on guys. This sort of coded misandry doesn't work on me anymore, it's so overused, many people have wised up.

So I will say it again: any woman who thinks she will accidentally develop a masculine physique is a fool. She has a poor understanding of weight training and the human body.

Just as any man who thinks he'll get that physique on accident is also a fool!

[lupusreal]

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?

[brezelgoring]

You must have heard it already but you won’t turn into Arnold by doing bodyweight squats 3 days a week for a year. It will, however, shape your body and rearrange fat deposits into more conventionally attractive positions and I don’t think there’s anyone around saying that’s not attractive.

[erklik]

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]

>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.

[ClumsyPilot]

> heard men mock.., women who are interested in male-coded activities like weight lifting.

This sounds like some really insecure men

[hyperthesis]

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]

I'd like to see that, the studies I've seen show around 1-5% per year.

[scott_w]

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]

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]

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?

[throwaway2037]

    > 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]

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.

[drakonka]

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]

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.

[cs02rm0]

Steroids have a lot to answer for when it comes to perceptions around exercise in general.

[amelius]

> 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]

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]

> 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]

> Cortisol is also released during strength training, though.

more than compensated for by the compressive loading signals from lifting heavy.

[ambicapter]

How do compressive loading signals compensate for cortisol production? Seems like one is a nerve signal and the other is a hormone?

[ben_w]

> 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".

[hilbert42]

""Wow, I'm really glad I've already cut back"."

What you said about caffeine worried me somewhat, so I looked it up on Wiki and what I found about it was mostly innocuous and some properties are even beneficial, it's even on WHO's list of essential medicines.

Many vegetables have much more dangerous compounds and toxins: oxalic acid (a rust remover and bleach that can rot your kidneys) in rhubarb and Popeye's spinach and many other green-leaf vegies, solanine in potatoes, and very dangerous cancer-causing aflatoxins in peanut butter, and that's just the beginning, there are many dozens more! Now you know, are you going to starve?

And to boot, caffeine is a nice looking heterocyclic purine-like molecule with a six and a five-member ring both heavily laden with nitrogen, so what's the worry about? What's not to like about it?

[creata]

Being on WHO's list of essential medicines is no indicator of how innocuous a substance is.

[ben_w]

https://en.wikipedia.org/wiki/Caffeine#Overdose

"""Consumption of 1–1.5 grams […] per day is associated with a condition known as caffeinism.[141] Caffeinism usually combines caffeine dependency with a wide range of unpleasant symptoms including nervousness, irritability, restlessness, insomnia, headaches, and palpitations after caffeine use."""

"""cases of very high caffeine intake (e.g. > 5 g) may result in caffeine intoxication with symptoms including mania, depression, lapses in judgment, disorientation, disinhibition, delusions, hallucinations or psychosis, and rhabdomyolysis."""

[littlestymaar]

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]

Estrogen replacement increases the risk of cancer in women.

[kridsdale1]

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]

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]

Did a quick search and found this one: 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.

[Auracle]

There are various forms of HRT and not all cause an increase in cancer. It’s a shame that notion has stuck around when it could be so helpful for so many women: bone density, hot flashes, vaginal atrophy, etc.

They do tend to cause an increase in blood clots though. The risk is manageable in relatively fit women. In overweight/sedentary women that gets a bit harder to balance out.

[wizzwizz4]

> They do tend to cause an increase in blood clots though.

That risk factor is specific to the oral route, and/or conjugated equine oestrogens. Injections, patches etc. of synthesised oestrogens don't seem to have that problem. https://www.bmj.com/content/364/bmj.k4810

> Transdermal preparations were not associated with risk of venous thromboembolism, which was consistent for different regimens

Don't eat your HRT: rub it on your gums!

[a2tech]

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]

Although I knew a woman who had breast cancer and a consequence was taking her off HRT. Which she was dreading.

[RoyalHenOil]

When I reach my elder years, I would happily undergo a preemptive mastectomy in exchange for stronger bones that would let me stay mobile for longer.

[mrmuagi]

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

[apwell23]

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]

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]

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.

[gavinmckenzie]

What my doctor has told me, after attending a urology + prostate cancer conference, is to think of the prostate as a sponge that absorbs testosterone. And once the sponge overflows, prostate cancer can be triggered.

But once cancer has occurred, adding more testosterone doesn't matter because the sponge is already super-saturated.

In fact, doctors who have this perspective will permit men with prostate cancer to continue testosterone therapy.

[apwell23]

> . 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?

[landryraccoon]

"Use it till you die" seems like less and less of a penalty the older you get.

[ambicapter]

Is their natural estrogen production not already suppressed from menopause?

[apwell23]

sure but wouldn't HRT suppress whats remanning? Otherwise you are just getting free biological lunch.

[Auracle]

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.