Reversing Osteoporosis with Hormone Therapy

Beyond the Thyroid – Episode 41: Reversing Osteoporosis with Hormone Therapy

In this episode of Beyond the Thyroid, Dr. Dana Gibbs takes a deep dive into osteoporosis — and why bone loss is often misunderstood, undertreated, and unnecessarily feared. Rather than focusing solely on prescription bone drugs, Dr. Gibbs explains the critical role hormones play in bone health, including estrogen, progesterone, testosterone, and thyroid hormone.

Using real patient stories and current science, Dr. Gibbs shows how osteoporosis is not just a calcium problem — it’s a hormonal and metabolic issue. She outlines how thoughtfully applied hormone therapy, combined with proper nutrition, supplements, and strength training, can stabilize or even improve bone density in the right patients.

This episode is essential listening if you’ve been told you have osteopenia or osteoporosis, are concerned about fractures, or want alternatives to standard pharmaceutical approaches.

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Episode Highlights
00:00 – Introduction to Episode 41
00:11 – Understanding Osteoporosis and Hormonal Connections
02:13 – Case Study: Elaine’s Journey
03:45 – The Role of Hormones in Bone Health
06:19 – Hormone Therapy and Bone Density
12:55 – Thyroid Hormones and Bone Loss
16:39 – Exercise and Nutrition for Bone Health
21:58 – Debunking Myths and Final Thoughts
25:02 – Conclusion and Next Steps

Strong bones require more than calcium — they require hormonal balance. Tune in now.

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✉️ Email Dr. Gibbs at drgibbs@DanaGibbsMD.com or visit https://www.danagibbsmd.com/ for more information.


Thank you so much for listening! Tune in on the next episode.


The medical information provided in this episode is intended for informational purposes only and should not be construed as medical advice. Always consult a qualified healthcare provider regarding any medical questions or concerns.

Transcript

dana-gibbs-md--she-_4_10-29-2025_135431 0:00

Welcome to episode 41. I'm Dr. Dana Gibbs, and welcome back to Beyond the Thyroid, where we talk about all the things your doctor didn't have time to explain, especially when it comes to your hormones. So today our topic is osteoporosis and not in the usual way. So if you've been told that your bones are thinning, or you've been handed a prescription for a bisphosphonate like Fosamax or an immune modulator like Prolia, and you're hesitant to start those medications, you're not alone. More and more my patients are asking, is there another way to treat bone loss? One that doesn't rely on drugs that have scary side effects? And the answer is actually yes. And it starts with understanding the hormonal connection between osteoporosis and bone loss. So let's get started.

1:00

You're listening to the Beyond the Thyroid podcast. I'm your host, Dr. Dana Gibbs. I'm an ENT surgeon and hormone specialist. For years, I struggled with my own unrecognized thyroid problems before and even after I was regularly performing thyroid surgeries. Then, one day, I learned something that turned my health around and opened my eyes to the limits of mainstream medicine in treating more subtle thyroid abnormalities. I spent the next 20 years fine tuning my hormone expertise in disorders like Hashimoto's disease, perimenopause, and stress related illness. Come join me as I share this new approach to hormones that empowers you to take control of your own thyroid and hormone imbalances. Let's dive in.

dana-gibbs-md--she-_4_10-29-2025_142827 1:52

Hello and welcome to Beyond the Thyroid. If you have been a long time listener, welcome back. If you're new here, we are so happy to have you. Today's topic is osteoporosis and the use of a hormonal approach to reverse or stop osteoporosis rather than drugs. So first I wanna tell you about a patient of mine, her name is Elaine. It's not her real name. She's a 62-year-old. She's active and she just came to see me after her doctor diagnosed her with osteoporosis, and she was devastated. She had just fractured her wrist in a fall and was told she'd need to start medication immediately. But she'd read about the risk of jaw necrosis and spontaneous femur fractures and really wasn't comfortable starting reclass. And she asked me if there was any way to rebuild bone without those medications. And the short answer is yes, and it starts with an understanding that bone is a living hormone responsive tissue. So when I looked at her labs, I saw what I often see, low estradiol, low testosterone, borderline vitamin D and an underactive thyroid that had never really been treated because her TSH was normal, she had also lost 15 pounds unintentionally and was experiencing insomnia and fatigue. Over the next 12 months, we worked together using hormone optimization, some diet changes, some targeted supplements and resistance training. And not only did she really regain her youthful energy and strength, her DEXA scans started improving. Not a hundred percent better, but improved. And that's great for just one year. So she managed to stay off the bisphosphonates, and that's what today's episode is all about. We're gonna look at the science of estrogen, testosterone, progesterone as related to bone health. And I'll throw in a little bit about thyroid as well. We're gonna look at myths and facts, and we're gonna talk about lifestyle and nutrition, and I'll share what I see in my practice, including how the right hormone balance can literally rebuild bone. So first of all, we need to talk about bone and estrogen, how hormones shape our bone health. So estrogen keeps bone turnover in check once a you lose estrogen, the osteoclasts, the cells in your bone that actually chew up the old bone start out pacing those that rebuild the bone, the osteoblast. So your skeleton is not any longer maintaining a balance between breakdown and rebuilding. And so during perimenopause is when this starts, your estrogen levels tend to drop sharply and then fluctuate, and your bone loss will accelerate even before you hit that magic day of menopause. And even if you have no symptoms at all. So testosterone, which is sometimes thought of as the male hormone, is equally critical in women. While it's true that women don't have as much testosterone as men do, we have a very much larger amount of testosterone in our body than we do of estrogen, and that's the way it's supposed to be. So testosterone supports the osteoblast, those bone building cells, and it also helps you build and maintain the muscle mass that protects you against falls. So in women, testosterone decline can be sneaky and it can start in your early thirties. Where some women will maintain pretty normal levels and others will lose nearly all of it early, especially if you have surgical menopause or years on oral contraceptives that suppress both estradiol and testosterone. And without enough of either of those hormones, bone loses not just its density, but its internal structure year by year, even if your calcium intake is perfect. So this is why post-menopausal women can lose up to 20% of their bone density within the first five years leading up to and after menopause. It's not a lack of calcium, it's a hormonal imbalance. So can hormone therapy reverse bone loss? Well, the evidence says yes when it's done correctly. So, transdermal estradiol at physiologic doses not only stabilizes bone density, but actually can increase it if the numbers are on average around 70. That's your blood level of estradiol. And that will reduce your fracture risk as effectively as, and sometimes better than bisphosphonates. In my own patients, I've seen women move from full on osteoporosis back to towards osteopenia range over two to three years when we combine hormone replacement with strength training and vitamin D, magnesium, vitamin K2. And when you add testosterone, when those levels are low, it really helps further, not only because it's stimulating the bone formation and muscle growth, but it helps you lift heavier and stay upright longer. And there is lots of evidence that doing that, even if you are postmenopausal and even if you've never lifted before, that it really, really helps. So what's the role of progesterone? Well, progesterone is subtle, but it's kind of important just as much. So estrogen prevents bone breakdown. Progesterone helps provoke new formation of bone. And this is not the synthetic progestins I'm talking. This is bioidentical progesterone also supports sleep, and it calms your nervous system and balances cortisol. And what does that do? It helps you have more energy. So when your cortisol is high because of chronic stress or because your adrenals aren't working as well as they should, it will accelerate your bone loss. So when I see a woman with insomnia and bone thinning, I often find that adding progesterone really helps on multiple fronts, better rest, calmer adrenals, stronger bones, and progesterone is necessary. If you're gonna take estradiol, you have to have at least a progestin, if not progestin and progesterone because of the increased risk for uterine cancer if you were to take estradiol without any balancing hormone. So you do wanna choose the right form of estrogen. My preference is for patches, creams, and gels. These bypass the liver, it lowers your blood clot, liver clot risk, and it lowers your production of estro, which is a lower potency estrogen that actually blocks your hormone receptors. Oral estrogen increases, binding proteins, raises your serum triglycerides and causes more fluctuation. Pellets, I absolutely don't recommend. They're very unpredictable over time and you go from really high levels to really low levels. And so not an acceptable choice in my opinion. For the best bone protection, I recommend transdermal, estrogen dosed to where your serum level is around 70, not really higher, not really lower, right around 70. So the support players are DHEA and pregnenolone and DHEA is a precursor to testosterone as is pernol alone. And both of these can have mild anabolic effects, helping you build some muscle and support bone formation. Especially if you are in a situation where your adrenals are not working well or your androgen levels are very, very low, and for some people they don't have to add testosterone. Adding DHEA is enough and your testosterone levels will come up and you'll feel well. So edol alone mainly helps ban it balance neuro steroids, and it helps you with your mood. So it's not really a direct bone stimulator, but you wanna optimize it so that it helps your overall hormone resilience and your mood, and helps you have energy to go exercise. So I don't tend to check those every time or even in every body. But if your cortisol is kind of low and your testosterone is low, these are precursors that can help fill in the gaps. So let's talk about men. Men get osteoporosis too. They're just underdiagnosed. So low testosterone is a major risk factor for bone loss in men over 50. And physiologic testosterone replacement carefully monitored, can significantly improve bone density and muscle mass. And the funny part about this is that the testosterone bone benefit, a lot of it comes from its natural conversion into estradiol in your body so that both hormones are working together here in men as well. Now, the best time to start hormone therapy for prevention is actually two years before you hit menopause. That's when it protects your brain, your heart, and your bones most effectively. But even then, it is not too late after 60. Now you don't necessarily with estradiol get the heart protection that you get if you start it in the perimenopausal timeframe. You may not get the dementia protection if you start it, but I see this in women who are in their mid 60s who have a lifespan expectancy that may be as long as 30 years. And if you look at the fine print with these bone mass increasing drugs, they cannot be taken for long periods of time. And so I really believe even if you're not gonna get any other benefits from the estradiol, that adding transdermal estrogen with careful dosing will give you long lasting increases in bone mass and bone health. Not just density, but bone health, even decades later. So we start low, we go slow and we monitor. And we also don't forget testosterone because what I've seen in my practice is that women over 60 almost always have pretty low levels and a gentle. Restoration, either with DHEA or with testosterone itself can really make a profound difference in their mental health, their energy, their bone health, and quality of life in general. So let's talk about thyroid hormones and bone loss, because here's where many people get confused. Patients are very often warned that taking liothyronine or T3 will increase fracture risk. And if you've listened to anything I've done before, you know that I strongly recommend liothyronine for people who have a low T3 or an elevated reverse T3, and the evidence is much more nuanced than high T3 increases fracture risk or a low TSH increases fracture risk. So studies show, actually, that long-term levothyroxine use, even when your TSH looks normal, is linked to increased bone loss, sometimes as much as double in older adults and postmenopausal women. So there was one large analysis that showed that people on levothyroxine. Lost significantly more bone mass over six years than non-users and women who are on higher doses, over 150 micrograms per day, have more than twice the fracture risk compared to peers who are not on those doses. Why? Well, because most doctors follow only the TSH, and if the TSH drops low, they reduce your dose. And if it's high, they increase it. But they're often overshooting in both directions. And this can cause big swings in your tissue level, thyroid activity, and what I find is that most people who come on to a balanced combination therapy, like I recommend a small controlled amount of T3 added to the regimen, patients often lead much less levothyroxine than they used to. And the careful checking of labs at mid dose rather than a trough only allows for the total amount of thyroid hormone to be much less than it was before. And not only that, but their energy improves, their metabolism stabilizes, and because their tissues finally are getting what they need, they can maintain optimal thyroid hormone levels without driving the TSH down too low. So this does 2 things. First one is it lowers your osteoporosis risk. Avoiding chronic over replacement, which I see all the time, and it restores the vitality that helps you get up and move and eat healthier, and do strength training, which is the single most powerful lifestyle tool for bone protection. So rather than fearing T3, the key is precision dosing, as I recommend and proper monitoring. All right. Let's talk a couple of lab markers for bone metabolism. So when I evaluate bone health, particularly in a post-menopausal woman, I'm gonna check your free and total testosterone. I'm gonna check your estradiol, your DHEAS, your vitamin D3 level, your parathyroid, your serum calcium, your alkaline phosphatase and then bone turnover markers like NTX or CTX. And then of course those five thyroid labs that I recommend. The TSH, the free T3 total, T3, free T4, and reverse T3. And we track your DEXA scans every couple years for real progress. There is also a newer scan that can be done for monitoring medication that can be done more often than every couple of years because it does not involve radiation and it's much less expensive. It's just a little bit hard to find. It's called REMS. And, I see that it will be gaining in popularity in the next few years. Strength training and exercise, of course, is not optional. It is the signal that bones need to stay strong, and the particular kinds of exercise that are the most important are those that provide impact to your bones and to your joints, and to stress load them in a certain way that does not over stress your cortisol. So it's high weights, low reps and the LIFTMOR trial, which was done on postmenopausal women who had never trained before, proved that supervised high intensity resistance training, increased bone density in both spine and hip, even in women who already have osteoporosis. So lifting heavy safely does more for bone than any supplement. So I encourage squats, dead lifts, and upper body presses and pull downs. And you could start low, you could start with your body weight when you're just starting out, and then you need to increase that based on your tolerance to where you're just below the maximum five rep. Weight that you can lift and then adding once you get to where you can do it hopping or briskly stepping or something like jump rope. The bones really respond to this. The other things that are helpful are walking, which can maintain bone, but really doesn't build it much. So you really need to combine that with something like heavy lifting that improves your bone and builds it. I also do like for folks to do yoga or Pilates'cause I do feel like they help with your balance and flexibility. But one of the things that I actually don't recommend is a lot of forward bending spine type activities, which I feel like can worsen your risk for a spine injury by stretching out the ligaments in the back of your spine. The other thing that I don't recommend is a whole lot of planks and crunches that improve your strength inflection versus your strength in extension. I really feel like keeping your back straight and strong is the healthiest way to exercise. So we're combining load impact and stability. Now, couple more things. We need to talk about nutrition, because you need 90 to a 100 grams of protein a day if you are an average size woman to provide the amino acids that form collagen, which is the framework of bone. You need to avoid sugar because too much sugar raises inflammation and robs magnesium. Both of those things accelerate bone loss. Supplements that may actually really help are magnesium glycinate, 400 to 600 milligrams a day, vitamin D3 to keep your blood levels around 65 nanograms per mil, vitamin K2, approximately a hundred micrograms a day, which helps moves calcium into your bone instead of into your blood vessels, and then maybe collagen peptides that help you build the matrix for the calcium to be deposited in your bones. Calcium is best from natural sources like greens, almonds, sardines, maybe dairy if it's tolerated. But large meta-analysis show that calcium supplements alone really only raise your bone mineral density, maybe 1% with minimal fracture benefit and high doses can increase your risk for kidney stones and maybe even heart calcifications. So if you need calcium, use it in small amounts. Pair it with magnesium, zinc, D3 and K2. Alright, so you can't build bone if your gut can't absorb your nutrients. So gut health is really, really important. So if you have low stomach acid or irritable bowel or food allergies that cause you to have gut disruption. Those are inflammation and they will impair your ability to absorb those mineral nutrients and vitamins that you really need. Inflammation also raises cortisol, which further harms bone as we spoke to about before. So treating gut health and reducing food sensitivities or gluten, if you react to that when it's appropriate, it's often a really key step in bone recovery. Now, let's talk one second about fasting. Extreme fasting or very low carb eating can suppress your insulin and the hormones that stimulate your appetite. It reduces calories and it can actually shrink your muscle mass if you're overdoing that. But moderate time restricted eating paired with sufficient protein and nutrients is usually fine. Balance is your goal here, not deprivation. Let's talk about fact from fear. Most of the scary headlines about hormones came from the Women's Health Initiative, which was released in the early 2000s, and they used synthetic progestin and non-human based estrogens, not the bioidentical to humans forms that we use today. These do not have, apparently, the cancer risk that was originally spouted. And they have a much lower clot risk and stroke risk than was originally discussed as well. There's also no increase in heart risk if you start hormones around the time of menopause or even before menopause. And as a matter of fact, my feeling is you actually improve your heart risk if you start prior to menopause. So really, this is about an informed consent and autonomy and individualization. It's the right dose, the right delivery, the right follow up. And there are not really good studies that show that there is no indication for adding hormones even if you are several years after menopause. We do need to talk about these bone drugs really quickly because hormone therapy does reduce both vertebral and hip fractures as effectively as the bisphosphonates, and you can take them for much longer. Sometimes works much, much better, particularly in early menopause. Prolia and reclass do increase bone mineral density, but they stopped the osteoclast, they stop the reabsorption of bone, but they do not help with bone remodeling. And what you can end up with is bones that are very brittle. You don't lay down any new bone. And this can carry issues like jaw necrosis or rebound fractures. So hormones actually help rebuild and remodel bone rather than simply freezing it in place. So just one final word of caution. If you are already on Prolia or bisphosphonates, you cannot just stop these abruptly because that actually increases your risk even further. What we would do in that situation would be to introduce the hormone replacement, track your DEXA scans, and then taper off of the bisphosphonate drugs occasionally, sometimes using a bridge medication. And the key is a supported transition so that the born turnover does not take over. And it's important to remember that bone remodeling is really slow. You usually see measurable gains in bone density. Within one to two years. But earlier, improvements like less back pain, better posture, fewer falls can happen within months. So consistency is everything. Hormones, strength training, nutrients, sleep, it's all really, really important. Let's recap. Bone is alive. It's constantly breaking down and rebuilding hormones are the master regulators of that cycle. Calcium and bisphosphonates are tools, but hormones, estrogen, progesterone, testosterone, DHEA, thyroid, these are the foundation they help keep the rebuilding of bone going, you may have been told it's too late or that you can't use hormones or that your only option is a bone drug. But I hope this conversation opens new doors to curiosity for you. In my practice, I've seen people not only halt bone loss, but reverse it regaining independence, strength, and confidence without excess risk. So if you'd like to explore this kind of personal care I have new patient appointments available this month. You can find those out at my website, danagibbsmd.com, and I would love to see you on a discovery call. So check it out. And I'll talk to you again next time.

26:12

Thank you for listening to this episode of Beyond the Thyroid. If you found this information valuable, it would mean so much to me to take a few seconds and give the podcast a five star review. It helps other people who need this information find the show and it's really easy. Just search and click on the name of the show, Beyond the Thyroid, and scroll to the bottom to ratings and reviews. I truly do read and appreciate. Remember, when it comes to hormones, there will always be more to discover, so follow the show so you get the next episode as soon as it's released. And if you or someone you care about needs a caring doctor to help figure out how to heal hormone problems that other doctors have dismissed, check out my website at www. danagibbsmd. com. And if you're not a physician, please keep in mind, while I'm a doctor, I'm not your doctor. The content of this podcast is my opinion and it's for educational and entertainment purposes only. This is not meant to be individual medical advice and you should consult your own physician for any medical issues or diagnoses that you may have. I look forward to continuing this journey with you beyond the thyroid.