Hormone Replacement Therapy Plus Calcium and Vitamin D Supplementation May Improve Bone Health

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There has long been a debate about whether older women benefit from calcium and vitamin D supplementation, but new research indicates that one group might: those taking hormone replacement therapy. The study, published online in Menopause, the journal of The North American Menopause Society, found that the supplements combined with hormone therapy protected women against hip fractures compared to placebo.


Hormone Changes and Bone Loss

Osteoporosis is a disease of the bones that is characterized by reduced bone mass and bone quality. Hormonal changes later in life—like the drop in estrogen production that occurs during menopause—can contribute to bone loss. Osteoporosis leaves bones more fragile and susceptible to fractures. In fact, nearly half of women over the age of 50 will have an osteoporosis-related fracture in their lifetime, according to the U.S. Preventive Services Task Force (USPSTF).


Coping with Menopause

Many women cope with uncomfortable symptoms during menopause, such as hot flashes, night sweats, vaginal dryness, moodiness, and difficulty concentrating. Some women choose to use hormone replacement therapy (HRT)—either estrogen alone or estrogen plus progesterone—to reduce these symptoms. HRT comes with its own set of risks and benefits and while not right for everyone, some women may benefit from it.


HRT, Supplementation, and Bones

Calcium is an important component in bone growth, and vitamin D helps the body absorb calcium. To evaluate the relationship between HRT and calcium and vitamin D supplementation and bone fractures, researchers evaluated data from the Women’s Health Study, which was a large study that included over 30,000 postmenopausal women between the ages of 50 and 79. Many of the women in the study were taking HRT (estrogen alone or combination estrogen and progesterone).

About 16,000 women participated in a portion of the study dedicated to calcium and vitamin D. They were randomly assigned to receive either a placebo or 1,000 milligrams of calcium and 400 international units of vitamin D each day—about 8,000 women took supplements, while 8,000 took placebo. These 16,000 women came from all three hormone groups in the study—estrogen alone, estrogen plus progesterone, or placebo.

The researchers then analyzed the rates of hip fracture among women who took hormones and supplements, those who took hormones alone, and those who took neither. The results indicated that the hormones and the supplements appeared to have a synergistic effect—working together to protect against hip fractures and bone loss. The results indicated that women taking hormone replacement therapy who also took daily supplements of calcium and vitamin D experienced a 40 percent reduction in the rate of hip fractures compared to those who took HRT and placebo supplements. In fact, women using both HRT and supplementation had a much greater protection against hip fractures than with only HRT or only supplementation.

Overall, the use of HRT and calcium and vitamin D supplementation together reduced the risk of hip fracture by 57 percent. Because calcium and vitamin D were taken together, the researchers were not able to identify whether one supplement had an edge over the other. What’s more, they were unable to identify an optimal dose for preventing hip fractures, though it appeared that women with a calcium intake of 1,200 mg or higher (from diet and supplements) and those with a higher vitamin D intake might reap more benefits.

The researchers concluded that postmenopausal women may benefit from the combination of HRT and calcium and vitamin D supplementation as a strategy for fending off hip fractures. Because HRT carries some risks, women are encouraged to discuss the best proactive bone health strategy with their individual physicians. Right now, the USPSTF does not recommend calcium and vitamin D supplementation in older women, but that could change as a result of this study.



Robbins JA, Aragaki A, Crandall CJ, et al. Women’s Health Initiative clinical trials: interaction of calcium and vitamin D with hormone therapy. Menopause: The Journal of the North American Menopause Society. Published early online June 24, 2013. doi: 10.1097/GME.0b013e3182963901