A year of learning: My journey with osteoporosis and hormones

They say we learn by experience, and this past year has been a big lesson learner for me. It started with my unforeseen osteoporosis diagnosis, which has given me the opportunity to learn, strategize, and become passionate about longevity and bone health. I want to share some of the key insights I have learned during my fight against this silent disease, and I’ll start with a very hot topic in the health space right now—hormones.

This last year, I spent hundreds of hours diving into research on bone health and began to realize the vital connection hormones have to both oral and systemic health. I was drawn to this area not only as a woman, but also as a health-care provider. This opened my eyes so much that I felt a desire to share what some of the key hormones are, why they are so important, and their effects on bone health.

Some of the biggest impacts on bone health are hormones, which include insulin, cortisol, and the sex hormones—estrogen and progesterone in women, and testosterone in men. These hormones are powerful metabolic components that act as communicators between the endocrine, immune, cardiovascular, and skeletal-muscular systems.¹ This process is not only critical for maintaining overall health, but it is especially important for the integrity of our bones. Numerous studies show that disruptions in these hormonal pathways can throw off the balance of the metabolic and immune systems, which may then impact bone density and strength.¹ Understanding these connections is essential for addressing bone health and preventing conditions such as osteoporosis.

What is osteoporosis?

Osteoporosis is a metabolic bone disorder that affects bone growth, turnover, and bone mass. It occurs when bone mineral density decreases, leading to a reduction in bone mass, which can then lead to a decline in bone quality and function.² This can result in bone becoming more fragile and prone to fractures, causing an increased risk of injury.² Lowered bone mass can also throw off the balance of essential minerals and nutrients that are normally stored within healthy bone.² When these vital minerals are unavailable, the body’s ability to rebuild bone is compromised, leading to systemic dysfunction and poor overall health.

Bones store and release vital minerals, and they also produce life-sustaining blood cells within the bone marrow and even store stem cells.² They also release many proteins, hormones, and growth factors into the body, affecting cellular function and energy homeostasis.² Our bones are affected by the metabolic status of each individual and, in turn, they affect the interior body’s metabolism of energy.² This relationship makes bone health particularly important because of its direct impact on other body systems, especially hormones.

Insulin: It’s your response to it that matters

I see patients every day who struggle in managing their blood sugar levels. I worry even more that one in three adults in the United States has prediabetes, now referred to as insulin resistance, and many are unaware they have it.³ Insulin is a crucial metabolic hormone that helps regulate blood sugar levels. However, when the body becomes resistant to insulin, the cells in the liver, fat, and muscles don’t respond to it, and glucose remains in the bloodstream.³ This not only puts extra strain on the pancreas, but it can also cause fat to accumulate in and around the liver, leading to fatty liver disease. People with prediabetes have a 50% higher risk of developing type 2 diabetes within the next five to 10 years if their condition is left unmanaged.³ As we look at the more localized oral effects of blood sugar levels, we see that diabetes can also accelerate periodontal disease, thus putting the patient at risk for other inflammatory health conditions.

There are studies that highlight a bidirectional relationship between bone loss and insulin resistance, showing that these conditions have a significant influence on each other. Bone metabolism is dependent on insulin. When insulin deficiencies happen, it can lead to increased osteoclast activity, promoting bone resorption and subsequent bone loss.⁴

On the other hand, osteoporosis, or low bone density, can make managing diabetes a challenge. This may be due to lower levels of osteocalcin, a bone-
derived hormone that plays a key role in regulating glucose metabolism.⁵ When osteocalcin levels are low, it can be more difficult for individuals to regulate blood sugar levels, potentially making a person more insulin-resistant.⁶ The relationship between insulin and bone health highlights the importance of considering metabolic health in the management of bone-related conditions. Educating individuals about the importance of insulin sensitivity and maintaining controlled blood sugar levels is crucial for reducing bone loss and promoting long-term health.

Cortisol: The fight-or-flight hormone

Cortisol is a powerful hormone that plays a central role in the body’s fight-or-flight response. Cortisol has a negative reputation, but it plays a crucial role in the body by motivating us, protecting us from harm, and even helping to manage inflammation.⁷ However, an imbalance in cortisol level, whether too high or too low, can have detrimental effects on both mental and physical health.⁷

Like insulin, cortisol has a bidirectional relationship with bone health, with implications for declining oral health conditions. Elevated cortisol levels, often a result of chronic stress, can lead to increased bone resorption (breakdown of bone tissue) and decreased bone formation, raising the risk of osteoporosis and fractures.⁸ Chronic stress along with elevated cortisol levels serve as risk factors for periodontal disease by promoting inflammation, impairing wound healing, and being associated with poor alveolar bone growth and osteoporosis.⁹

Individuals with low bone quality, such as osteoporosis, may experience reduced physical activity due to the increased risk of fractures or limitations in mobility. Physical exercise, however, can help regulate cortisol levels by boosting dopamine, a neurotransmitter that can counteract the negative effects of cortisol.¹⁰ Additionally, the added stress associated with a diagnosis of low bone density can increase anxiety and depression, potentially creating a destructive cycle of heightened cortisol levels and deteriorating bone health.

The connection between cortisol and bone health highlights the need for regular screening, particularly in patients dealing with chronic stress. Long-term high cortisol levels can harm bones, so managing stress and keeping cortisol levels in check are important keys to support both bone health and overall well-being.

The complex role of sex hormones

When we talk about hormones, it is usually the sex hormones—estrogen, progesterone, and testosterone—that come to mind. However, the sex hormones are only a part of more than 50 different hormones that regulate the body’s functions.

Sex hormones, particularly estrogen and testosterone, are a crucial part of maintaining bone density throughout life. In women, estrogen and progesterone are essential for bone health, with estrogen playing a more dominant role in regulating the bone remodeling process by replacing old bone with new. During and after perimenopause, estrogen levels can drop significantly, which can lead to increased bone resorption (the breakdown of bone) and decreased bone formation.¹¹ This imbalance of estrogen contributes to a rapid decline in bone density, affecting both systemic and oral bone structures.¹¹ Studies have shown that postmenopausal women are at higher risk for periodontal disease and tooth loss, as the supportive structures of the teeth weaken due to bone loss.¹²

Testosterone is considered primarily a male hormone, but it also plays a significant role in maintaining bone density in both men and women. In men, testosterone promotes bone formation and inhibits bone resorption, working in conjunction with estrogen. This is why men can achieve a higher peak bone mass—typically 8%–10% higher than in women.¹³ Low testosterone levels, particularly in men, are associated with osteoporosis and an increased fracture risk.¹⁴

Though controversial, studies are showing the benefits of hormone replacement therapy, especially with estrogen in women and testosterone in men, which could help mitigate bone density loss by helping reduce fracture risk and improving health outcomes.^15,16 For dental professionals, understanding the role of these hormones is crucial when assessing patients’ oral health and overall bone health.

Conclusion

My osteoporosis diagnosis sparked a year-long journey of learning and growth, but this is just the beginning. As I continue to seek out new information, therapies, and treatments for osteoporosis prevention, I am passionate about educating dental professionals on their critical role in improving patient health outcomes. When we understand the connection between hormones and bone health, dental professionals can better support patients in preventing both oral and systemic bone loss.

Early screenings for risk factors, such as hormone imbalances, are essential for identifying those at risk and for helping prevent oral and systemic bone loss. Additionally, education on preventive measures such as promoting healthy oral habits and scheduling individualized, timely preventive care appointments can help mitigate the risks associated with osteoporosis. Collaborative care with other health-care providers is also key, as effective communication and monitoring can enhance overall patient outcomes.

My goal is to bring more awareness about the importance of bone health and provide helpful insights for others facing similar health challenges. I hope that my health journey can help you and others gain insight into prevention and healing, and help remind us that today is the day to take control of our health and well-being. 

Editor's note: This article appeared in the March 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

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