Treatment Options for Osteoporosis: Hormone-related Therapy (Nursing)

00:01 In this part of this series, we're going to talk about hormone related therapy, in treating osteoporosis.

00:09 First up, estrogen.

00:11 Now, estrogen does a lot of things in the body.

00:15 But I want to look at three main things.

00:18 If the estrogen levels are appropriate for the bone needs, you're going to have increased bone resorption, maintenance of bone formation, and decreased activation of bone remodeling.

00:32 Okay, that's a list.

00:34 That's never gonna stick in your mind, right? So know that your bones need estrogen, to have the osteoclast, do what they do.

00:45 We know that's clean.

00:46 Have the osteoblasts do what they do.

00:49 We know that's building.

00:51 And then the osteocytes help us with bone remodeling.

00:55 So with appropriate levels of estrogen, the patient is going to be keep up better with that bone destruction and bone rebuilding.

01:04 So focus in on that maintenance of bone formation.

01:09 The osteoblasts are going to be able to keep up more with the destruction of the bone as it's being repaired.

01:15 Okay, so estrogen is a hormone.

01:18 That's the first one we're looking at.

01:20 And we're talking about patients who take extra estrogen as part of their treatment.

01:26 Now, there are some risks.

01:27 When you see HRT, that means hormone replacement therapy.

01:33 Now there is research being completed on this all the time.

01:37 This is a pretty hot topic.

01:39 Because here's the risks that we've seen in previous clients.

01:44 It can increase the risk for blood clots.

01:46 You'd like of venous thromboembolisms.

01:49 So it might increase the patient's risk for developing a blood clot.

01:53 Also has some coronary heart disease risks can increase the risk for stroke, and breast cancer.

02:00 Okay, those are all really serious options.

02:04 Now, you might wonder where we got that.

02:06 We list our references right there for you in the handout.

02:10 So we only use evidence based teaching here.

02:13 And we'll always list the references for you if you want to double check on that.

02:17 But be aware, research is ongoing and updates come all the time.

02:24 Now, this graphic is really cool. I like it a lot because you can learn about the levels of estrogen in a woman's body as she ages.

02:34 So first of all, look at the ages at the bottom, right.

02:37 Find your age and put your finger on it, where you line up with age.

02:42 Okay, now let's kind of look at the ebb and flow.

02:46 Now you'll see that the estrogen level in a woman's body is represented by that purpley pink color.

02:51 Starting from the character's feet moving upwards.

02:54 So 20, oh is lower than 30.

02:59 What is the estrogen level in a 40 year old compared to a 30 year old? So look at the progression of that.

03:08 What is the comparison of an 80 year old to a 30 year old? Yeah, there's a big difference.

03:15 Now, we've labeled menopause there.

03:17 For you look, look at the range of menopause.

03:20 Yeah, it's a wide range. And sometimes, perimenopause, meaning, you're circling menopause can last for almost a decade.

03:27 So, that's why there is such a range there.

03:32 Okay, so hormone-related therapy means we're going to replace the hormone estrogen.

03:37 Why do we do that? Because estrogen can help the client maintain bone density, especially after menopause.

03:46 Now, why do we say especially after menopause? We'll look at what happens to the estrogen levels after menopause.

03:55 And if we know that estrogen can help maintain bone density, that's why it's most helpful after menopause.

04:02 So, it's got the risk. So right.

04:05 Estrogen therapy can increase the risk of breast cancer and blood clots.

04:09 Nobody wants either of those.

04:11 So we primarily use it for younger women or women needing estrogen therapy for their menopausal symptoms.

04:17 And trust me, those are no fun if someone's going through that.

04:22 So this is what we use to treat to help correct a problem.

04:26 Younger women or women who need estrogen therapy to deal with menopausal symptoms.

04:31 But there's a very special and particular group of people I want you to be aware of transgender women.

04:39 Now these are clients who are assigned male at birth and chose to transition and receive gender affirmation therapy.

04:47 Hormone-related therapy is just one part of that treatment option.

04:52 I want you to keep in mind that our role as nurses and healthcare providers is to support all humans.

05:00 All humans deserve peace and health care.

05:03 So just know that you may have patients who are in hormone related therapy.

05:08 And if it's estrogen, it could be gender affirmation therapy, as a assigned male at birth client has decided to transition to a transgender woman.

05:22 Raloxifene is a SERM.

05:24 It's kind of fun to say to.

05:25 But that means selective estrogen receptor modulator.

05:30 Now write down what that is.

05:31 This isn't technically an estrogen.

05:34 So it's not a hormone, as we say.

05:37 But this is a drug that can mimic the benefits of estrogen.

05:40 I mean, how cool is that? So it's not estrogen, but it can mimic the benefits of estrogen.

05:47 So the client will have an increase to the density of their bones.

05:51 Now, how does that work? Well, raloxifene down modulates the activity of what type of cell would you guess? Yeah, osteoclast.

05:59 We wouldn't want them to down modulate the builders, the osteoblast.

06:03 They down modulate the osteoclast.

06:06 So there's less bone reabsorption.

06:08 How does that help an osteoporosis client? Remember, osteoporosis is when they are absorbing more bones than they can rebuild.

06:17 So if we can slow down those osteoclast less bone will be reabsorbed, therefore their bones should be denser.

06:26 Testosterone is a hormone that does some pretty incredible things when it comes to your bones.

06:31 But I want to hit these two points first, before I break it down, and we bring in the testes.

06:36 So this is what I want you to think about.

06:38 Testosterone primarily helps you increase your bone mass density.

06:43 Now we know that's a cool thing, right? Because denser bones are stronger bones, and at less risk for fractures.

06:50 So that's why we want appropriate levels of testosterone in the body.

06:54 But I really want to make sure that I explain this one extra fact to you, before we get into the testes.

07:02 Testosterone stimulates red blood cell production in the bone marrow.

07:07 So that's another thing that testosterone does to the bone.

07:11 But sometimes it's an easy thing to forget.

07:14 So if I have an appropriate amount of testosterone in the body, I'm going to have an appropriate amount of red blood cell production, as long as everything is working the way that it should.

07:24 Alright, enough of that side note. Now let's bring in the testes.

07:29 There it is, okay.

07:30 So we've got that there to remind you about testosterone being the hormone.

07:35 Now take a look at the bone, we've got key points labeled for you.

07:39 You've got the cortex, the periosteum, the trabecular bone.

07:44 Now we've gone into detail about the different layers of the bones and what they do earlier on in our series.

07:50 So if you haven't seen that, be sure to check it out.

07:53 But I want to talk about the role of testosterone coming from the testes and what it does to the bone, specifically.

08:00 Okay, so you see how we've kind of got them connected.

08:03 Let me break that down for you.

08:05 Testosterone is an androgen.

08:08 So androgen receptors, they have these signals that communicate with osteoblasts.

08:14 Okay, now these osteoblasts are located in a very particular part of the bone.

08:20 So the androgen receptor signaling in osteoblasts in trabecular bone is what we're hitting on.

08:27 We talk about what testosterone does.

08:29 So the androgen receptor signaling in osteoblasts is particularly in the trabecular bone formation, and androgens prevent osteocytes from ripping apart that bone loss.

08:42 Okay, that was a lot of use of the words of androgen and receptors. And let me break it down.

08:49 Look at that trabecular bone.

08:53 What androgen receptor signaling does I mean is the message that you get from this testosterone is to tell the osteocytes to not destroy so much bone.

09:05 Okay, so testosterone is going to reduce the amount of bone destruction just by their presence and they're acting on the trabecular bone.

09:14 That will help make a denser bone.

09:17 So when you're thinking about testosterone, I want you to keep in mind first, that red blood cell role.

09:22 What do you remember? What happens to red blood cells when testosterone is available? Right. There's more of them.

09:31 And where does it act? On the bone marrow.

09:34 Now, how does it make the bone denser and stronger? Remember, testosterone is going to help those osteocytes chill out a little bit.

09:43 So you're going to have less bone destruction, and the bones will be denser and stronger, with a lower risk of fractures.

09:53 Now, I love this drawing similar to the one that we drew for the women and estrogen.

09:57 But if you take a look at this, we're thinking about hormones.

10:01 So we see that that kind of tannish yellow color represents the level of testosterone.

10:07 All get the difference between an 18 year old and an 80 year old.

10:12 Yeah, there's a significant difference.

10:16 Plays a significant role in behaviors too.

10:19 So keep that in mind when you're working with your clients across the lifespan.

10:24 So here's another great question we received.

10:27 If estrogen can be used to treat osteoporosis in women, can testosterone be used to treat osteoporosis in men? I love it when you guys come up with great questions.

10:38 Now you've seen the picture of the women that's in the previous section.

10:42 You see the differences in the men.

10:44 Hey, if you really want to go after studying it this, lay them next to each other and really compare the differences.

10:51 Wow, how does it difference in a man's testosterone level compared to a woman's changing estrogen level? But back to our question? Okay, so if we can use estrogen therapy for osteoporosis in women.

11:04 Can we use testosterone in men? Predict your answer, pause, play along, and then we'll walk through the answer.

11:15 The short answer to the question can testosterone be used to treat osteoporosis in men? Is no.

11:22 It's generally not recommended that testosterone be used as the primary osteoporosis treatment for men.

11:28 Now we've got some other approved osteoporosis treatments for men, and they're especially effective in men with low testosterone levels.

11:36 Now they're going to look familiar to you.

11:38 What? You'll see biphosphonates and denosumab.

11:42 Those are medications that we've talked about with females who suffer from osteoporosis.

11:47 So these two types of medications are approved to treat osteoporosis in men.

11:52 Now, it's pretty cool because the effects of these medications on bone mass, they're similar to their effects in women.

11:58 So that's why they're also approved for men because they have similar benefits.

12:04 And we feel that these are likely helpful in treating men with osteoporosis.

12:08 But I want to give you one note about denosumab.

12:11 This one is approved to protect bone mass in men who are taking androgen deprivation therapy for prostate cancer.

12:19 Why are we going over that? Well, think about what you know, what's the role of testosterone in bones? Two things, right.

12:29 We know that it increases the bone mass density and it helps make extra red blood cells.

12:35 But if someone has prostate cancer, and they're taking androgen deprivation therapy, they're not going to have that level of testosterone available.

12:45 So they're not going to have the same level of red blood cells as they would have had if they weren't on this deprivation therapy.

12:51 And their bones are not going to be as dense if they would have been, if they weren't on this androgen deprivation therapy because remember, testosterone is an androgen.

13:03 So this particular one is good for patients in this particular situation.

13:09 So if you have prostate cancer, and they're receiving androgen deprivation therapy, this would most likely be the medication that would be recommended.