Your scan says osteopenia. Should you start Fosamax?
In the 1998 trial of alendronate (Fosamax), run with its maker, it worked in women whose scans showed real osteoporosis: over about four years, roughly one woman in fifteen avoided a fracture. In the women with osteopenia, hip density ended close to 5% ahead of placebo, and they had no fewer of the fractures that send you to a doctor.
In the Women's Health Initiative, hormones cut fractures in women who mostly did not have osteoporosis. One treatment helped only below a line on a scan. The other helped regardless of where a woman sat on it. That's because your bones run on hormones, at every age and in both sexes.
Bone is alive, and estradiol is the brake
Bone is living tissue, torn down and rebuilt your whole life by two crews: one digs out old bone, and a slower one refills the pits. The most important hormone running that job, in women and in men, is estradiol. It is the brake on the demolition crew, and when it falls at menopause, bone turnover goes up 50 to 100%. Prolia, an osteoporosis drug, works by blocking RANKL, the signal that sends the demolition crew out, which estradiol already holds down.
The bank you build young
Bone works like a bank: you build most of it by your mid twenties and live on the balance. A monthly period isn't the same as protected bone. In a 1990 study of women with regular periods, women who skipped ovulating even once lost about 4% of their spinal bone in a year.
When a body burns more than it takes in for long enough, the brain reads famine and shuts down the ovaries, in anorexia and in athletes who look healthy. The pill brings back a bleed without the bone: in young athletes who had lost their periods, an estradiol patch with progesterone raised spine density about 2.7% in a year, against about 0.4% on the pill. If food or weight has become a struggle for you or someone you love, the National Alliance for Eating Disorders has a helpline.
When the hormones leave
Bone loss begins about a year before the final period. Men break too, and fare worse: in the three months after a hip fracture, a man's risk of dying runs about eight times that of a man his age without one, and a woman's about six. In PATCH, about half as many men with prostate cancer broke a bone on estradiol patches, which also shut off testosterone, as on the usual injections, with their cancer controlled just as well. That's why I tell people never to crush estradiol in a man on testosterone.
Giving them back
In the Women's Health Initiative, Premarin alone, a drug I don't prescribe, still cut hip fractures by about a third, and by more than half in the women who kept taking it. Pooled, the estradiol trials cut fractures by about 45%, against about a quarter for Premarin. A 2002 review noted the FDA demanded fracture data for drugs like Fosamax and not for hormones. And nobody funds a giant fracture trial of a molecule they can't patent.
Age is no reason not to start. In a 2004 trial in women with osteoporosis averaging 71, about 22 years past menopause, estradiol beat alendronate at the neck of the thighbone: it alone significantly raised density there at both one year and two. Testosterone builds bone too: older men with low testosterone gained about 7.5% in the spongy bone of the spine in a year. Estradiol holds back demolition and progesterone helps the builders, so I pair estradiol with progesterone and never with a synthetic progestin.
Thyroid: it's the disease, not the dose
A large UK study of people with an underactive thyroid, nearly all on replacement, found no link between low or high TSH and fractures overall. The one signal was a TSH above 10, which means too little thyroid. Women whose own glands were overactive had about 10 to 17% less bone at the hip and wrist, while women with an equally suppressed TSH from taking thyroid hormone had the same bone density as healthy controls. There has never been a bone density or fracture trial on desiccated thyroid.
Did they give enough?
The Women's Health Initiative's calcium and vitamin D trial gave 400 units a day, which typically raises your level only three or four points, and hip fractures didn't fall significantly. Its own authors wrote that preventing fractures might require higher doses, and in the women who took most of their pills, hip fractures were about 30% lower. Pooled, counting their own supplements too, hip fractures fell only at about 800 units and above. I aim for a level as close to 100 as possible, and for most people I recommend 5,000 units a day, then we check.
The drugs, the scan line, and stopping
Fosamax and Prolia reduce fractures in women who truly have osteoporosis. But the T-score line is a cut a committee drew in 1994 across a smooth slope of risk, and most broken bones happen on the normal or osteopenic side of it. My position: always hormones first. Prolia isn't stored in bone, so when a dose wears off its effect stops: spine fractures ran about 1 per 100 women a year on the drug and about 7 after stopping, back to the untreated rate. If you're on Prolia, don't stop it on your own, and don't miss a dose.
Load, food and falls
Women past menopause with low bone mass who did supervised heavy lifting twice a week gained about 3% at the spine in eight months. Balance training cuts falls by about a quarter, so it's two prescriptions: load for bone, balance for falls. In nursing homes, more dairy cut fractures by a third. After a gastric sleeve or bypass, hip bone can keep falling after the weight holds steady, despite calcium and vitamin D, so your hormones belong in the plan.
Questions for your next appointment
What do my hormones look like? For women, my floors are an estradiol of at least 75, a testosterone above 250 for most, a free T3 of at least 4 and a vitamin D as close to 100 as possible. For men, a testosterone above 1,000. If it's osteopenia, why Fosamax? Which way is my bone moving, and can we check NTX? If it's Prolia, what's the plan for the day I stop? If my thyroid dose is being cut for my bones, is the loss from the disease or the dose? And whenever someone quotes a study: did they give enough?
You have every right to ask, and to a provider who answers with the research.
The whole argument:
Listen to podcast Part One on Spotify
⚠️ Educational content, not individual medical advice or a treatment recommendation. Nobody should start, stop or change a prescription because of an article. Your labs and history belong in a one on one.
🩺 DNP led telehealth hormone optimization. Book a consultation and find everything: withinyou.health/links
Sources
AbbVie Inc. (2024, April 3). Citizen petition (Docket No. FDA-2024-P-1715). U.S. Food and Drug Administration. https://www.regulations.gov/docket/FDA-2024-P-1715
Abrahamsen, B., Vestergaard, P., Rud, B., Bärenholdt, O., Jensen, J. E., Nielsen, S. P., Mosekilde, L., & Brixen, K. (2006). Ten-year absolute risk of osteoporotic fractures according to BMD T score at menopause: the Danish Osteoporosis Prevention Study. J Bone Miner Res, 21(5), 796-800. https://doi.org/10.1359/jbmr.020604
Ackerman, K. E., Singhal, V., Baskaran, C., Slattery, M., Campoverde Reyes, K. J., Toth, A., Eddy, K. T., Bouxsein, M. L., Lee, H., Klibanski, A., & Misra, M. (2019). Oestrogen replacement improves bone mineral density in oligo-amenorrhoeic athletes: a randomised clinical trial. Br J Sports Med, 53(4), 229-236. https://doi.org/10.1136/bjsports-2018-099723
Alevizaki, M., Mantzou, E., Cimponeriu, A. T., Alevizaki, C. C., & Koutras, D. A. (2005). TSH may not be a good marker for adequate thyroid hormone replacement therapy. Wien Klin Wochenschr, 117(18), 636-40. https://doi.org/10.1007/s00508-005-0421-0
Alibhai, S. M., Duong-Hua, M., Sutradhar, R., Fleshner, N. E., Warde, P., Cheung, A. M., & Paszat, L. F. (2009). Impact of androgen deprivation therapy on cardiovascular disease and diabetes. J Clin Oncol, 27(21), 3452-8. https://doi.org/10.1200/JCO.2008.20.0923
2023 American Geriatrics Society Beers Criteria® Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
American Thyroid Association. (2025, September 18). [Statement on the FDA's action on animal-derived thyroid products].
Amory, J. K., Watts, N. B., Easley, K. A., Sutton, P. R., Anawalt, B. D., Matsumoto, A. M., Bremner, W. J., & Tenover, J. L. (2004). Exogenous testosterone or testosterone with finasteride increases bone mineral density in older men with low serum testosterone. J Clin Endocrinol Metab, 89(2), 503-10. https://doi.org/10.1210/jc.2003-031110
Avenell, A., Mak, J. C., & O'Connell, D. (2014). Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev, 2014(4), CD000227. https://doi.org/10.1002/14651858.CD000227.pub4
Barake, M., Klibanski, A., & Tritos, N. A. (2014). Effects of recombinant human growth hormone therapy on bone mineral density in adults with growth hormone deficiency: a meta-analysis. J Clin Endocrinol Metab, 99(3), 852-60. https://doi.org/10.1210/jc.2013-3921
Bassett, J. H., & Williams, G. R. (2016). Role of Thyroid Hormones in Skeletal Development and Bone Maintenance. Endocr Rev, 37(2), 135-87. https://doi.org/10.1210/er.2015-1106
Baum, H. B., Biller, B. M., Finkelstein, J. S., Cannistraro, K. B., Oppenhein, D. S., Schoenfeld, D. A., Michel, T. H., Wittink, H., & Klibanski, A. (1996). Effects of physiologic growth hormone therapy on bone density and body composition in patients with adult-onset growth hormone deficiency. A randomized, placebo-controlled trial. Ann Intern Med, 125(11), 883-90. https://doi.org/10.7326/0003-4819-125-11-199612010-00003
Behre, H. M., Kliesch, S., Leifke, E., Link, T. M., & Nieschlag, E. (1997). Long-term effect of testosterone therapy on bone mineral density in hypogonadal men. J Clin Endocrinol Metab, 82(8), 2386-90. https://doi.org/10.1210/jcem.82.8.4163
Belaya, Z. E., Melnichenko, G. A., Rozhinskaya, L. Y., Fadeev, V. V., Alekseeva, T. M., Dorofeeva, O. K., Sasonova, N. I., & Kolesnikova, G. S. (2007). Subclinical hyperthyroidism of variable etiology and its influence on bone in postmenopausal women. Hormones (Athens), 6(1), 62-70.
Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., Wu, F. C., & Yialamas, M. A. (2018). Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 103(5), 1715-1744. https://doi.org/10.1210/jc.2018-00229
Bischoff-Ferrari, H. A., Dawson-Hughes, B., Staehelin, H. B., Orav, J. E., Stuck, A. E., Theiler, R., Wong, J. B., Egli, A., Kiel, D. P., & Henschkowski, J. (2009). Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ, 339, b3692. https://doi.org/10.1136/bmj.b3692
Bischoff-Ferrari, H. A., Willett, W. C., Wong, J. B., Stuck, A. E., Staehelin, H. B., Orav, E. J., Thoma, A., Kiel, D. P., & Henschkowski, J. (2009). Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med, 169(6), 551-61. https://doi.org/10.1001/archinternmed.2008.600
Bischoff-Ferrari, H. A., Willett, W. C., Orav, E. J., Lips, P., Meunier, P. J., Lyons, R. A., Flicker, L., Wark, J., Jackson, R. D., Cauley, J. A., Meyer, H. E., Pfeifer, M., Sanders, K. M., Stähelin, H. B., Theiler, R., & Dawson-Hughes, B. (2012). A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med, 367(1), 40-9. https://doi.org/10.1056/NEJMoa1109617
Blum, M. R., Bauer, D. C., Collet, T. H., Fink, H. A., Cappola, A. R., da Costa, B. R., Wirth, C. D., Peeters, R. P., Åsvold, B. O., den Elzen, W. P., Luben, R. N., Imaizumi, M., Bremner, A. P., Gogakos, A., Eastell, R., Kearney, P. M., Strotmeyer, E. S., Wallace, E. R., Hoff, M., . . . Rodondi, N. (2015). Subclinical thyroid dysfunction and fracture risk: a meta-analysis. JAMA, 313(20), 2055-65. https://doi.org/10.1001/jama.2015.5161
Bone, H. G., Greenspan, S. L., McKeever, C., Bell, N., Davidson, M., Downs, R. W., Emkey, R., Meunier, P. J., Miller, S. S., Mulloy, A. L., Recker, R. R., Weiss, S. R., Heyden, N., Musliner, T., Suryawanshi, S., Yates, A. J., & Lombardi, A. (2000). Alendronate and estrogen effects in postmenopausal women with low bone mineral density. Alendronate/Estrogen Study Group. J Clin Endocrinol Metab, 85(2), 720-6. https://doi.org/10.1210/jcem.85.2.6393
Brzozowska, M. M., Tran, T., Bliuc, D., Jorgensen, J., Talbot, M., Fenton-Lee, D., Chen, W., Hong, A., Viardot, A., White, C. P., Nguyen, T. V., Pocock, N., Eisman, J. A., Baldock, P. A., & Center, J. R. (2021). Roux-en-Y gastric bypass and gastric sleeve surgery result in long term bone loss. Int J Obes (Lond), 45(1), 235-246. https://doi.org/10.1038/s41366-020-00660-x
Bundred, N. J., Kenemans, P., Yip, C. H., Beckmann, M. W., Foidart, J. M., Sismondi, P., Schoultz Bv, Vassilopoulou-Sellin, R., Galta, R. E., Lieshout, E. V., Mol-Arts, M., Planellas, J., & Kubista, E. (2012). Tibolone increases bone mineral density but also relapse in breast cancer survivors: LIBERATE trial bone substudy. Breast Cancer Res, 14(1), R13. https://doi.org/10.1186/bcr3097
Burnett-Bowie, S. A., McKay, E. A., Lee, H., & Leder, B. Z. (2009). Effects of aromatase inhibition on bone mineral density and bone turnover in older men with low testosterone levels. J Clin Endocrinol Metab, 94(12), 4785-92. https://doi.org/10.1210/jc.2009-0739
Burt, L. A., Billington, E. O., Rose, M. S., Raymond, D. A., Hanley, D. A., & Boyd, S. K. (2019). Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength: A Randomized Clinical Trial. JAMA, 322(8), 736-745. https://doi.org/10.1001/jama.2019.11889
Carr, B., Dmowski, W. P., O'Brien, C., Jiang, P., Burke, J., Jimenez, R., Garner, E., & Chwalisz, K. (2014). Elagolix, an oral GnRH antagonist, versus subcutaneous depot medroxyprogesterone acetate for the treatment of endometriosis: effects on bone mineral density. Reprod Sci, 21(11), 1341-51. https://doi.org/10.1177/1933719114549848
Cartwright, B., Robinson, J., Seed, P. T., Fogelman, I., & Rymer, J. (2016). Hormone Replacement Therapy Versus the Combined Oral Contraceptive Pill in Premature Ovarian Failure: A Randomized Controlled Trial of the Effects on Bone Mineral Density. J Clin Endocrinol Metab, 101(9), 3497-505. https://doi.org/10.1210/jc.2015-4063
Cauley, J. A., Robbins, J., Chen, Z., Cummings, S. R., Jackson, R. D., LaCroix, A. Z., LeBoff, M., Lewis, C. E., McGowan, J., Neuner, J., Pettinger, M., Stefanick, M. L., Wactawski-Wende, J., & Watts, N. B. (2003). Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial. JAMA, 290(13), 1729-38. https://doi.org/10.1001/jama.290.13.1729
Chapuy, M. C., Arlot, M. E., Duboeuf, F., Brun, J., Crouzet, B., Arnaud, S., Delmas, P. D., & Meunier, P. J. (1992). Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med, 327(23), 1637-42. https://doi.org/10.1056/NEJM199212033272305
Cheung, A. M., Tile, L., Cardew, S., Pruthi, S., Robbins, J., Tomlinson, G., Kapral, M. K., Khosla, S., Majumdar, S., Erlandson, M., Scher, J., Hu, H., Demaras, A., Lickley, L., Bordeleau, L., Elser, C., Ingle, J., Richardson, H., & Goss, P. E. (2012). Bone density and structure in healthy postmenopausal women treated with exemestane for the primary prevention of breast cancer: a nested substudy of the MAP.3 randomised controlled trial. Lancet Oncol, 13(3), 275-84. https://doi.org/10.1016/S1470-2045(11)70389-8
Coelingh Bennink, H. J. T., Prowse, A., Egberts, J. F. M., Debruyne, F. M. J., Huhtaniemi, I. T., & Tombal, B. (2024). The Loss of Estradiol by Androgen Deprivation in Prostate Cancer Patients Shows the Importance of Estrogens in Males. J Endocr Soc, 8(7), bvae107. https://doi.org/10.1210/jendso/bvae107
Corona, G., Vena, W., Pizzocaro, A., Giagulli, V. A., Francomano, D., Rastrelli, G., Mazziotti, G., Aversa, A., Isidori, A. M., Pivonello, R., Vignozzi, L., Mannucci, E., Maggi, M., & Ferlin, A. (2022). Testosterone supplementation and bone parameters: a systematic review and meta-analysis study. J Endocrinol Invest, 45(5), 911-926. https://doi.org/10.1007/s40618-021-01702-5
Cummings, S. R., Black, D. M., Thompson, D. E., Applegate, W. B., Barrett-Connor, E., Musliner, T. A., Palermo, L., Prineas, R., Rubin, S. M., Scott, J. C., Vogt, T., Wallace, R., Yates, A. J., & LaCroix, A. Z. (1998). Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA, 280(24), 2077-82. https://doi.org/10.1001/jama.280.24.2077
Cummings, S. R., Ferrari, S., Eastell, R., Gilchrist, N., Jensen, J. B., McClung, M., Roux, C., Törring, O., Valter, I., Wang, A. T., & Brown, J. P. (2018). Vertebral Fractures After Discontinuation of Denosumab: A Post Hoc Analysis of the Randomized Placebo-Controlled FREEDOM Trial and Its Extension. J Bone Miner Res, 33(2), 190-198. https://doi.org/10.1002/jbmr.3337
CVS Caremark. (2026). [Template formulary change removing desiccated thyroid, effective April 1, 2026].
Davis, S. R., McCloud, P., Strauss, B. J., & Burger, H. (2008). Testosterone enhances estradiol's effects on postmenopausal bone density and sexuality. Maturitas, 61(1-2), 17-26. https://doi.org/10.1016/j.maturitas.2008.09.006
Dawood, M. Y., Ramos, J., & Khan-Dawood, F. S. (1995). Depot leuprolide acetate versus danazol for treatment of pelvic endometriosis: changes in vertebral bone mass and serum estradiol and calcitonin. Fertil Steril, 63(6), 1177-83. https://doi.org/10.1016/s0015-0282(16)57593-1
Dawson-Hughes, B., Harris, S. S., Krall, E. A., & Dallal, G. E. (1997). Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med, 337(10), 670-6. https://doi.org/10.1056/NEJM199709043371003
Dejeu, V., Dejeu, P., Muresan, A., Bradea, P., & Dejeu, D. (2025). Bone Composition Changes and Calcium Metabolism in Obese Adolescents and Young Adults Undergoing Sleeve Gastrectomy: A Systematic Review. J Clin Med, 14(2). https://doi.org/10.3390/jcm14020393
Delbarba, A., Amer, M., Vena, W., Cangiano, B., Ferrante, E., Pizzocaro, A., Chilà, A., Romeo, M., Lanzi, V., Buoso, C., Tiecco, G., Riva, M., Berruti, A., Mazziotti, G., Ferlin, A., & Bonomi, M. (2026). Body composition in male hypogonadism: practical considerations to the use of dual-energy x-ray absorptiometry. Rev Endocr Metab Disord, 27(4), 875-891. https://doi.org/10.1007/s11154-026-10054-5
Eghbali-Fatourechi, G., Khosla, S., Sanyal, A., Boyle, W. J., Lacey, D. L., & Riggs, B. L. (2003). Role of RANK ligand in mediating increased bone resorption in early postmenopausal women. J Clin Invest, 111(8), 1221-30. https://doi.org/10.1172/JCI17215
El Khoudary, S. R., Greendale, G., Crawford, S. L., Avis, N. E., Brooks, M. M., Thurston, R. C., Karvonen-Gutierrez, C., Waetjen, L. E., & Matthews, K. (2019). The menopause transition and women's health at midlife: a progress report from the Study of Women's Health Across the Nation (SWAN). Menopause, 26(10), 1213-1227. https://doi.org/10.1097/GME.0000000000001424
Elraiyah, T., Sonbol, M. B., Wang, Z., Khairalseed, T., Asi, N., Undavalli, C., Nabhan, M., Altayar, O., Prokop, L., Montori, V. M., & Murad, M. H. (2014). Clinical review: The benefits and harms of systemic dehydroepiandrosterone (DHEA) in postmenopausal women with normal adrenal function: a systematic review and meta-analysis. J Clin Endocrinol Metab, 99(10), 3536-42. https://doi.org/10.1210/jc.2014-2261
Eviö, S., Tiitinen, A., Laitinen, K., Ylikorkala, O., & Välimäki, M. J. (2004). Effects of alendronate and hormone replacement therapy, alone and in combination, on bone mass and markers of bone turnover in elderly women with osteoporosis. J Clin Endocrinol Metab, 89(2), 626-31. https://doi.org/10.1210/jc.2003-030198
Falahati-Nini, A., Riggs, B. L., Atkinson, E. J., O'Fallon, W. M., Eastell, R., & Khosla, S. (2000). Relative contributions of testosterone and estrogen in regulating bone resorption and formation in normal elderly men. J Clin Invest, 106(12), 1553-60. https://doi.org/10.1172/JCI10942
Farr, J. N., Khosla, S., Miyabara, Y., Miller, V. M., & Kearns, A. E. (2013). Effects of estrogen with micronized progesterone on cortical and trabecular bone mass and microstructure in recently postmenopausal women. J Clin Endocrinol Metab, 98(2), E249-57. https://doi.org/10.1210/jc.2012-3406
Fenton, T. R., Lyon, A. W., Eliasziw, M., Tough, S. C., & Hanley, D. A. (2009). Meta-analysis of the effect of the acid-ash hypothesis of osteoporosis on calcium balance. J Bone Miner Res, 24(11), 1835-40. https://doi.org/10.1359/jbmr.090515
Finkelstein, J. S., Lee, H., Leder, B. Z., Burnett-Bowie, S. A., Goldstein, D. W., Hahn, C. W., Hirsch, S. C., Linker, A., Perros, N., Servais, A. B., Taylor, A. P., Webb, M. L., Youngner, J. M., & Yu, E. W. (2016). Gonadal steroid-dependent effects on bone turnover and bone mineral density in men. J Clin Invest, 126(3), 1114-25. https://doi.org/10.1172/JCI84137
Food and Drug Administration. (1997). Prescription drug products; levothyroxine sodium. Federal Register, 62, 43535.
Fuchs, R. K., Bauer, J. J., & Snow, C. M. (2001). Jumping improves hip and lumbar spine bone mass in prepubescent children: a randomized controlled trial. J Bone Miner Res, 16(1), 148-56. https://doi.org/10.1359/jbmr.2001.16.1.148
Garnero, P., Sornay-Rendu, E., Claustrat, B., & Delmas, P. D. (2000). Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Miner Res, 15(8), 1526-36. https://doi.org/10.1359/jbmr.2000.15.8.1526
Giske, L. E., Hall, G., Rud, T., & Landgren, B. M. (2002). The effect of 17beta-estradiol at doses of 0.5, 1 and 2 mg compared with placebo on early postmenopausal bone loss in hysterectomized women. Osteoporos Int, 13(4), 309-16. https://doi.org/10.1007/s001980200031
Gupta, B., Mittal, P., Khuteta, R., & Bhargava, A. (2013). A Comparative Study of CEE, Tibolone, and DHEA as Hormone Replacement Therapy for Surgical Menopause. J Obstet Gynaecol India, 63(3), 194-8. https://doi.org/10.1007/s13224-012-0297-7
Haentjens, P., Magaziner, J., Colón-Emeric, C. S., Vanderschueren, D., Milisen, K., Velkeniers, B., & Boonen, S. (2010). Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med, 152(6), 380-90. https://doi.org/10.7326/0003-4819-152-6-201003160-00008
Harding, A. T., Weeks, B. K., Lambert, C., Watson, S. L., Weis, L. J., & Beck, B. R. (2020). A Comparison of Bone-Targeted Exercise Strategies to Reduce Fracture Risk in Middle-Aged and Older Men with Osteopenia and Osteoporosis: LIFTMOR-M Semi-Randomized Controlled Trial. J Bone Miner Res, 35(8), 1404-1414. https://doi.org/10.1002/jbmr.4008
Heemstra, K. A., Hamdy, N. A., Romijn, J. A., & Smit, J. W. (2006). The effects of thyrotropin-suppressive therapy on bone metabolism in patients with well-differentiated thyroid carcinoma. Thyroid, 16(6), 583-91. https://doi.org/10.1089/thy.2006.16.583
Heikkinen, J., Kyllönen, E., Kurttila-Matero, E., Wilén-Rosenqvist, G., Lankinen, K. S., Rita, H., & Väänänen, H. K. (1997). HRT and exercise: effects on bone density, muscle strength and lipid metabolism. A placebo controlled 2-year prospective trial on two estrogen-progestin regimens in healthy postmenopausal women. Maturitas, 26(2), 139-49. https://doi.org/10.1016/s0378-5122(96)01098-5
Hofsø, D., Hillestad, T. O. W., Halvorsen, E., Fatima, F., Johnson, L. K., Lindberg, M., Svanevik, M., Sandbu, R., & Hjelmesæth, J. (2021). Bone Mineral Density and Turnover After Sleeve Gastrectomy and Gastric Bypass: A Randomized Controlled Trial (Oseberg). J Clin Endocrinol Metab, 106(2), 501-511. https://doi.org/10.1210/clinem/dgaa808
Hosking, D., Chilvers, C. E., Christiansen, C., Ravn, P., Wasnich, R., Ross, P., McClung, M., Balske, A., Thompson, D., Daley, M., & Yates, A. J. (1998). Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. Early Postmenopausal Intervention Cohort Study Group. N Engl J Med, 338(8), 485-92. https://doi.org/10.1056/NEJM199802193380801
Institute of Medicine. (2011). Dietary reference intakes for calcium and vitamin D. The National Academies Press. https://doi.org/10.17226/13050
Isidori, A. M., Giannetta, E., Greco, E. A., Gianfrilli, D., Bonifacio, V., Isidori, A., Lenzi, A., & Fabbri, A. (2005). Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clin Endocrinol (Oxf), 63(3), 280-93. https://doi.org/10.1111/j.1365-2265.2005.02339.x
Iuliano, S., Poon, S., Robbins, J., Bui, M., Wang, X., De Groot, L., Van Loan, M., Zadeh, A. G., Nguyen, T., & Seeman, E. (2021). Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial. BMJ, 375, n2364. https://doi.org/10.1136/bmj.n2364
Jackson, R. D., LaCroix, A. Z., Gass, M., Wallace, R. B., Robbins, J., Lewis, C. E., Bassford, T., Beresford, S. A., Black, H. R., Blanchette, P., Bonds, D. E., Brunner, R. L., Brzyski, R. G., Caan, B., Cauley, J. A., Chlebowski, R. T., Cummings, S. R., Granek, I., Hays, J., . . . Barad, D. (2006). Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med, 354(7), 669-83. https://doi.org/10.1056/NEJMoa055218
Jackson, R. D., Wactawski-Wende, J., LaCroix, A. Z., Pettinger, M., Yood, R. A., Watts, N. B., Robbins, J. A., Lewis, C. E., Beresford, S. A., Ko, M. G., Naughton, M. J., Satterfield, S., & Bassford, T. (2006). Effects of conjugated equine estrogen on risk of fractures and BMD in postmenopausal women with hysterectomy: results from the women's health initiative randomized trial. J Bone Miner Res, 21(6), 817-28. https://doi.org/10.1359/jbmr.060312
Jankowski, C. M., Gozansky, W. S., Schwartz, R. S., Dahl, D. J., Kittelson, J. M., Scott, S. M., Van Pelt, R. E., & Kohrt, W. M. (2006). Effects of dehydroepiandrosterone replacement therapy on bone mineral density in older adults: a randomized, controlled trial. J Clin Endocrinol Metab, 91(8), 2986-93. https://doi.org/10.1210/jc.2005-2484
Jankowski, C. M., Gozansky, W. S., Kittelson, J. M., Van Pelt, R. E., Schwartz, R. S., & Kohrt, W. M. (2008). Increases in bone mineral density in response to oral dehydroepiandrosterone replacement in older adults appear to be mediated by serum estrogens. J Clin Endocrinol Metab, 93(12), 4767-73. https://doi.org/10.1210/jc.2007-2614
Jankowski, C. M., Wolfe, P., Schmiege, S. J., Nair, K. S., Khosla, S., Jensen, M., von Muhlen, D., Laughlin, G. A., Kritz-Silverstein, D., Bergstrom, J., Bettencourt, R., Weiss, E. P., Villareal, D. T., & Kohrt, W. M. (2019). Sex-specific effects of dehydroepiandrosterone (DHEA) on bone mineral density and body composition: A pooled analysis of four clinical trials. Clin Endocrinol (Oxf), 90(2), 293-300. https://doi.org/10.1111/cen.13901
Jódar, E., Muñoz-Torres, M., Escobar-Jiménez, F., Quesada-Charneco, M., & Lund del Castillo, J. D. (1997). Bone loss in hyperthyroid patients and in former hyperthyroid patients controlled on medical therapy: influence of aetiology and menopause. Clin Endocrinol (Oxf), 47(3), 279-85. https://doi.org/10.1046/j.1365-2265.1997.2261041.x
Jones, C., Gray, S., Brown, M., Brown, J., McCloskey, E., Rai, B. P., Clarke, N., & Sachdeva, A. (2024). Risk of Fractures and Falls in Men with Advanced or Metastatic Prostate Cancer Receiving Androgen Deprivation Therapy and Treated with Novel Androgen Receptor Signalling Inhibitors: A Systematic Review and Meta-analysis of Randomised Controlled Trials. Eur Urol Oncol, 7(5), 993-1004. https://doi.org/10.1016/j.euo.2024.01.016
Kanis, J. A., Johansson, H., Johnell, O., Oden, A., De Laet, C., Eisman, J. A., Pols, H., & Tenenhouse, A. (2005). Alcohol intake as a risk factor for fracture. Osteoporos Int, 16(7), 737-42. https://doi.org/10.1007/s00198-004-1734-y
Kelly, T. (2014). A favorable risk-benefit analysis of high dose thyroid for treatment of bipolar disorders with regard to osteoporosis. J Affect Disord, 166, 353-8. https://doi.org/10.1016/j.jad.2014.04.022
Khastgir, G., Studd, J., Holland, N., Alaghband-Zadeh, J., Fox, S., & Chow, J. (2001). Anabolic effect of estrogen replacement on bone in postmenopausal women with osteoporosis: histomorphometric evidence in a longitudinal study. J Clin Endocrinol Metab, 86(1), 289-95. https://doi.org/10.1210/jcem.86.1.7161
Kistler-Fischbacher, M., Weeks, B. K., & Beck, B. R. (2021). The effect of exercise intensity on bone in postmenopausal women (part 2): A meta-analysis. Bone, 143, 115697. https://doi.org/10.1016/j.bone.2020.115697
Kistler-Fischbacher, M., Armbrecht, G., Gängler, S., Theiler, R., Rizzoli, R., Dawson-Hughes, B., Kanis, J. A., Hofbauer, L. C., Schimmer, R. C., Vellas, B., Da Silva, J. A. P., John, O. E., Kressig, R. W., Andreas, E., Lang, W., Wanner, G. A., & Bischoff-Ferrari, H. A. (2024). Effects of vitamin D3, omega-3s, and a simple strength training exercise program on bone health: the DO-HEALTH randomized controlled trial. J Bone Miner Res, 39(6), 661-671. https://doi.org/10.1093/jbmr/zjae054
Komulainen, M. H., Kröger, H., Tuppurainen, M. T., Heikkinen, A. M., Alhava, E., Honkanen, R., & Saarikoski, S. (1998). HRT and Vit D in prevention of non-vertebral fractures in postmenopausal women; a 5 year randomized trial. Maturitas, 31(1), 45-54. https://doi.org/10.1016/s0378-5122(98)00085-1
Landin-Wilhelmsen, K., Nilsson, A., Bosaeus, I., & Bengtsson, B. A. (2003). Growth hormone increases bone mineral content in postmenopausal osteoporosis: a randomized placebo-controlled trial. J Bone Miner Res, 18(3), 393-405. https://doi.org/10.1359/jbmr.2003.18.3.393
Lang, T., LeBlanc, A., Evans, H., Lu, Y., Genant, H., & Yu, A. (2004). Cortical and trabecular bone mineral loss from the spine and hip in long-duration spaceflight. J Bone Miner Res, 19(6), 1006-12. https://doi.org/10.1359/JBMR.040307
Langley, R. E., Kynaston, H. G., Alhasso, A. A., Duong, T., Paez, E. M., Jovic, G., Scrase, C. D., Robertson, A., Cafferty, F., Welland, A., Carpenter, R., Honeyfield, L., Abel, R. L., Stone, M., Parmar, M. K., & Abel, P. D. (2016). A Randomised Comparison Evaluating Changes in Bone Mineral Density in Advanced Prostate Cancer: Luteinising Hormone-releasing Hormone Agonists Versus Transdermal Oestradiol. Eur Urol, 69(6), 1016-25. https://doi.org/10.1016/j.eururo.2015.11.030
Langley, R. E., Gilbert, D. C., Mangar, S., Rosen, S., Bourmaki, E., Rush, H. L., Kananga Sundaram, S., Alhasso, A., Kockelbergh, R., Abdel-Aty, H., Amos, C. L., Brown, L., Brown, S., Carvalho, C., Chan, K., Collins, G., Cross, W., Deighan, J., Dixit, S., . . . Nankivell, M. (2026). Transdermal Estradiol Patches in Locally Advanced Prostate Cancer. N Engl J Med, 394(16), 1595-1607. https://doi.org/10.1056/NEJMoa2511781
Lappe, J., Cullen, D., Haynatzki, G., Recker, R., Ahlf, R., & Thompson, K. (2008). Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits. J Bone Miner Res, 23(5), 741-9. https://doi.org/10.1359/jbmr.080102
Law, M. R., & Hackshaw, A. K. (1997). A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ, 315(7112), 841-6. https://doi.org/10.1136/bmj.315.7112.841
LeBoff, M. S., Chou, S. H., Ratliff, K. A., Cook, N. R., Khurana, B., Kim, E., Cawthon, P. M., Bauer, D. C., Black, D., Gallagher, J. C., Lee, I. M., Buring, J. E., & Manson, J. E. (2022). Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults. N Engl J Med, 387(4), 299-309. https://doi.org/10.1056/NEJMoa2202106
Leese, G. P., Soto-Pedre, E., & Donnelly, L. A. (2016). Liothyronine use in a 17 year observational population-based study - the tears study. Clin Endocrinol (Oxf), 85(6), 918-925. https://doi.org/10.1111/cen.13052
Lindner, H. H. (2025). Clinical thyroidology: beyond the 1970s' TSH-T4 Paradigm. Front Endocrinol (Lausanne), 16, 1529791. https://doi.org/10.3389/fendo.2025.1529791
Lips, P., Graafmans, W. C., Ooms, M. E., Bezemer, P. D., & Bouter, L. M. (1996). Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med, 124(4), 400-6. https://doi.org/10.7326/0003-4819-124-4-199602150-00003
Lorentzon, M., Johansson, H., Harvey, N. C., Liu, E., Vandenput, L., Crandall, C. J., Cauley, J. A., LeBoff, M. S., McCloskey, E. V., & Kanis, J. A. (2022). Menopausal hormone therapy reduces the risk of fracture regardless of falls risk or baseline FRAX probability-results from the Women's Health Initiative hormone therapy trials. Osteoporos Int, 33(11), 2297-2305. https://doi.org/10.1007/s00198-022-06483-y
Lufkin, E. G., Wahner, H. W., O'Fallon, W. M., Hodgson, S. F., Kotowicz, M. A., Lane, A. W., Judd, H. L., Caplan, R. H., & Riggs, B. L. (1992). Treatment of postmenopausal osteoporosis with transdermal estrogen. Ann Intern Med, 117(1), 1-9. https://doi.org/10.7326/0003-4819-117-1-1
Maghrabi, A. H., Wolski, K., Abood, B., Licata, A., Pothier, C., Bhatt, D. L., Nissen, S., Brethauer, S. A., Kirwan, J. P., Schauer, P. R., & Kashyap, S. R. (2015). Two-year outcomes on bone density and fracture incidence in patients with T2DM randomized to bariatric surgery versus intensive medical therapy. Obesity (Silver Spring), 23(12), 2344-8. https://doi.org/10.1002/oby.21150
Mantzoros, C. S., Magkos, F., Brinkoetter, M., Sienkiewicz, E., Dardeno, T. A., Kim, S. Y., Hamnvik, O. P., & Koniaris, A. (2011). Leptin in human physiology and pathophysiology. Am J Physiol Endocrinol Metab, 301(4), E567-84. https://doi.org/10.1152/ajpendo.00315.2011
Mehta, J., Kling, J. M., & Manson, J. E. (2021). Risks, Benefits, and Treatment Modalities of Menopausal Hormone Therapy: Current Concepts. Front Endocrinol (Lausanne), 12, 564781. https://doi.org/10.3389/fendo.2021.564781
Misra, M., Papakostas, G. I., & Klibanski, A. (2004). Effects of psychiatric disorders and psychotropic medications on prolactin and bone metabolism. J Clin Psychiatry, 65(12), 1607-18; quiz 1590, 1760-1. https://doi.org/10.4088/jcp.v65n1205
Misra, M., Katzman, D., Miller, K. K., Mendes, N., Snelgrove, D., Russell, M., Goldstein, M. A., Ebrahimi, S., Clauss, L., Weigel, T., Mickley, D., Schoenfeld, D. A., Herzog, D. B., & Klibanski, A. (2011). Physiologic estrogen replacement increases bone density in adolescent girls with anorexia nervosa. J Bone Miner Res, 26(10), 2430-8. https://doi.org/10.1002/jbmr.447
Morishima, A., Grumbach, M. M., Simpson, E. R., Fisher, C., & Qin, K. (1995). Aromatase deficiency in male and female siblings caused by a novel mutation and the physiological role of estrogens. J Clin Endocrinol Metab, 80(12), 3689-98. https://doi.org/10.1210/jcem.80.12.8530621
Mosekilde, L., Beck-Nielsen, H., Sørensen, O. H., Nielsen, S. P., Charles, P., Vestergaard, P., Hermann, A. P., Gram, J., Hansen, T. B., Abrahamsen, B., Ebbesen, E. N., Stilgren, L., Jensen, L. B., Brot, C., Hansen, B., Tofteng, C. L., Eiken, P., & Kolthoff, N. (2000). Hormonal replacement therapy reduces forearm fracture incidence in recent postmenopausal women - results of the Danish Osteoporosis Prevention Study. Maturitas, 36(3), 181-93. https://doi.org/10.1016/s0378-5122(00)00158-4
Mott, A., Bradley, T., Wright, K., Cockayne, E. S., Shearer, M. J., Adamson, J., Lanham-New, S. A., & Torgerson, D. J. (2019). Effect of vitamin K on bone mineral density and fractures in adults: an updated systematic review and meta-analysis of randomised controlled trials. Osteoporos Int, 30(8), 1543-1559. https://doi.org/10.1007/s00198-019-04949-0
Naessen, T., Lindmark, B., Lagerström, C., Larsen, H. C., & Persson, I. (2007). Early postmenopausal hormone therapy improves postural balance. Menopause, 14(1), 14-9. https://doi.org/10.1097/01.gme.0000248707.53075.7f
Neer, R. M. (2010). Bone loss across the menopausal transition. Ann N Y Acad Sci, 1192, 66-71. https://doi.org/10.1111/j.1749-6632.2009.05233.x
Ng Tang Fui, M., Hoermann, R., Bracken, K., Handelsman, D. J., Inder, W. J., Stuckey, B. G. A., Yeap, B. B., Ghasem-Zadeh, A., Robledo, K. P., Jesudason, D., Zajac, J. D., Wittert, G. A., & Grossmann, M. (2021). Effect of Testosterone Treatment on Bone Microarchitecture and Bone Mineral Density in Men: A 2-Year RCT. J Clin Endocrinol Metab, 106(8), e3143-e3158. https://doi.org/10.1210/clinem/dgab149
Paccou, J., Martignène, N., Lespessailles, E., Babykina, E., Pattou, F., Cortet, B., & Ficheur, G. (2020). Gastric Bypass But Not Sleeve Gastrectomy Increases Risk of Major Osteoporotic Fracture: French Population-Based Cohort Study. J Bone Miner Res, 35(8), 1415-1423. https://doi.org/10.1002/jbmr.4012
Penna, G. C., Bianco, A. C., & Ettleson, M. D. (2024). A Cross-Sectional Analysis of Cardiovascular and Bone Health Care Utilization During Treatment With Thyroid Hormone. J Clin Endocrinol Metab, 109(3), e1143-e1150. https://doi.org/10.1210/clinem/dgad629
PEPI Writing Group. (1996). Effects of hormone therapy on bone mineral density: results from the postmenopausal estrogen/progestin interventions (PEPI) trial. JAMA, 276(17), 1389-96.
Pfeifer, M., Begerow, B., Minne, H. W., Suppan, K., Fahrleitner-Pammer, A., & Dobnig, H. (2009). Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int, 20(2), 315-22. https://doi.org/10.1007/s00198-008-0662-7
Popat, V. B., Calis, K. A., Kalantaridou, S. N., Vanderhoof, V. H., Koziol, D., Troendle, J. F., Reynolds, J. C., & Nelson, L. M. (2014). Bone mineral density in young women with primary ovarian insufficiency: results of a three-year randomized controlled trial of physiological transdermal estradiol and testosterone replacement. J Clin Endocrinol Metab, 99(9), 3418-26. https://doi.org/10.1210/jc.2013-4145
Prestwood, K. M., Kenny, A. M., Kleppinger, A., & Kulldorff, M. (2003). Ultralow-dose micronized 17beta-estradiol and bone density and bone metabolism in older women: a randomized controlled trial. JAMA, 290(8), 1042-8. https://doi.org/10.1001/jama.290.8.1042
Prince, R. L., Devine, A., Dhaliwal, S. S., & Dick, I. M. (2006). Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med, 166(8), 869-75. https://doi.org/10.1001/archinte.166.8.869
Prior, J. C., Vigna, Y. M., Schechter, M. T., & Burgess, A. E. (1990). Spinal bone loss and ovulatory disturbances. N Engl J Med, 323(18), 1221-7. https://doi.org/10.1056/NEJM199011013231801
Prior, J. C. (2015). Progesterone or progestin as menopausal ovarian hormone therapy: recent physiology-based clinical evidence. Curr Opin Endocrinol Diabetes Obes, 22(6), 495-501. https://doi.org/10.1097/MED.0000000000000205
Prior, J. C., Seifert-Klauss, V. R., Giustini, D., Adachi, J. D., Kalyan, S., & Goshtasebi, A. (2017). Estrogen-progestin therapy causes a greater increase in spinal bone mineral density than estrogen therapy - a systematic review and meta-analysis of controlled trials with direct randomization. J Musculoskelet Neuronal Interact, 17(3), 146-154.
Rabaglio, M., Sun, Z., Price, K. N., Castiglione-Gertsch, M., Hawle, H., Thürlimann, B., Mouridsen, H., Campone, M., Forbes, J. F., Paridaens, R. J., Colleoni, M., Pienkowski, T., Nogaret, J. M., Láng, I., Smith, I., Gelber, R. D., Goldhirsch, A., & Coates, A. S. (2009). Bone fractures among postmenopausal patients with endocrine-responsive early breast cancer treated with 5 years of letrozole or tamoxifen in the BIG 1-98 trial. Ann Oncol, 20(9), 1489-1498. https://doi.org/10.1093/annonc/mdp033
Riggs, B. L., Khosla, S., & Melton LJ 3rd (2002). Sex steroids and the construction and conservation of the adult skeleton. Endocr Rev, 23(3), 279-302. https://doi.org/10.1210/edrv.23.3.0465
Riis, B. J., Thomsen, K., Strøm, V., & Christiansen, C. (1987). The effect of percutaneous estradiol and natural progesterone on postmenopausal bone loss. Am J Obstet Gynecol, 156(1), 61-5. https://doi.org/10.1016/0002-9378(87)90203-1
Rochira, V., Faustini-Fustini, M., Balestrieri, A., & Carani, C. (2000). Estrogen replacement therapy in a man with congenital aromatase deficiency: effects of different doses of transdermal estradiol on bone mineral density and hormonal parameters. J Clin Endocrinol Metab, 85(5), 1841-5. https://doi.org/10.1210/jcem.85.5.6583
Rossouw, J. E., Anderson, G. L., Prentice, R. L., LaCroix, A. Z., Kooperberg, C., Stefanick, M. L., Jackson, R. D., Beresford, S. A., Howard, B. V., Johnson, K. C., Kotchen, J. M., & Ockene, J. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA, 288(3), 321-33. https://doi.org/10.1001/jama.288.3.321
Sanders, K. M., Stuart, A. L., Williamson, E. J., Simpson, J. A., Kotowicz, M. A., Young, D., & Nicholson, G. C. (2010). Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA, 303(18), 1815-22. https://doi.org/10.1001/jama.2010.594
Schini, M., Vilaca, T., Gossiel, F., Salam, S., & Eastell, R. (2023). Bone Turnover Markers: Basic Biology to Clinical Applications. Endocr Rev, 44(3), 417-473. https://doi.org/10.1210/endrev/bnac031
Scholes, D., Hubbard, R. A., Ichikawa, L. E., LaCroix, A. Z., Spangler, L., Beasley, J. M., Reed, S., & Ott, S. M. (2011). Oral contraceptive use and bone density change in adolescent and young adult women: a prospective study of age, hormone dose, and discontinuation. J Clin Endocrinol Metab, 96(9), E1380-7. https://doi.org/10.1210/jc.2010-3027
Seifert-Klauss, V., & Prior, J. C. (2010). Progesterone and bone: actions promoting bone health in women. J Osteoporos, 2010, 845180. https://doi.org/10.4061/2010/845180
Sestak, I., Singh, S., Cuzick, J., Blake, G. M., Patel, R., Gossiel, F., Coleman, R., Dowsett, M., Forbes, J. F., Howell, A., & Eastell, R. (2014). Changes in bone mineral density at 3 years in postmenopausal women receiving anastrozole and risedronate in the IBIS-II bone substudy: an international, double-blind, randomised, placebo-controlled trial. Lancet Oncol, 15(13), 1460-1468. https://doi.org/10.1016/S1470-2045(14)71035-6
Shahinian, V. B., Kuo, Y. F., Freeman, J. L., & Goodwin, J. S. (2005). Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med, 352(2), 154-64. https://doi.org/10.1056/NEJMoa041943
Shea, B., Wells, G., Cranney, A., Zytaruk, N., Robinson, V., Griffith, L., Hamel, C., Ortiz, Z., Peterson, J., Adachi, J., Tugwell, P., & Guyatt, G. (2004). Calcium supplementation on bone loss in postmenopausal women. Cochrane Database Syst Rev(1), CD004526. https://doi.org/10.1002/14651858.CD004526.pub2
Sherrington, C., Fairhall, N., Wallbank, G., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. (2020). Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. Br J Sports Med, 54(15), 885-891. https://doi.org/10.1136/bjsports-2019-101512
Snyder, P. J., Kopperdahl, D. L., Stephens-Shields, A. J., Ellenberg, S. S., Cauley, J. A., Ensrud, K. E., Lewis, C. E., Barrett-Connor, E., Schwartz, A. V., Lee, D. C., Bhasin, S., Cunningham, G. R., Gill, T. M., Matsumoto, A. M., Swerdloff, R. S., Basaria, S., Diem, S. J., Wang, C., Hou, X., . . . Keaveny, T. M. (2017). Effect of Testosterone Treatment on Volumetric Bone Density and Strength in Older Men With Low Testosterone: A Controlled Clinical Trial. JAMA Intern Med, 177(4), 471-479. https://doi.org/10.1001/jamainternmed.2016.9539
Snyder, P. J., Bauer, D. C., Ellenberg, S. S., Cauley, J. A., Buhr, K. A., Bhasin, S., Miller, M. G., Khan, N. S., Li, X., & Nissen, S. E. (2024). Testosterone Treatment and Fractures in Men with Hypogonadism. N Engl J Med, 390(3), 203-211. https://doi.org/10.1056/NEJMoa2308836
Solmi, M., Veronese, N., Correll, C. U., Favaro, A., Santonastaso, P., Caregaro, L., Vancampfort, D., Luchini, C., De Hert, M., & Stubbs, B. (2016). Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis. Acta Psychiatr Scand, 133(5), 341-51. https://doi.org/10.1111/acps.12556
Starrach, T., Santl, A., & Seifert-Klauss, V. R. (2022). Perimenopausal Bone Loss Is Associated with Ovulatory Activity-Results of the PeKnO Study (Perimenopausal Bone Density and Ovulation). Diagnostics (Basel), 12(2). https://doi.org/10.3390/diagnostics12020305
Stephens-Shields, A. J., Snyder, P. J., Ellenberg, S. S., Taylor, L., & Bhasin, S. (2022). Relation of Testosterone, Dihydrotestosterone, and Estradiol With Changes in Outcomes Measures in the Testosterone Trials. J Clin Endocrinol Metab, 107(5), 1257-1269. https://doi.org/10.1210/clinem/dgac028
Tan, L., He, R., & Zheng, X. (2024). Effect of vitamin D, calcium, or combined supplementation on fall prevention: a systematic review and updated network meta-analysis. BMC Geriatr, 24(1), 390. https://doi.org/10.1186/s12877-024-05009-x
Thayakaran, R., Adderley, N. J., Sainsbury, C., Torlinska, B., Boelaert, K., Šumilo, D., Price, M., Thomas, G. N., Toulis, K. A., & Nirantharakumar, K. (2019). Thyroid replacement therapy, thyroid stimulating hormone concentrations, and long term health outcomes in patients with hypothyroidism: longitudinal study. BMJ, 366, l4892. https://doi.org/10.1136/bmj.l4892
Tomkinson, A., Reeve, J., Shaw, R. W., & Noble, B. S. (1997). The death of osteocytes via apoptosis accompanies estrogen withdrawal in human bone. J Clin Endocrinol Metab, 82(9), 3128-35. https://doi.org/10.1210/jcem.82.9.4200
Torgrimson, B. N., Meendering, J. R., Kaplan, P. F., & Minson, C. T. (2011). Depot-medroxyprogesterone acetate and endothelial function before and after acute oral, vaginal, and transdermal estradiol treatment. Hypertension, 57(4), 819-24. https://doi.org/10.1161/HYPERTENSIONAHA.110.163386
U.S. Food and Drug Administration. (2025, August). [Letters to manufacturers of unapproved animal-derived thyroid drug products].
Vatrasresth, J., Suwan, A., & Panyakhamlerd, K. (2021). Effects of early estradiol valerate administration on bone turnover markers in surgically induced menopausal women. BMC Womens Health, 21(1), 363. https://doi.org/10.1186/s12905-021-01508-w
Vestergaard, P., & Mosekilde, L. (2002). Fractures in patients with hyperthyroidism and hypothyroidism: a nationwide follow-up study in 16,249 patients. Thyroid, 12(5), 411-9. https://doi.org/10.1089/105072502760043503
Vestergaard, P., Emborg, C., Støving, R. K., Hagen, C., Mosekilde, L., & Brixen, K. (2002). Fractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders--a nationwide register study. Int J Eat Disord, 32(3), 301-8. https://doi.org/10.1002/eat.10101
Wang, C., Swerdloff, R. S., Iranmanesh, A., Dobs, A., Snyder, P. J., Cunningham, G., Matsumoto, A. M., Weber, T., & Berman, N. (2001). Effects of transdermal testosterone gel on bone turnover markers and bone mineral density in hypogonadal men. Clin Endocrinol (Oxf), 54(6), 739-50. https://doi.org/10.1046/j.1365-2265.2001.01271.x
Watson, S. L., Weeks, B. K., Weis, L. J., Horan, S. A., & Beck, B. R. (2015). Heavy resistance training is safe and improves bone, function, and stature in postmenopausal women with low to very low bone mass: novel early findings from the LIFTMOR trial. Osteoporos Int, 26(12), 2889-94. https://doi.org/10.1007/s00198-015-3263-2
Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A., & Beck, B. R. (2018). High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res, 33(2), 211-220. https://doi.org/10.1002/jbmr.3284
Watts, N. B., Cauley, J. A., Jackson, R. D., LaCroix, A. Z., Lewis, C. E., Manson, J. E., Neuner, J. M., Phillips, L. S., Stefanick, M. L., Wactawski-Wende, J., & Crandall, C. (2017). No Increase in Fractures After Stopping Hormone Therapy: Results From the Women's Health Initiative. J Clin Endocrinol Metab, 102(1), 302-308. https://doi.org/10.1210/jc.2016-3270
Wells, G., Tugwell, P., Shea, B., Guyatt, G., Peterson, J., Zytaruk, N., Robinson, V., Henry, D., O'Connell, D., & Cranney, A. (2002). Meta-analyses of therapies for postmenopausal osteoporosis. V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women. Endocr Rev, 23(4), 529-39. https://doi.org/10.1210/er.2001-5002
Williams, G. R. (2013). Thyroid hormone actions in cartilage and bone. Eur Thyroid J, 2(1), 3-13. https://doi.org/10.1159/000345548
World Health Organization. (1994). Assessment of fracture risk and its application to screening for postmenopausal osteoporosis (WHO Technical Report Series No. 843).
Wu, K. C., McCauley, K. E., Lynch, S. V., Nayak, R. R., King, N. J., Patel, S., Kim, T. Y., Condra, K., Fadrosh, D., Nguyen, D., Lin, D. L., Lynch, K., Rogers, S. J., Carter, J. T., Posselt, A. M., Stewart, L., & Schafer, A. L. (2024). Alteration in the gut microbiome is associated with changes in bone metabolism after laparoscopic sleeve gastrectomy. J Bone Miner Res, 39(2), 95-105. https://doi.org/10.1093/jbmr/zjad017
Yao, P., Bennett, D., Mafham, M., Lin, X., Chen, Z., Armitage, J., & Clarke, R. (2019). Vitamin D and Calcium for the Prevention of Fracture: A Systematic Review and Meta-analysis. JAMA Netw Open, 2(12), e1917789. https://doi.org/10.1001/jamanetworkopen.2019.17789
Zerwekh, J. E., Ruml, L. A., Gottschalk, F., & Pak, C. Y. (1998). The effects of twelve weeks of bed rest on bone histology, biochemical markers of bone turnover, and calcium homeostasis in eleven normal subjects. J Bone Miner Res, 13(10), 1594-601. https://doi.org/10.1359/jbmr.1998.13.10.1594
Zhu, L., Jiang, X., Sun, Y., & Shu, W. (2016). Effect of hormone therapy on the risk of bone fractures: a systematic review and meta-analysis of randomized controlled trials. Menopause, 23(4), 461-70. https://doi.org/10.1097/GME.0000000000000519
