Hormone replacement therapy osteoporosis prevention

PRINCE R L, SMITH M, DICK I M, PRICE R I, WEBB P G, HENDERSON N K and HARRIS M M (1991) Prevention of postmenopausal osteoporosis. A comparative study of exercise, calciiun supplementation, and hormone-replacement therapy. N Eng J Med 325, 1189-95. 

Hormone-replacement therapy is also indicated for the prevention of osteoporosis but is not recommended for longterm use. Alternatives such as bisphosphonates or raloxifene should be considered as first-line therapy for the prevention of osteoporosis, in addition to appropriate doses of calcium and vitamin D. 

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 23 529-539... 

Estradiol (valerate) Estradiol + norethindronate (acetate) Estradiol (valerate ) + levonorgestrel Hormone-replacement therapy in estrogen-deficiency symptoms and prevention of osteoporosis in postmenopausal women... 

Options for treatment include hormone replacement therapy (HRT), bisphosphonates, calcitriol, calcitonin, raloxifene, strontium ranelate, and teriparatide. Hormone replacement therapy is generally indicated for women who are under 50 years and are experiencing a premature menopause. Symptomatic menopausal women may opt to use HRT also, as the benefits outweigh the risks for up to 5 years treatment. They may choose an alternative treatment for osteoporosis if preferred. Hormone replacement therapy is not recommended for first line treatment for long-term prevention of osteoporosis in women over 50 years of age. 

The United States government is currently conducting a study with nine years of follow-up which will examine the effect of hormone replacement therapy on the prevention of heart disease and osteoporosis. The study is expected to enroll 63,000 women ages 50-79, and will include scientifically selected control and treatment groups. 

Wells G, Tugwell R Shea B, et al. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women. Endocr Rev 2002 23 529-539. 

Alendronate is currently the drug of choice to prevent osteoporosis in patients who must be maintained on steroids for their antiinflammatory and immunosuppressive effects. The drug also decreases bone resorption during menopause and is sometimes favored in patients who are at risk for neoplasias if treated with sex hormones. Care must be taken with alendronate to avoid esophageal ulceration. Estrogen hormone replacement therapy +/- vitamin D also has proven value for slowing bone resorption in menopause, and increases in bone mass have been reported for combinations of estrogens with alendronate. 

Primary ovarian failure. This is indicated by elevated gonadotrophins and low oestradiol concentration (a postmenopausal pattern). Hormone replacement therapy assists libido and prevents osteoporosis, but does not restore fertility. 

Estrogen Postmenopausal status or estrogen deficiency at any age significantly increases the risk for osteoporosis. Likewise, overwhelming evidence supports the positive impact of postmenopausal estrogen replacement on bone conservation and protection against osteoporotic fractures. The apparently increased risk of adverse cardiovascular events in prospective studies has led to the recommendation that hormone replacement therapy should not be first-line therapy for prevention or treatment of osteoporosis. 

Hassager C, Jensen SB, Christiansen C (1994) Nonresponders to hormone replacement therapy for the prevention of postmenopausal bone loss - do they exist. Osteoporosis International 4 36 1. 

The nurse is discussing ways to prevent osteoporosis to a group of elderly women. A woman in the audience asks, Why aren t doctors prescribing hormone replacement therapy Which statement by the nurse would be most appropriate ... 

Non-compliance is a serious problem in the prevention of osteoporosis and osteoporotic fractures. This is due to adverse effects, lack of noticeable benefit and ignorance. It is difficult to convince regular intake of oral calcium, biphosphonates, vitamin D and in post-menopausal women hormone replacement. Long-term compliance to hormone replacement is worse in developing countries. The most cost-effective therapy for osteoporosis is primary prevention. 

Once skeletal maiurily has been attained, it is the magnitude of the subsequent bone loss which may lead to osteoporosis. Tlie use of corticosteroid drugs should be minimized. Stopping smoking is impttrtant. At the menopause, hormone replacement iherapy is of benefit, not only for the relief of menopausal symptoms but also to prevent rapid bone loss. Indeed, cardiovascular protection also follows as an incidental benefit of such therapy. 

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