Hormone replacement therapy vitamin

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. 

KOMULAINEN M, KROGER H, TUPPURAINEN M T, HEIKKINEN A M, ALHAVA E, HONKANEN R, lURVELIN I and SAARiKOSKi s (1999) Prevention of femoral and lumbar bone loss with hormone replacement therapy and vitamin D3 in early postmenopausal women a population-based 5-year randomized trial. J Clin Endocrinol Metab 84, 546-52. 

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. 

Osteoporosis Oral calcium supplementation (1000-5000 mg/day) Oral vitamin D Calcifediol (1000 lU/day) Calcitriol (0.5 mcg/day) Hormone-replacement therapy Calcitonin or oral bisphosphonates If daily intake less than 1000 mg elemental calcium Documented deficiency If kidney functioning If kidney not functioning Post-menopausal women without contraindications Documented loss in bone mineral density greater than 3% Data lacking for bisphosphonates in patients with Rl... 

The clinical problems that arise in the menopause are hot flushes, sweating, depression, decreased libido, increased risk of cardiovascular disease and osteoporosis. The latter results in increased incidence of hip, radial and vertebral fractures. Oestrogen is one factor controlling synthesis of active vitamin D and osteoporosis is in part due to a deficiency of vitamin D. Not surprisingly, to reduce these problems, administration of oestrogen is recommended (known as hormone replacement therapy or HRT). HRT reduces some of the risk factors for coronary artery disease since it reduces blood pressure and decreases the blood level of LDL-cholesterol and increases that of HDL-cholesterol. However, there is considerable debate about whether HRT increases the risk of breast or endometrial cancer. 

The reference values for human adults are in the range of 6 to 12 mM. Values exceeding 16 xM characterize hyperhomocysteinemia. Hyperhomocysteinemia can be fiuther subclassified as mild, intermediate, and severe [3,92]. Elevated homocysteine levels are found in 1-2% in the general population. Higher prevalence is associated with vascular diseases [3,93]. It increases with age. The vitamin deficiency, frequent in the elderly, contributes for the elevation of homocysteine levels [3,94]. Homocysteine levels increase in post-menopausal women, and are attenuated by hormone replacement therapy [3,94]. Hyperhomocysteinemia may result from [2,3,88,93] ... 

Waters, D. D., E. L. Alderman, J. Hsia, B. V. Howard, F. R. Cobb, W. J. Rogers, P. Ouyang et al. 2002. Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women A randomized controlled trial. JAMA 288 2432-2440. 

Slatore CG, Chien JW, Au DH, Satia JA, White E. Lung cancer and hormone replacement therapy association in the vitamins and lifestyle study. J Clin Oncol 2010 28 1540-6. 

Waters DD, Alderman EL, Hsia J, Howard BV, Cobb FR, Rogers WJ, et al. Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary arteriosclerosis in postmenopausal women a randomized controlled trial. J Am Med Assoc 2002 288(19) 2432- 0. 

Estrogens do not cause vitamin Bg deficiency. However, there is evidence that high doses of vitamin Bg may overcome some of the side effects of estrogenic steroids used in contraceptives and as menopausal hormone replacement therapy. At very high levels of intake, supplements may cause sensory nerve damage. 

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. 

Zinc is the prosthetic group for many enzymes. It is also incorporated into the receptor proteins for steroid and thyroid hormones, calcitriol and vitamin A. Recommended daily intake of zinc is 10 mg/day. Zinc is found in all tissues of the body, but it is particularly high in the bone, liver and kidney. Zinc deficiency causes growth retardation, decreased wound healing and hypogonadism (i.e. much delayed puberty). It is only normally seen in populations whose diet is based on unleavened wholemeal bread, because wheat flour does not provide much zinc, and that which is available is bound to phytate. Phytate also inhibits the absorption of iron. Zinc depletion may also be caused by drugs such as thiazide and loop diuretics, and alcohol. Zinc deficiency can be successfully treated with replacement zinc therapy. 

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