Osteoporosis hormone replacement therapy

Estrogens are most commonly used as a component of combination contraceptives or as hormone replacement therapy in postmenopausal women. Benefits in postmenopausal women include relief of moderate to severe vasomotor symptoms and decreased risk of osteoporosis. Hormone replacement therapy also may be used in vaginal and vulvar atrophy and in hypoestrogenism caused by hypogonadism, castration, or primary ovarian failure. Less commonly, select breast or prostate cancer... 

Estrogens and progestins are diminished in menopausal or ovarectomized women. In hormone replacement therapy (HRT), these hormones are substituted to alleviate hot flushes, mood changes, sleep disorders, and osteoporosis. 

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. 

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... 

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... 

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. 

Hormone replacement therapy provides relief from vasomotor symptoms, decreases the risk of osteoporosis and decreases the risk of cardiovascular disease in post-menopausal women. 

This combination product is on example of a combined hormone replacement therapy that increases the risk of stroke slightly and, with long-term use, increases the risk of ovarian cancer slightly. Hormone replacement therapy alleviates symptoms of menopause and can be used as a prophylaxis of osteoporosis. 

The chief therapeutic uses of estrogens and progestins are as oral contraceptives and hormone replacement therapy. Progestins and SERMs are also important agents in the treatment of osteoporosis, breast cancer, endometrial cancer, and infertility. 

The ability of androgens to counter osteoporosis is the basis of their use as a supplement to estrogens in one version of hormone replacement therapy. Testosterone can increase markers of bone formation (66). However, the early closure of epiphyses, with an arrest of growth, is a risk if children are exposed to these substances this latter effect may be produced by the estrogen to which testosterone is metabolized. In some patients with... 

Cranney A, Wells GA. Hormone replacement therapy for postmenopausal osteoporosis. Clin Geriatr Med 2003 19 361-70. 

Gambacciani M, Vacca F. Postmenopausal osteoporosis and hormone replacement therapy. Minerva Med. 2004 95 507-520. 

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. 

Hormone replacement therapy (HRT), including tibolone, is not recommended for postmenopausal women over the age of 50 years unless other treatments for osteoporosis are contraindicated or not tolerated (MHRA, 2005). 

Invention Significance Hormone replacement therapy for osteoporosis... 

A 50-year-old woman, who had taken one conjugated estrogen tablet daily for hormone replacement therapy and tricalcium phosphate twice daily for osteoporosis, took zolpidem 10 mg for insomnia and paracetamol 500 mg for a headache at bedtime (31). She began to have visual hallucinations within 20 minutes, lasting for about 30 minutes, and then her vision returned to normal. She only partially recalled the event. She had never taken zolpidem before and had not had any such disturbances in the past. 

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