Osteoporosis hormone therapy

The benefits of hormonal therapies for osteoporosis prevention are discussed in Chap. 3. Hormone therapy should be considered for osteoporosis prevention only in women at significant risk for osteoporosis who cannot take nonestrogen regimens. 

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... 

Alternatives to steroid hormone therapy for osteoporosis include raloxifene, bisphosphonates, sodium fluoride, vitamin D and calcium supplementation, calcitonin, and parathyroid hormone. Tamoxifen has estrogenic effects on bone and delays bone loss in postmenopausal women. However as a result of estrogenic activity in the uterus, long-term tamoxifen administration has been associated with an increased risk of... 

MacLennan AH, Sturdee D. Is hormone therapy still an option for the management of osteoporosis Climacteric 2003 6 89-91. 

The most frequent uses of estrogens are for contraception (see p. 268), for postmenopausal hormone therapy and for osteoporosis. Estrogens are also used extensively for replacement therapy in patients deficient in this hormone. Such a deficiency can be due to lack of development of the ovaries, menopause, or castration. 

Idiopathic osteoporosis cannot be prevented by prophylactic therapy, but its development can be delayed. This requires a healthy lifestyle with plenty of physical exercise (sports, hiking), daily intake of calcium (lOOOmg/day Ca2+) and of vitamin D (1000 IU/day). The same principle holds for postmenopausal osteoporosis. Hormone Luellmann, Color Atlas of Pharmacology All rights reserved. Usage subject to terms... 

Both undertreatment and underutilization of medications are common problems in the elderly. It is often a result of stereotyping by healthcare professionals, lack of education of managing medications in the elderly, and lack of research. Examples include treatment of hypertension, prescribing hormone therapy, osteoporosis, treating MI, lipid management, pain management, and depression. 

Estrogen-based postmenopausal hormone therapy should be used for the treatment of menopausal symptoms (i.e., vasomotor and urogenital symptoms) and, when specifically indicated, for osteoporosis prevention. 

Osteoporosis prevention remains an approved indication for estrogen-based hormone therapy, but alternative strategies are available and should be considered as first-line agents for asymptomatic women. Vitamin D deficiency should be excluded before any other treatment is prescribed... 

Approved indications of hormone therapy include treatment of menopausal symptoms and osteoporosis prevention. Therapy directed at menopausal symptoms, such as hot flushes, is often short term. However, therapy directed at prevention of osteoporosis should be long term. For osteoporosis prevention, the advantages of hormone therapy must be weighed against risks, including thrombosis and the increased incidence of cardiovascular disease and breast cancer, and consideration should be given to approved nonestrogen alternatives. 

Osteoporosis prevention remains an indicated use of estrogen products however, nonestrogen products, such as raloxifene and bis-phosphonates, are as effective as hormone therapy for preventing osteoporosis (Table 80-7). The FDA has withdrawn the osteoporosis treatment indication from estrogen products. 

TABLE 80—7. Alternatives to Hormone Therapy for Osteoporosis Prevention... 

Menopause is a natural life event, not a disease. The decision to take hormone therapy must be individualized and based on several parameters, including menopausal symptoms, osteoporosis risk, coronary artery disease risk, breast cancer risk, and thromboem-... 

Long-term use of hormone therapy cannot be recommended routinely for osteoporosis prevention given the availability of alternative therapies, such as raloxifene and the bisphosponates. For longterm hormone therapy use, the potential harm (cardiovascular disease, breast cancer, and thromboembolism) outweighs the potential benefits. 

The American Academy of Pediatrics recommends low-dose estrogen supplementation for amenorrhea if age is greater than 16 until normal menses returns. Most studies do not find that oral contraceptives improve BMD. Bisphosphonates are not approved for children. Hormone therapy and bisphosphonates may be used in adults. Recombinant IGF-I and dehydroepiandrosterone are being explored as possible for treatments for women with osteoporosis. 

The goals of osteoporosis treatment are to control pain from the disease, reduce bone loss, and prevent bone fractures with medicines or hormone therapies. There are several types of treatments for osteoporosis including most famous bisphosphonates, estrogen agonists/antagonists, parathyroid... 

Pentti, K., Tuppurainen, M. T., Honkanen, R., Sandini, L., Kroger, H., Alhava, E., and Saarikoski, S. (2009). Hormone therapy protects from diabetes The Kuopio osteoporosis risk factor and prevention study. Eur. J. Endocrinol. 160, 979-983. 

A 74-year-old woman, who was referred for evaluation of pain and persistently abnormal exposure of jaw bone after extraction of teeth, had been using weekly oral alendronate for osteoporosis for about 5 years. She had the clinical features of bisphosphonate-associated osteonecrosis of the mandible, which was precipitated by extraction of teeth 14 months before she was referred for assessment. She had multiple susceptibility factors for osteonecrosis of the jaw, including older age, type 2 diabetes mellitus, and a long duration of bisphosphonate therapy. The mandibular lesions did not improve despite repeated operations over 14 months. Bisphosphonate therapy was withdrawn and parathyroid hormone therapy was started after 2 months the oral mucosa had healed, after 4 months the pain had completely subsided, and after 6 months the patient s eating and drinking habits had returned. The serum concentration of osteocalcin, a marker of bone formation, which was initially suppressed, increased by 174% from baseline after 6 months of treatment with parathyroid hormone. 

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