Estrogen therapy / Hormone therapy
Prevention and treatment of osteoporosis should always
include a nutrient-rich diet, the recommended intake of calcium and vitamin D,
regular physical activity, safety precautions for fall prevention, avoidance of
smoking and limited consumption of alcohol. If osteoporosis is
diagnosed, you still must continue to make bone healthy lifestyle
choices. However, lifestyle modifications alone are often not enough.
Your healthcare provider may prescribe an osteoporosis
medication to help stop further bone loss and reduce your risk for
broken bones.
What are the medication options for osteoporosis?
The
U.S. Food and Drug Administration (FDA) has approved several
medications for osteoporosis which fall into two classes: antiresorptive medications and anabolic medications. Antiresorptive medications are used to strengthen bone, prevent bone loss and reduce the risk of fracture (broken bone).
The antiresorptive medications include a class of drugs called bisphosphonates.The four bisphosphonate medications are:
- alendronate - available as a generic medication (Brand name: Fosamax, Fosamax D)
- risedronate (Brand name: Actonel, Actonel with Calcium )
- ibandronate ( Brand name: Boniva)
- zoledronic acid (Brand name: Reclast)
Other approved antiresorptive medications include:
Anabolic medication builds new bone, increases bone density and helps reduce fracture risk. At this time the only approved anabolic medication is:
It is important to speak to your healthcare provider about the medication option that is right for you
What should I know about estrogen therapy or hormone therapy?
Estrogen is a hormone that protects bone. Estrogen
therapy (ET), refers to estrogen given alone,and can be considered for postmenopausal women who have had their uterus removed. Hormone therapy (HT), estrogen plus progestin (progesterone), can be prescribed for a woman with an intact uterus. Progestin is given in combination with estrogen to protect the uterine lining and reduce the risk of uterine cancer. Both ET and HT are FDA-approved for the prevention of
osteoporosis in postmenopausal women. ET and HT are
available in either tablet form or as a skin patch. There are many brand and generic forms of ET and HT available. When taking estrogen therapy or hormone therapy,
it is necessary to consume the recommended amount of calcium and vitamin D each day. It also important to follow the universal strategies for the promotion of strong bones.
What are the risks and benefits of estrogen therapy or hormone therapy?
ET
or HT is often prescribed for the relief of the most common menopausal
symptoms experienced by women including hot flashes, night sweats and
other genitourinary symptoms including vaginal dryness.
There
is evidence that ET and HT have some similar and some different risks
and benefits. These conclusions are based on the findings of the
Women's Health Initiative (WHI). The WHI studied a large group of
postmenopausal women prescribed conjugated equine estrogen (0.625mg)
with progestin (HT) or prescribed estrogen alone (ET) and concluded the
following about the use of ET or HT in postmenopausal women:
1.
Both ET and HT protect against the rapid loss of bone that occurs in
the first five years after menopause. A woman can lose up to 15% of her
lifetime skeleton without estrogen protection. In postmenopausal women,
ET and HT reduce the risk of fractures in the spine, hip and other bones.
2. HT decreases colorectal cancer occurrence, however ET does not provide this benefit.
3. Both ET and HT increase the risk for stroke and phlebitis (blood clots in the veins).
4.
HT increases the risk for breast cancer and heart disease.
However, estrogen alone does not seem to affect the risk for breast
cancer or heart disease
5. The Women's Health Initiative Memory
Study recently showed that there is no protective effect of
estrogen-alone for dementia or cognitive function. Both HT and ET
should not be used for the prevention of dementia or Alzheimer's
disease.
How do I know if estrogen therapy or hormone therapy is the right choice for me?
For
many women, the benefits of using ET or HT for osteoporosis prevention may
not outweigh the risks. You and your healthcare provider, taking into
consideration your menopausal status as well as your personal and
family history of osteoporosis, heart disease, and certain cancers,
must carefully weigh the benefits and risks of taking or continuing to
take ET or HT.
In general, ET or HT should be used for the
shortest period of time possible. If your healthcare provider
prescribes ET or HT, it is important to discuss how long you should
remain on the medication.
It is also important to understand
that the same rapid loss of bone (up to 15% over 5 years) will occur
when you stop taking ET or HT, no matter how long you have been on it.
It is important to
know that there are other medication options to prevent bone
loss and reduce the risk of fracture related to osteoporosis.
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