Estrogen therapy / Hormone therapy

Prevention and treatment of osteoporosis should always include a well-balanced diet, adequate intake of calcium and vitamin D, regular exercise, safety precautions for fall prevention, avoidance of tobacco products 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 medical professional may tell you that you need an osteoporosis medication to help stop further bone loss and to 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 prevention and/or treatment including: four bisphosphonate medications: [alendronate sodium [Fosamax], risedronate sodium [Actonel]),  ibandronate sodium [Boniva]), and zoledronic acid (Reclast)], calcitonin-salmon (Miacalcin), estrogen therapy or hormone therapy, raloxifene hydrochloride (Evista), teriparatide (Forteo), Speak to your doctor or medical professional about the medication option that is right for you.

What should I know about estrogen therapy or hormone therapy?

Estrogen therapy and Hormone therapy are FDA-approved for the prevention of osteoporosis in postmenopausal women. Estrogen therapy (ET) is available in either tablet form or in a skin patch. If you have a uterus, your medical professional will probably prescribe the hormone progestin (progesterone) in combination with estrogen. Estrogen plus progestin is called hormone therapy (HT) and is available in a tablet or patch. When taking estrogen therapy or hormone therapy, it is recommended to get adequate calcium and vitamin D each day. It also important to follow the universal strategies for promotion of healthy 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 for fractures including hip fractures.

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/HT for osteoporosis prevention may not outweigh the risks. You and your medical professional, 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 medical professional 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. When choosing ET/HT for osteoporosis prevention, it is important to understand that there are other medication options to prevent bone loss and reduce the risk for osteoporosis-related fractures.