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Women need information about alternatives, risks, and benefits of hormone therapy for osteoporosis to make an informed decision

For many decades, menopausal hormone therapy (HT) has been the mainstay for preventing and treating osteoporosis (loss of bone mass and density) that can lead to fractures among older women. However, HT has been shown to increase the risk of breast cancer, venous thromboses, stroke, and coronary heart disease. In addition, several medications are now available that are comparably effective to HT in preventing osteoporotic fractures.

Careful examination of the benefits and risks of each treatment for an individual woman is critical to help patients make an informed choice, explains Brown University investigator, Nananda F. Col, M.D. For example, a woman with osteoporosis experiencing debilitating hot flashes who is at low risk for cardiovascular disease and breast cancer might be interested in a trial of HT, providing that she is aware of the concomitant risks and feels that the benefits of HT outweigh the risks.

On the other hand, a woman with osteoporosis who does not have hot flashes should be informed of the benefits and risks of HT and encouraged to use non-hormonal alternatives. These include the bisphosphonates: alendronate, risendronate, and ibandronate, as well as raloxifene, a selective estrogen receptor modulator, which may also help prevent breast cancer. Another less efficacious alternative is calcitonin, which it is generally well-tolerated. Finally, teriparatide was recently approved to prevent fractures among postmenopausal women at very high fracture risk. These findings were based on a systematic review of clinical studies on the impact of menopausal hormone therapy on osteoporosis. The study was supported by the Agency for Healthcare Research and Quality (HS13329).

More details are in "The role of menopausal hormone therapy in preventing osteoporotic fractures: A critical review of the clinical evidence," by Dr. Col, Lynn A. Bowlby, M.D., and Kelly McGarry, M.D., in the October 2005 Minerva Medica 96(5), pp. 331-342.

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