Long-term estrogen and hormone replacement therapy for the prevention and treatment of osteoporosis.

Abstract

Recent studies have called into question whether the risks of hormone replacement therapy (HRT) outweigh its long-term benefits. There is a clear causal relationship between estrogen deficiency and osteoporosis. Postmenopausal status or estrogen-deficiency at any age significantly increases a patient's risk for osteoporosis and subsequent fragility fractures. Estrogen, in various formulations, is currently FDA-indicated for the prevention of osteoporosis. However, estrogen is not FDA-approved for the treatment of osteoporosis. Recent randomized clinical trials have demonstrated that estrogen significantly reduces fractures among osteoporotic postmenopausal women. Most postmenopausal women choose to use estrogen for relief of vasomotor symptoms and urogenital atrophy. HRT should be limited to osteoporosis prevention in women with significant ongoing vasomotor symptoms who are not at an increased risk for cardiovascular disease. An annual, individualized, risk/benefit reassessment should be performed on these patients. Further research is needed to assess the potential risks and benefits of various formulations, combinations, doses, and delivery routes of estrogen for postmenopausal women.