Hormone Replacement Therapy (HRT) | International …

Hormone replacement therapy (HRT) may consist of oestrogens alone or in combination with progestin. HRT slows bone turnover and increases bone mineral density(BMD) at all skeletal sites in early and late postmenopausal women [1, 2].

The anti-fracture efficacy of HRT has been assessed in observational studies, case-control studies, meta-analyses and randomized clinical trials: (Womens Health Initiative), Heart and Estrogen/progestin Replacement Study (HERS), Womens Interventional Study of long Duration Oestrogen after Menopause (WISDOM).

Overall, these analyses (except HERS) show that HRT decreases fragility fracture risk by 20-35% [3-5]. Discontinuation of HRT results in acceleration of bone turnover, decrease in BMD and eventual loss of anti-fracture efficacy.

However, despite this anti-fracture efficacy and a decrease in the risk for colon cancer, overall health risks generally outweigh benefits from HRT in older postmenopausal women with a higher incidence of cardiovascular events (unstable angina, thromboembolic stroke, venous thromboembolism including pulmonary embolism) and increased incidence of the endometrial and breast cancer [3-6].

HRT can also induce vaginal bleeding and breast tenderness. Finally, HRT may increase the risk of myocardial infarction, ovarian cancer as well as deterioration of the global cognitive function; however, the evidence is weaker.

More recent studies show that even low doses of HRT may protect bone by decreasing bone turnover markers (BTM) levels and preventing bone loss [7, 8]. The anti-fracture efficacy of these regimens has not been studied.

Currently, HRT is regarded as the acceptable treatment for osteoporosis only after all other treatments have been considered and when all the risks and benefits are carefully explained to the patient.

Women who decide to take HRT to relieve menopausal symptoms should use the lowest effective dose and for the shortest possible time [6].

Read IOF views re Global Consensus Statement on Menopausal Hormone Therapy issued in 2013

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