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Estrogen for osteoporosis
Examples
Women can take estrogen by:
- Taking a pill every day. These include:
- Conjugated estrogen (for example, Premarin).
- Esterified estrogen (for example, Menest).
- Estradiol (for example, Estrace).
- Ethinyl estradiol (for example, Estinyl).
- Using an adhesive patch. Options include:
- Climara (applied to the skin once a week).
- Estraderm (applied to the skin 1 to 2 times a week).
- Menostar (a lower-dose estrogen patch, applied to the skin once a week).
- Vivelle (applied to the skin 2 times a week).
How It Works
Taking estrogen increases a woman's levels of the hormone estrogen after menopause. Estrogen slows bone thinning and causes some increase in bone thickness.
Why It Is Used
Estrogen is used to prevent osteoporosis in women after menopause. It may also be used to slow bone loss in women who have osteoporosis.
How Well It Works
Estrogen has been shown to prevent bone loss and lower the risk of hip fractures in postmenopausal women. 1
Side Effects
The side effects of estrogen include:
- Headache.
- Holding fluid in the body (fluid or water retention).
- Weight gain caused by fluid retention.
- Swollen breasts.
The Women's Health Initiative (WHI) study linked the use of ERT to an increase in a woman's risk of stroke. Many experts recommend that long-term estrogen replacement therapy only be considered for women with a significant risk for osteoporosis that outweighs the risks of taking HRT. 2, 1 To learn more about this study, see WHI: Risks and benefits of taking ERT.
Estrogen should be taken at the lowest dose and for the shortest duration possible. Women who have side effects from taking estrogen need to report them to a health professional.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Researchers are studying the effects of low-dose estrogen on women age 65 and older. An early, small study indicates that a low estrogen dose (one-quarter that of conventional ERT) may provide the same benefit-increased bone density and decreased fractures-as the higher dose. In the same study, about one-third of the women were given the low estrogen dose and progesterone (because these women had not had hysterectomies). This group of women also experienced increased bone density. However, the long-term risks of taking low-dose estrogen (and progesterone in one-third of the cases) were not studied and are unclear. 3
Estrogen may be used along with bisphosphonate medicines that prevent bone loss. Bisphosphonate medicines include risedronate (Actonel) or alendronate (Fosamax). Studies show that taking a bisphosphonate with hormone therapy results in increased bone mass when compared to taking either a bisphosphonate or hormone therapy alone. 4, 5
Estrogen alone is prescribed only for a woman who has had her uterus removed (hysterectomy), because taking estrogen increases a woman's risk for developing endometrial cancer. Adding another hormone, progesterone, lowers this risk but may have additional risks that you should discuss with your doctor.
Women who have certain conditions, such as liver or gallbladder disease and high amounts of certain fats (triglycerides) in their blood, often use the estrogen patch rather than take estrogen in pill form. This helps prevent some side effects that may occur from taking the pill form. Even low doses of estrogen seem to have a beneficial effect on bones.
You should not take estrogen if you have been diagnosed with any of the following conditions:
- Uterine bleeding
- Uterine cancer
- Breast lumps that have not yet been diagnosed
- Breast cancer (now or in the past)
- A family history (mother, sister, daughter, or two or more other close relatives, such as cousins) of breast cancer
- An increased risk of developing blood clots
Complete the new medication information form (PDF)
(What is a PDF document?)
to help you understand this medication.
Citations
Women's Health Initiative Steering Committee (2004). Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. JAMA, 291(14): 1701–1712.
National Heart, Lung, and Blood Institute (2004). Questions and answers about the WHI postmenopausal hormone therapy trials. Available online: http://www.nhlbi.nih.gov/whi/whi_faq.htm.
Prestwood KM, et al. (2003). Ultralow-dose micronized 17 B-estradiol and bone density and bone metabolism in older women. JAMA, 290(8): 1042–1048.
Harris ST, et al. (2001). Effect of combined risedronate and hormone replacement therapies on bone mineral density in postmenopausal women. Journal of Clinical Endocrinology and Metabolism, 86(5): 1890–1897.
Greenspan SL, et al. (2003). Combination therapy with hormone replacement and alendronate for prevention of bone loss in elderly women. JAMA, 289(19): 2525–2533.
WebMD Medical Reference from Healthwise
VIVELLE-DOT (estradiol transdermal system) IS AVAILABLE BY PRESCRPTION ONLY.
INDICATION
Vivelle-Dot is used after menopause to: reduce moderate to severe hot flashes; treat moderate to severe dryness, itching and burning in or around the vagina; help reduce your chances of getting osteoporosis (thin weak bones); and treat certain conditions in which a young woman's ovaries do not produce enough estrogens naturally. Vivelle-Dot 0.025 mg/day is only used to prevent osteoporosis from menopause. If you use Vivelle-Dot only to treat your dryness, itching, and burning in and around your vagina or if you use Vivelle-Dot only to prevent osteoporosis from menopause, talk with your healthcare professional about whether a different treatment or medicine without estrogens might be better for you.
IMPORTANT SAFETY INFORMATION
Estrogens increase the chances of getting cancer of the uterus (womb). Report any unusual vaginal bleeding right away while you are taking estrogens. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb).
Do not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes. Using estrogens with or without progestins may increase your chances of getting heart attacks, strokes, breast cancer, and blood clots. Using estrogens with progestins may increase your risk of dementia (decline in memory and thinking skills).
Vivelle-Dot should not be used if you have unusual vaginal bleeding; currently have or have had certain cancers, including cancer of the breast or uterus; had a stroke or heart attack in the recent past (for example, in the past year); currently have or have had blood clots; currently have or have had liver problems; or think you may be, or know that you are, pregnant.
The most common side effects that may occur with Vivelle-Dot are headache, breast tenderness, and back pain.
You and your healthcare professional should talk regularly about whether you still need treatment with Vivelle-Dot.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Full Prescribing Information for Vivelle-Dot.
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