New Weapons to Fight Osteoporosis
Battling Brittle Bones
Do Benefits Exceed Risk?
Estrogen has not been shown to significantly reduce fractures
in women who are 60 years old or over, according to the authors of the
JAMA editorial. They say, "Since women in their 50s who do not have
osteoporosis have a relatively low risk of fracture, the benefit of long-term
treatment with estrogen to prevent bone loss and fractures may not exceed the
According to Ettinger, a woman's decision to take hormone
replacement should not be based only on preventing osteoporosis, since there
are other options.
But more studies need to be done: The JAMA authors say
no large trial has tested what effect estrogen may have on fracture risk in
women who do have osteoporosis.
"The debate surrounding the use of HRT underscores the need
for a greatly expanded osteoporosis research effort, including definitive
studies of HRT," says National Osteoporosis Foundation director Sandra
Raymond in a June 2001 news release. "Osteoporosis is an enormous public
health problem, causing 1.5 million fractures annually. Until and unless the
osteoporosis research effort is greatly increased, these answers will not be
Women Have a Choice
Bones normally lose density as we age. Only a severe loss
results in osteoporosis. Experts say many things besides estrogen decline may
contribute to postmenopausal women developing the disease, including
- Family history
- Individual metabolism
- Parathyroid hormone
- Vitamin D
- Blood factors that direct cell growth
- Certain drugs
- Certain illnesses, including diabetes
According to Ettinger, "It's rare for women to be affected
much before age 65 or 70 and most of the fractures we worry about occur after
age 70 or 75. The average age for hip fracture is 81 and for spine fracture 72
or so. That's 25 to 30 years or so after menopause."
"Women can delay the decision to take a drug to prevent
osteoporosis and instead pursue reasonable lifestyle changes," he says.
"Why take a drug for years and years? Drugs cost money and have potential
side effects, as opposed to doing the right thing in your life. Instead,
reserve drugs for women who are at much higher risk."
Ettinger says: "I would suggest a woman ask, 'Is this going
to affect me in the next five to 10 years?' If so, take some of the good
medications available. We're getting better in treating the disease and the new
drugs are more powerful in restoring bone strength."