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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 risks."

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 forthcoming."

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."

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