Raising Bone Mineral Density Without HRT
Straight Talk on Preventing Bone Loss After Menopause
March 25, 2003 (New York) -- In July 2002, when the National Institutes of Health ended a major trial of hormone replacement therapy because of risks, the door was slammed shut on using HRT for boosting bone mineral density to prevent osteoporosis.
By August 2002, prescriptions for hormone replacement therapy decreased -- putting millions of women at risk for the brittle bone disease, experts said here Tuesday at a news conference sponsored by the Society for Women's Health Research.
And now that the dust is beginning to settle, experts urge women who discontinued their hormones to get a bone mineral density test and discuss new treatments for osteoporosis with their doctor.
"Once hormones are stopped, bone loss resumes, so for a women who stopped hormones -- and there are a lot of them out there -- bone mineral density testing is critical to identify those women who need continued therapy with another [agent]," says Ethel Siris, MD, director of the Toni Stabile Osteoporosis Center of Columbia Presbyterian Medial Center in New York City.
There are a number of new treatments for osteoporosis for women who need them, she says.
"Women lose bone density quicker and quicker after either menopause or the discontinuation of [HRT]," says James Simon, MD, clinical professor of obstetrics and gynecology at George Washington University School of Medicine in Washington, D.C. "The time to intervene is early on because the largest loss of bone occurs during the first three to five years."
In the early 1990s, it was widely held that hormone replacement therapy lowered risk of heart disease, bone fractures, and potentially the risk of colorectal cancer. It was suspected that HRT raised the risk of blood clots in legs and lungs and breast cancer. But 5.2 years into this part of the study, investigators sent letters to participants telling them to stop taking their medication because they noted increases in heart disease, stroke, and pulmonary embolism in study participants on estrogen plus progestin, compared with women taking placebos.
There were, however, noteworthy benefits of estrogen plus progestin, including fewer cases of hip fractures and colon cancer, but on balance the harm was greater than the benefit.
But, experts said, the benefit was not large enough to justify taking hormone replacement therapy solely to increase bone mineral density and stave off osteoporosis.
"If you are taking HRT as a bone drug, don't," Siris says. "But if you are taking it because you can't live without it, bone protection may be an added benefit."