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    There are many conditions that are associated with the menopause, but the one with the greatest social economic impact is postmenopausal osteoporosis. The effects of sex hormones and the skeleton have been well studied, and the link between ageing and loss of bone mass widely reported. It was first proposed in 1940 by F Albright that osteoporosis is linked to a loss in ovarian function, whether by castration or through natural means such as the menopause.

    The first areas that are affected by osteoporosis fractures tend to be fractures of the distal radius, and then of veritable bodies, normally the latest increase in fracture frequency occurs at the femoral neck.

    The hormone oestrogen was first isolated in 1923; further hormones such as ethinyloestridol and stilboestrol were isolated by 1938. The discovery of these hormones enabled hormone replacement experiments to take place, and it was found that the loss of height that is associated with the post menopause could be reduced substantially in women who took hormone supplementation.

    By the 1960’s methods had been established to measure bone density ; these techniques allowed the association between estrogen and bone mass to be further investigated by carrying out cross sectional studies of bones. This led to the use of estrogen replacement therapy until the mid 1970’s; at this time it was discovered that increased estrogen could lead to an increase in the rates of endometrial cancers. This led to the implementation of progesterogen supplementation and the dual hormone replacement therapy methods. The addition of progesterone allows the endometrial to be shed, in a similar manner to what occurs in a normal period.

    Bone mass studies

    There have been many studies that have supported the theory that osteoporosis and hence loss of bone mass can be prevented by hormone replacement treatments. It has been found that the cessation of hormone supplementation in menopausal women leas to a return of bone loss rate to that seen in non-treated women. In conclusion, although the use of hormone replacement therapy has not been shown to increase bone mass by more than ten percent in women with established osteoporosis; it is perhaps the delaying impact of these hormones that is the most important.