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The strongest detrimental loss of bone mass in women occurs during the menopause. Hormone replacement treatment used to be the preferred method to prevent further bone loss post-menopausal and to reduce the likelihood of fractures in post-menopausal women.
Nowadays with the development of bisphosphanate treatments such as Fosamax, BONIVA and Zometa, HRT is rarely recommended for the treatment of osteoporosis alone as it is considered to be a riskier treatment due to side effects such as endometrial and breast cancers. The International Menopause Society has offered guidelines as to when hormone replacement therapy is recommended. These recommendations are strongly linked to age and personal circumstances; your doctor will be able to advise you on the correct treatment following a medical examination.
Female sex hormones play a major role in skeletal development in women and in the loss rate of bone mass. Both late menarche and early menopause can lead to a decrease in bone mass, whereas the use of the contraceptive can help to maintain/increase bone mass. There is a strong link between changes in hormone levels and osteoporosis, with the onset of the condition typically occurring at the start of the menopause.
Since the 1950’s hormone replacement has been known to have a beneficial effect upon the skeleton; its use overcame the loss of height often seen in postmenopausal women. The use of oestrogen was common place until the 1970’s when medical research linked its use with an increased chance of endometrial carcinoma. The addition of progestogen to oestrogen eliminated these risks and the use of hormone replacement treatment is commonplace once again.
Studies aimed at better understanding the relationships between hormone replacement therapy for women and stabilisation of bone mass, have shown that after a three year use of 17beta-oestridiol, oestriol and norethisterone there was a marked increase in radial bone mass in patients, whilst the control group lost bone mass. Furthermore, upon stopping of the hormone replacement therapy osteoporosis treatment bone mass was lost at a similar rate as seen in the control group. The use of hormone replacement was found to be still effective if carried out two years after the onset of the menopause, and the use of a calcium supplement alone did not prevent loss of bone mass.
There have been many studies that have looked into the relationship of the use of hormone replacement treatment with the incidence of bone fractures. Most of these investigations have found that there is a reduction in the likelihood of fractures in people who have been taking treatments for a five year period
To summarise the use of hormone replacement therapy helps to reduce bone mass loss and hence protect vertebral bone mass and height. Additionally it helps to reduce the incidence of bone fractures and it is recommended that for the best beneficial effects that hormone replacement treatment is taken as soon as possible after the onset of the menopause and for as long a period as possible. However there are many possible side-effects associated with this type of osteoporosis treatment, and it is no longer recommended for the treatment of osteoporosis alone.