Advertisement

Clinical Rheumatology

, Volume 14, Supplement 3, pp 14–17 | Cite as

Osteoporosis Prevention and Treatment with Sex Hormone Replacement Therapy

  • S. Rozenberg
  • M. Kroll
  • A. Pastijn
  • J. Vandromme
Article

Summary

Oestrogen deficiency is by far the major factor contributing to the high rate of osteoporotic fractures in women. The anti-osteoporotic effect of estrogen may be explained by its property to regulate cytokine secretion and thus balance bone remodeling. In oestrogen deficiency, increased resorption and remodeling will occur leading to osteoporosis. It has been extensively shown that oestrogen replacement therapy (ERT) prevents postmenopausal bone loss and reduces fracture risk by half, provided that an appropriate dose is used. In order to optimize osteoporosis prevention, ERT should be started as early as possible in menopause and be maintained as long as possible. ERT may also be effective in elderly osteoporotic patients in preventing bone loss and, reducing fracture risk. The acceptance of ERT, however, at an older age has not been thoroughly evaluated.

A reduction of cardiovascular disease and of climacteric symptoms are among other benefits of ERT. So far, only few postmenopausal women are treated with ERT. ERT without progestins has been repeatedly found associated with an increased risk of developing endometrial cancer, but the cyclic addition of progestins protects from endometrial hyperplasia and carcinoma. Combined oestrogen-progestin therapy is as efficient as estrogen therapy alone, but not more so. Since progestins may oppose some of the beneficial effects of estrogens, the lowest dose with the least metabolic impact should be prescribed. Women who have had a hysterectomy, should probably be treated by estrogen replacement therapy only.

Meta-analyses concerning breast cancer associated with ERT found a very moderately increased risk (RR=1.06). Therefore ERT prescription should be discussed openly with women considering all risks and benefits. In women who have suffered from breast cancer, a bone sparing effect of tamoxifen has been shown.

Key words

Osteoporosis Oestrogen Menopause 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Lindsay, R., Aitken, J.M., Anderson, J.B., Ghart, D.M., Mac Donald, E.B., Clarke, A.C. Long-term prevention of postmenopausal osteoporosis by oestrogen. Lancet 1976, i, 1038–140.Google Scholar
  2. 2.
    Geusens, P., Dequeker, J., Verstraeten, A., Nijs, J. Age-, Sex, and Menopause related changes of vertebral and peripheral bone: Population study using Dual and Single Photon absorptiometry and radiogrammetry. J Nucl Med 1986, 27, 1540–1549.Google Scholar
  3. 3.
    Rozenberg, S., Ham, H., Bosson, D., Peretz, A., Robyn, C. Age, steroids and bone mineral content. Maturitas 1990, 12, 137–143.Google Scholar
  4. 4.
    Rozenberg, S., Robyn, C. Hyperprolactinaemia and osteoporosis. IRCS Med Sci 1986, 14, 413–414.Google Scholar
  5. 5.
    Devogelaer, J.P., Nagant de Deuxchaisnes, C., Donnez, J., Thomas, K. LHRH agonists and bone loss (letter). Lancet 1987, 1, 1498.Google Scholar
  6. 6.
    Komm, B.S., Terpening, C.M., Benz, D.L. Oestrogen binding, receptor mRNA and biologic response in osteoblast-like osteosarcoma cells. Science 1988, 241, 81–84.Google Scholar
  7. 7.
    Eriksen, E.F., Colvard, D.S., Berg, N.J. et al., Evidence of oestrogen receptors in normal human osteoblast-like cells. Science 1988, 241, 84–86.Google Scholar
  8. 8.
    Pacifici, R., Is there a causal role for IL-1 in postmenopausal bone loss? (Editorial) Calcif Tissue Int 1992, 50, 295–299.Google Scholar
  9. 9.
    Jilka, R.L., Hangoc, G., Girasole, G., Passeri, G., Williams, D.C., Abrams, J.S., Boyce, B., Broxmeyer, H., Manolagas, S.C. Increased osteoclast development after oestrogen loss: mediation by interleukin-6. Science 1992, 3, 257 (5066), 88–91.Google Scholar
  10. 10.
    Horowitz, M.C. Cytokines and oestrogen in bone: anti-osteoporotic effects. Science 1993, 260 (5108), 626–627.Google Scholar
  11. 11.
    Ettinger, B., Genant, H.K., Cann, C.E. Long-term oestrogen replacement therapy prevents bone loss and fractures. Ann Inter Med 1985, 102, 319–324.Google Scholar
  12. 12.
    Riis, B.J., Thomson, K., Strom, V., Christiansen, C. The effect of percutaneous estradiol and natural progesterone on postmenopausal bone loss. Am J Obstet Gynecol 1987, 156, 61–65.Google Scholar
  13. 13.
    Genant, H.K., Baylink, D.J., Gallagher, J.C. Estrogens in the prevention of osteoporosis in postmenopausal women. Am J Obstet Gynecol 1989, 161 (6 Pt 2), 1842–1846.Google Scholar
  14. 14.
    Weiss, N.S., Ure, C.L., Ballard, J.H., Williams, A.R., Daline, G.J.R. Decreased risk of fractures of the hip and lower forearm with postmenopausal use of oestrogens. N Engl J Med 1980, 303, 1195–1198.Google Scholar
  15. 15.
    Johnson, R.E., Specht, E.E. The risk of hip fracture in postmenopausal females with and without oestrogen exposure. Am J Public health 1981, 71, 138–144.Google Scholar
  16. 16.
    Reginster, J.Y., Sarlet, N., Deroisy, R., Albert, A., Gaspard, U., Franchimont, P. Minimal levels of serum estradiol prevent postmenopausal bone loss. Calcif Tissue Int 1992, 51(5), 340–343.Google Scholar
  17. 17.
    Lindsay, R., Hart, D.M., Clark, D.M., The minimum effective dose of oestrogen for prevention of postmenopausal bone loss. Obstet Gynecol 1984, 63, 759–763.Google Scholar
  18. 18.
    Field, C.S., Ory, S.J., Wahner, H.W., Herrmann, R.R., Judd, H.L., Riggs, B.L. Preventive effects of transdermal 17 beta-estradiol on osteoporotic changes after surgical menopause: a two-year placebo-controlled trial. Am J Obstet Gynecol, 1993, 168(1), 114–121.Google Scholar
  19. 19.
    Lindsay, R. Oestrogen therapy in the prevention and management of osteoporosis. Am J Obstet Gynecol 1987, 156, 1347–1351.Google Scholar
  20. 20.
    Rozenberg, S., Gevers, R., Peretz, A., Vandromme, J., Robyn, C., Ham, H. Decrease of bone mineral density during oestrogen substitution therapy. Maturitas 1993, 17, 205–210.Google Scholar
  21. 21.
    Cummings, S.R. Bone mass and bone loss in the elderly: A special case? Int J Fert 1993, 38(S2), 92–97.Google Scholar
  22. 22.
    Christiansen, C., Riis, B.J. 17 Beta-estradiol and continuous norethisterone: a unique treatment for established osteoporosis in elderly women. J Clin Endocrinol Metab 1990, 71 (4), 836–841.Google Scholar
  23. 23.
    Lufkin, E., Wahner, H.W., O'Fallon, W.M., Hodgson, S.F., Kotowicz, M.A., Lane, A.W., Judd, H.L., Caplan, R.H., Riggs, B.L. Treatment of postmenopausal osteoporosis with transdermal oestrogen. Ann Int Med 1992, 117, 1–9.Google Scholar
  24. 24.
    Rozenberg, S., Liebens, I., Vandromme, J., Hotimsky, A., Van Rijsselberge, M. Cardiovascular protection by oestrogen: a hemodynamic mechanism? Int J Fertil 1994, 39, 36–42.Google Scholar
  25. 25.
    Goulding, A., Gold, E., Feng, W. Tamoxifen in the rat prevents oestrogen-deficiency bone loss elicited with the LHRH agonist buserelin. Bone Miner 1992, Aug 18 (2), 143–152.Google Scholar
  26. 26.
    Prior, J.C., Vigna, Y.M., Schechter, M.T., Burgess, A.E. Spinal bone loss and ovulatory disturbances. N Eng J Med 1990, 323 (18), 1221–1273.Google Scholar
  27. 27.
    Sierro-Arenas, M., Delgado-Rodriguez, M., Rodrigues-Canteras, R., Bueno-Cavanillas, A., Galvez-Vargas, R. Menopausal hormone replacement therapy and beast cancer: a meta analysis. Obstet Gynecol 1992, 79 (2), 286–294.Google Scholar
  28. 28.
    Love, R.R., Mazess, R.B., Barden, H.S., Epstein, S., Newcomb, P.A., Jordan, V.C. Effects of tamoxifen on bone mineral density in postmenopausal women with breast cancer. N Engl J Med 1992, 326, 852–856.Google Scholar

Copyright information

© Acta Medica Belgica 1995

Authors and Affiliations

  • S. Rozenberg
    • 1
  • M. Kroll
    • 1
  • A. Pastijn
    • 1
  • J. Vandromme
    • 1
  1. 1.Department of GynecologyFree Universities of Brussels (VUB-ULB), St. Pieter HospitalBrusselsBelgium

Personalised recommendations