Featured Editorial Hormone replacement therapy and the prevention of postmenopausal osteoporosis

Abstract

Fracture prevention is one of the public health priorities worldwide. Estrogen deficiency is the major factor in the pathogenesis of postmenopausal osteoporosis, the most common metabolic bone disease. Different effective treatments for osteoporosis are available. Hormone replacement therapy (HRT) at different doses rapidly normalizes turnover, preserves bone mineral density (BMD) at all skeletal sites, leading to a significant, reduction in vertebral and non-vertebral fractures. Tibolone, a selective tissue estrogenic activity regulator (STEAR), is effective in the treatment of vasomotor symptoms, vaginal atrophy and prevention/treatment of osteoporosis with a clinical efficacy similar to that of conventional HRT. Selective estrogen receptor modulators (SERMs) such as raloxifene and bazedoxifene reduce turnover and maintain or increase vertebral and femoral BMD and reduce the risk of osteoporotic fractures. The combination of bazedoxifene and conjugated estrogens, defined as tissue selective estrogen complex (TSEC), is able to reduce climacteric symptoms, reduce bone turnover and preserve BMD. In conclusion, osteoporosis prevention can actually be considered as a major additional benefit in climacteric women who use HRT for treatment of climacteric symptoms. The use of a standard dose of HRT for osteoporosis prevention is based on biology, epidemiology, animal and preclinical data, observational studies and randomized, clinical trials. The antifracture effect of a lower dose HRT or TSEC is supported by the data on BMD and turnover, with compelling scientific evidence.

The Protective Effect of Amphimas pterocarpoides Plant Extract on Bone Mineral Density and Strength in Estrogen Deficient Ovariectomized Wistar Rats

“…It is well documented that estrogen deficiency is an important risk factor in the pathogenesis of osteoporosis. Although, HRT is an established therapeutic option for postmenopausal bone loss, recent evidence indicate that its long term use is related to side effects such as the increased risk of endometrial and breast cancer [5]. Thus, alternative treatments are under investigation.…”

“…Hormone replacement therapy (HRT) has been the first line therapy for the prevention and treatment of osteoporotic fractures in women younger than 60 years or within 10 years of menopause [5]. However, clinical data showed that long term use of conventional HRT is associated with various side effects, including increased risk for endometrial or breast cancer and cardiovascular diseases, which outweighs any benefit [6].…”

Lentivirus-TAZ Administration Alleviates Osteoporotic Phenotypes in the Femoral Neck of Ovariectomized Rats

“…Osteoporosis affects 55% of Americans aged 50 and above. Of these, approximately 80% are postmenopausal women [17]. Postmenopausal osteoporosis is attributable to the estrogen deficiency after menopause.…”

Synthetic Peptide CK2.3 Enhances Bone Mineral Density in Senile Mice

“…Treatment of osteoporosis-related fractures is costly [3]. Current treatments for osteoporosis include bisphosphonates or hormone therapy; however these treatments exhibit some serious side effects including jaw pain, esophageal cancer, and stroke [4,5]. Therefore, a new treatment for osteoporosis with less severe side effects is needed to improve the quality of life for patients.…”