Hormone Replacement Therapy and Fractures in Older Adults

Abstract

Estrogen deficiency in women is associated with accelerated bone loss, and estrogen replacement therapy has been proven to be effective in preventing osteoporosis and fractures in postmenopausal women. The introduction of selective estrogen receptor modulators that have an estrogen-like effect on the skeleton but have a different pattern of effects on other tissues may have an important role in the management of osteoporosis in women in the near future. In men, androgen deficiency has been shown to be associated with osteoporosis. Although androgen replacement in hypogonadal men may decrease bone resorption and increase bone mass, long-term placebo-controlled trials are needed to better define the benefits and risks of such therapy before it can be recommended. Sex hormone deficiency is linked to the development of osteoporosis in both women and men. In women, hormonal replacement by estrogen or the newly developed selective estrogen receptor modulators may prevent the development of osteoporosis and its related fractures. In men, there is early evidence that testosterone replacement therapy may enhance bone mass in hypogonadal men.

Androgen deficiency in the aging male: Pathophysiology, diagnosis, and treatment alternatives

“…Along with testosterone, decreased levels of estradiol and estrone are associated with osteoporosis in aging males [13•,22]. Whereas benefit was shown with estrogen or estrogen receptor modulators in treatment of women, most authorities recommend that testosterone replacement is of benefit to men [23]. The rate of bone degradation decreases with testosterone therapy in vitro.…”

Hormones and the Aging Process

“…Estrogen deficiency has been classically associated with bone mineral loss and hip fracture 21 . The recent Women's Health Initiative 22 and other studies have suggested that estrogen administration to older women increases total mortality, cardiovascular disease, and breast cancer but decreases hip fracture.…”

The diagnosis of age-related androgen deficiency

“…Ce phenomene concerne davantage le rachis que le col du femur. Dans ce contexte, il faut garder & I'esprit que les fractures de I'homme &ge provoquent une morbidite plus importante que celles de la femme de m~me age [9]. Les etudes recentes suggerent que I'effet favorable des androgenes sur le squelette de l'homme serait d0, en realite, a l'aromatisation de ceux-ci en estrog6nes.…”