Women’s health 2019: Osteoporosis, breast cancer, contraception, and hormone therapy

Abstract

K eeping up with current evidence-based healthcare practices is key to providing good clinical care to patients. This review presents 5 vignettes that highlight key issues in women's health: osteoporosis screening, hormonal contraceptive interactions with antibiotics, hormone replacement therapy in carriers of the BRCA1 gene mutation, risks associated with hormonal contraception, and breast cancer diagnosis using digital tomosynthesis in addition to digital mammography. Supporting articles, all published in 2017 and 2018, were selected from high-impact medical and women's health journals. ■ OSTEOPOROSIS SCREENING FOR FRACTURE PREVENTION A 60-year-old woman reports that her last menstrual period was 7 years ago. She has no history of falls or fractures, and she takes no medications. She smokes 10 cigarettes per day and drinks 3 to 4 alcoholic beverages on most days of the week. She is 5 feet 6 inches (170 cm) tall and weighs 107 lb. Should she be screened for osteoporosis? Osteoporosis is underdiagnosed It is estimated that, in the United States, 12.3 million individuals older than 50 will develop osteoporosis by 2020. Missed opportunities to screen high-risk individuals can lead to fractures, including fractures of the hip. 1 Updated screening recommendations In 2018, the US Preventive Services Task Force (USPSTF) developed and published evidence-based recommendations for osteoporosis screening to help providers identify and REVIEW

Pharmacological Management of Osteoporosis in Postmenopausal Women: The Current State of the Art

“…However, recent evidence showed that estrogen-alone therapy was not associated with any increase in mortality 19 or in the risk of breast cancer, even in the women who carry the BRCA1 gene mutation. 20 We need to remember that, in females who carry the BRCA1 mutation, the cumulative risk of ovarian and breast cancer by age 80 is over 40 and 70%, respectively. 21 Prophylactic salpingo-oophorectomy is currently the only strategy able to reduce the risk of both cancers.…”

“…Unfortunately, the premature withdrawal of ovarian hormones induced by this surgery causes long-term AEs that can be avoided, or at least limited, with HRT without a significant increase in cancer incidence. 14,20 For this reason, there is now a large scientific consensus that hormonal therapy at menopause represents an effective prevention strategy for osteoporosis and fragility fractures, with an overall favorable benefit to risk ratio when it is started before 60 years of age and within 10 years from the last menses. 15 The hormonal options available for the treatment and prevention of postmenopausal bone loss are HRT, tibolone, and SERMs.…”