Preventing And Treating Bone Loss - Page 209 Growing Older Getting Better Section - Page 187 Preventing And Treating Bone Loss - Page 205 Preventing And Treating Bone Loss - Page 211

"When estrogen therapy is begun," continues the same editorial, "it is unclear how long it must be continued to maintain the benefit, because its discontinuation leads to a phase of accelerated bone loss like that which follows natural menopause and protection against fractures may therefore be lost five or more years after estrogen therapy is discontinued. Thus, although it is widely believed that five to ten years of estrogen therapy is sufficient to lower the frequency of osteoporosis related fractures, much longer treatment, possibly 20 years or more is required."

More recently, researchers analyzed the data on 670 women in the Framingham study. Of these, only 212 had taken estrogen replacement therapy. Only one third took the estrogen for seven years or longer. Among women under 75, Dr. David Felson and his colleagues at the Boston Arthritic Center found that bone density was higher in women treated with estrogen.

"Unfortunately, the effect of estrogen does not persist long after the discontinuation of therapy. In women over 75, even 10 years of past estrogen use did not have a significant effect on bone density."

In an accompanying editorial, Dr. Bruce Ettinger and Dr. Deborah Grady argue that one alternative to lifelong HRT for prevention of osteoporosis might be to start HRT at age 70. Based on his own research, Ettinger, has shown that half the usual estrogen dosage plus 1500mg calcium daily prevents bone loss and may produce fewer long term effects for women.

Meanwhile, Prior asks, should all menopausal women be given menopausal hormone therapy when only 20 to 25 percent are at high risk for bone loss?

Estrogen skin patches also preserve bone just as well as the oral forms and the patch was approved for treatment of osteoporosis in 1992. The 50 microgram patch has been shown to stop the loss of bone. The 100 microgram patch combined with exercise and adequate calcium will apparently build new bone. Studies at the Mayo Clinic using an experimental estrogen-progesterone patch have shown that the patch increases bone in the hip and the spine.

All women who have not had their uteruses removed will need to take progesterone as well as estrogen, to minimize the risk of uterine cancer. This means that a woman will continue to bleed every month after menopause, as long as she is on the hormone replacement.

An editorial in the Lancet (Apr 6/91) commented: "Since the long-term safety of hormone replacement has not yet been fully elucidated, there is need for other effective therapies for the prevention and treatment of osteoporosis."

Estrogen And Progesterone - Which One Is Most Important For Bone Health ? Give Us Feedback On This Subject Text Scroll This Chapter Check Out Doctor DeMarco's Recommended Health Products New Research On Progesterone Alone Preventing Bone Loss Other Drugs For Osteoporosis

A new drug on the market called editronate belongs to a family of compounds called biphosphonates. Biphosphonates are absorbed to bone crystals. When these biphosphonate bone crystal complexes are taken up by the bone cells that resorb bone, these cells stop resorbing bone. This allows bone mass to be preserved.

Biphosphonates also impair mineralization of new bone and thus can only be taken for 14 days at a time. This is followed by a rest period of between 11 and 13 weeks and repeated four times a year. Treatment regimens are complicated and expensive.

Two well designed studies on one of the biphosphonates, editronate disodium, have now been reported in the medical literature.

American researchers studied 429 post-menopausal women with osteoporosis in seven different centers. Results showed a significant increase in the bone mineral density of the spine within one year of treatment and a significant decrease in the rate of new fractures of the spine. Similar results had been reported earlier in a single center study in Copenhagen involving 66 women with proven osteoporosis.

Etridonate is available both in the U.S. and Canada, but has not yet been approved for use in osteoporosis. However, problems are emerging with long-term use. In one study, by the third year of treatment, fracture rates increased in the treatment group compared to the controls. Other problems are the fact that decreasing bone resorption may cause reduced bone formation, the unresolved question of increasing hip fracture incidence and the uncertainty about long-term safety.

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