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Is it safe to use hormone therapy for osteoporosis?

David Slovik, MD
Endocrinology Diabetes & Metabolism
The Women's Health Initiative found that two different types of hormone treatments -- estrogen-only and combined hormone therapy (estrogen and progestin) -- protected against hip fracture. The study of Prempro, the estrogen-and-progestin formula, established that this medication reduced the risk for hip fractures and spinal fractures by 34% each. Similarly, the estrogen-only formulation (Premarin) was effective in decreasing hip fracture.
 
But the studies came to abrupt ends when the health risks of taking the hormone therapies emerged. The trial of Prempro was closed after researchers found significant increases in breast cancer, heart disease, stroke, and blood clots in the veins and lungs. The 16,000 women in the study were told to stop taking the medication. Similarly, women in the estrogen-only portion of the study were told to stop taking their pills because of a nearly 40% increase in stroke risk. Unlike Prempro, Premarin didn't appear to affect heart disease risk in any way.
 
While these studies established that hormone therapy could indeed reduce hip fractures, they led many women to abandon using this treatment for osteoporosis. For these women, the increased risk for breast cancer and heart disease wasn't an acceptable tradeoff for the reduced fracture risk, especially since other drugs can effectively prevent and treat osteoporosis.
 
Hormone therapy is certainly down, but it may not be out. Critics of these studies point out deficiencies in the study and the interpretation of the results. They note that only one hormone preparation was used in each arm of the Women's Health Initiative and that other formulas may not carry the same risks or benefits. Others note that the women in the study began taking the hormones in their 60s and 70s, long after the start of menopause, and question whether the results may be different for women who take hormones earlier.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.