Bone Abstracts

Hormone replacement therapy (HRT) comprises estrogen, with or without progestogen addition, given to postmenopausal women. HRT is by far the most effective treatment for the relief of menopausal symptoms such as vasomotor and genito-urinary symptoms. It is as effective as alternative treatments for the prevention of postmenopausal osteoporosis. It increases bone mass, reduces bone turnover, and reduces fracture risk at all the important skeletal sites. It has a beneficial effect on collagen in bone and skin, and helps preserve inter-vertebral discs. It is now increasingly realised that low doses of oestrogen may be effective for bone conservation in most women. There is no increased incidence of osteonecrosis of the jaw or femoral fragility fractures as are seen with some alternative treatments. HRT should remain the first-line therapy for primary prevention of osteoporosis. Concerns about increased cardiovascular risks were inappropriately raised by the Women’s Health Initiative, but the totality of current data shows coronary benefits and no increased stroke risks when HRT is initiated early in the menopause, and there is a reduction in mortality. Other benefits associated with HRT use include prevention of type 2 diabetes, improvements in cognitive function and a possible reduction in colo-rectal cancer. Increased venous thrombo-embolic events can be avoided with non-oral HRT which may also reduce stroke risk, Any possible increased risk of breast cancer remains controversial and unproven with estrogen-progestogen HRT, and the magnitude of any increased risk is extremely small, being less than many lifestyle factors. With estrogen-alone HRT there is a significant reduction in breast cancer. Finally, the benefits of HRT on quality of life are profound, and this should leave no doubt that there are far more benefits than risks.

HRT learning objectives: Understand the benefits such as relief of menopausal symptoms, prevention of osteoporosis, prevention of coronary heart disease, reduced incidence of diabetes, reduced mortality and improvement in quality of life.

Understand the magnitude of any risks such as stroke, venous thrombo-embolism, and possibly breast cancer, and learn how to avoid or minimise these risks.