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HRT no longer recommended for PM women

CLINICAL UPDATE - Osteporosis: Osteoporosis – particularly in those who are predisposed to it – accelerates around the time of menopause. In the past there was a lot less that clinicians could do about it.

Hormones that become depleted after menopause, are helpful in maintaining bone strength and density. Physiologically, when they are diminished, bone density reduces. There are many options that can be considered for menopausal osteoporosis. First-line treatments include bisphosphonates.

There is also strontium ranelate, which has antiresorptive properties and possibly increases bone formation. It has been shown to reduce vertebral and non-vertebral fractures. A post hoc analysis showed a significant reduction in hip fractures in women over 74 years.

Selective oestrogen-receptor modulators (SERMs) reduce the rate of bone loss in postmenopausal women.

Raloxifene, the trade name for Evista, is a SERM. It is similar to HRT, with fewer side effects.

HRT includes synthetic estrogens alone, or in combination with progesterones, that interact with estrogen cellular receptors in women.

Raloxifene is a drug which was designed to interact with those same receptors – and to modify them – though it is not an HRT.

“It has been shown to reduce vertebral fractures in women,” said Prof Geraldine McCarthy of the Mater Hospital in Dublin.

HRT is no longer recommended for treatment of osteoporosis because of an unfavourable balance of risks and benefits.

For severe cases with very low bone density and a history of fractures, injections of a synthetic parathyroid hormone fragment are given for no more than two years. This builds up bone.

Parathyroid hormone (PTH) increases bone remodelling and increases bone formation (anabolic agent).

Treatment with either the intact molecule (recombinant PTH 1-84) or the 1-34 N-terminal fragment (teriparatide) reduces vertebral fractures.

Teriparatide has also been shown to reduce non-vertebral fractures (not hip fractures) in PM women and has efficacy in men and glucocorticoid induced osteoporosis.

Bone Mineral Density (BMD) reduces rapidly after discontinuation unless followed by an antiresorptive agent.

Posted in Musculoskeletal on 06 November 2009
Tags: osteoporosis

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abortion, accupuncture, ACE inhibitors, acne, ADHD, alcohol, allergies, Alzheimer's, anaemia, anaethesia, anorexia, antibiotics, antidepressants, antihistamine, anxiety, appetite control, arthritis, ASCOT, aspirin, asthma, atherosclerosis, autism, autoantibodies, back pain, beta carotene, beta-blockers, bipolar disorder, birth, bleeding, blindness, blood pressure, body dysmorphic disorder, body mass, breast cancer, breast feeding, bronchitis, Caesarean section, calcium, cancer, carcinogens, carcinoma, cardiac syncope, cardiolgy, cataracts, cervical cancer, chemotherapy, child psychiatry, children, cholesterol, clinical trial, clopidogrel, Clostridium difficile, cognitive behavioural therapy, colectomy, colic, colorectal cancer, complementary and alternative therapies, contraception, COPD, coronary care, coronary stents, Crohn's, cystic fibrosis, defibrillator, dementia, depression, dermatology, diabetes management, diet, disability, DNA, Down's syndrome, eating disorders, echinacea, ECT, eczema, elderly people, endoscopy, epilepsy, erectile dysfunction, euthanasia, exercise, fat, fertility, fitness, flu pandemic, fluoxetine, folic acid, food labelling, fracture, fragile X syndrome, general surgery, genetics, gerontology, GIK infusion therapy, GORD, gout, haemodialysis, hearing, heart attack, heart disease, heart failure, heart health, hepatitis, HIV, hospital care, HPV, HRT, hyperglycaemia, hypertension, hypoglycaemia, IBD, ICU, incontinence, infant, infant mortality, infection, inflammatory bowel disease, influenza, invasive candidiasis, IQ, Irish Heart Foundation, irritable bowel syndrome, keyhole surgery, kidney disease, laser, learning difficulties, leukaemia, liver disease, lumbar disk herniation, lung cancer, lung disease, lymph nodes, macular degeneration, macular oedema, magnetic resonance imaging (MRI), malaria, malnutrition, Marfan syndrome, media, medical ethics, medical research, medication, meningitis, mental illness, metabolic syndrome, migraine, miscarriage, mortality rate, MRSA, multiple sclerosis (MS), NCHDs, nephrology, neurology, OAB, obesity, obstetrics, occupational health, ocular medicine, omega-3, opthalmology, oral cancer, organ transplantation, orthopaedics, osteoporosis, otolaryngology, ovarian cancer, paediatrics, pain management, pancreatic cancer, panic, Parkinson’s disease, patient safety, patient-physician communication, personality disorders, physiotherapy, plastic surgery, polio, practice, pre-eclampsia, pregnancy, preventative health care, probiotics, prostate cancer, psoriasis, psychiatric admission, psychiatry, psychotherapy, PTSD, public health, quality of life, radiology, radiotherapy, rectal cancer, reproductive health, research, resuscitation, rheumatoid arthritis, rheumatology, rhinitis, salt, SARS, schizophrenia, screening, seizures, self harm, sexual abuse, sexual health, sexually transmitted infections, SGA, sinusitis, skin cancer, sleep disorders, smoking, smoking ban, spinal injury, sports medicine, statins, stress, stroke, substance abuse, suicide, supplement, surgery, syncope, technology, teenagers, testosterone, thoracic surgery, thrombosis, thyroid cancer, tonsillectomy, tonsillitis, Tourette's syndrome, toxicology, travel medicine, tuberculosis, tumour angiogenesis, type 1 diabetes, type 2 diabetes, ulcer, ulcerative colitis, urinary incontinence, vaccine, vitamins, weight, WHO, women's health, World Health Assembly

«Previous article | Next article»

HRT no longer recommended for PM women

CLINICAL UPDATE - Osteporosis: Osteoporosis – particularly in those who are predisposed to it – accelerates around the time of menopause. In the past there was a lot less that clinicians could do about it.

Hormones that become depleted after menopause, are helpful in maintaining bone strength and density. Physiologically, when they are diminished, bone density reduces. There are many options that can be considered for menopausal osteoporosis. First-line treatments include bisphosphonates.

There is also strontium ranelate, which has antiresorptive properties and possibly increases bone formation. It has been shown to reduce vertebral and non-vertebral fractures. A post hoc analysis showed a significant reduction in hip fractures in women over 74 years.

Selective oestrogen-receptor modulators (SERMs) reduce the rate of bone loss in postmenopausal women.

Raloxifene, the trade name for Evista, is a SERM. It is similar to HRT, with fewer side effects.

HRT includes synthetic estrogens alone, or in combination with progesterones, that interact with estrogen cellular receptors in women.

Raloxifene is a drug which was designed to interact with those same receptors – and to modify them – though it is not an HRT.

“It has been shown to reduce vertebral fractures in women,” said Prof Geraldine McCarthy of the Mater Hospital in Dublin.

HRT is no longer recommended for treatment of osteoporosis because of an unfavourable balance of risks and benefits.

For severe cases with very low bone density and a history of fractures, injections of a synthetic parathyroid hormone fragment are given for no more than two years. This builds up bone.

Parathyroid hormone (PTH) increases bone remodelling and increases bone formation (anabolic agent).

Treatment with either the intact molecule (recombinant PTH 1-84) or the 1-34 N-terminal fragment (teriparatide) reduces vertebral fractures.

Teriparatide has also been shown to reduce non-vertebral fractures (not hip fractures) in PM women and has efficacy in men and glucocorticoid induced osteoporosis.

Bone Mineral Density (BMD) reduces rapidly after discontinuation unless followed by an antiresorptive agent.

Posted in Musculoskeletal on 06 November 2009
Tags: osteoporosis