Hormonal treatment:
Post menopausal hormone therapy effectively reduces the number of all osteoporotic fractures.
WHI reported decreased fractures rate in women taken daily 0.625 mg of conjugated estrogen & 2.5 mg medroxy progesterone acetate comparing placebo treatment.
With estrogen therapy, 50-60% decrease in fractures of arm & hip expected.
When supplemented with calcium 80% reduction in vertebral compression fractures can be observed in patients who have taken estrogen for more than 5yrs. Protection against fractures wanes with age & long term estrogen use is necessary to maximally reduce the risk of fractures after age 75. Transdermally administered 50 micro grms of estrogen protects against fractures as well as standard oral doses.
Around 40-60 pg/ml is required to protect against bone loss.
Women HOPE trail:
Showed a gain in bone density in women taken 0.3mg of conjugated estrogen with or without 1.5mg medroxyprogesterone acetate.
A lower dose of estrogen more acceptable in elderly women but should have followup assessments for response.
Synergistic result of combining estrogen with progestin is limited to members of 19 nortestosterone family.
The addition of testosterone to an estrogen therapy provides no additional beneficial impact on bone or on relief from hot flushes. In one study, 12% of treated women lost bone despite apparently good compliance.
So followup assessment should be there.
Changes of bone remodeling
Pathophysiology
Signs and symptoms
Risk factors and investigations
Investigations
Diagnostic tests and biochemical markers
Hormonal treatment
Estrogen modulators, calcium
Vitamin D
Bisphosphonates
Calcitonin, Fluoride, Tibolone
Prevention
Post menopausal hormone therapy effectively reduces the number of all osteoporotic fractures.
WHI reported decreased fractures rate in women taken daily 0.625 mg of conjugated estrogen & 2.5 mg medroxy progesterone acetate comparing placebo treatment.
With estrogen therapy, 50-60% decrease in fractures of arm & hip expected.
When supplemented with calcium 80% reduction in vertebral compression fractures can be observed in patients who have taken estrogen for more than 5yrs. Protection against fractures wanes with age & long term estrogen use is necessary to maximally reduce the risk of fractures after age 75. Transdermally administered 50 micro grms of estrogen protects against fractures as well as standard oral doses.
Around 40-60 pg/ml is required to protect against bone loss.
Women HOPE trail:
Showed a gain in bone density in women taken 0.3mg of conjugated estrogen with or without 1.5mg medroxyprogesterone acetate.
A lower dose of estrogen more acceptable in elderly women but should have followup assessments for response.
Synergistic result of combining estrogen with progestin is limited to members of 19 nortestosterone family.
The addition of testosterone to an estrogen therapy provides no additional beneficial impact on bone or on relief from hot flushes. In one study, 12% of treated women lost bone despite apparently good compliance.
So followup assessment should be there.
Changes of bone remodeling
Pathophysiology
Signs and symptoms
Risk factors and investigations
Investigations
Diagnostic tests and biochemical markers
Hormonal treatment
Estrogen modulators, calcium
Vitamin D
Bisphosphonates
Calcitonin, Fluoride, Tibolone
Prevention
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