Wednesday, May 14, 2003

HRT offers short-term solutions

Recent study

By Peggy O'Farrell
The Cincinnati Enquirer

A study in last week's issue of the New England Journal of Medicine concludes that hormone replacement therapy has no significant impact on quality of life for postmenopausal women and should only be taken on a short-term basis to relieve symptoms like hot flashes.

The latest study follows research issued last summer by the Women's Health Initiative that long-term HRT carried more risks than benefits.

But the lead author of last week's study worries that women who stopped taking HRT because of health concerns are now unprotected against bone loss and osteoporosis.

"In all the confusion over the Women's Health Initiative research, what has gotten lost is that millions of women just stopped taking their hormones," says Dr. Jennifer Hays, director of the Center for Women's Health at Baylor College of Medicine in Houston. "Those women are now experiencing bone loss at approximately the same rate as when they went through menopause. I'm not sure anyone has informed them of this. I don't hear it being talked about."

HRT isn't the best option women have for preventing bone loss or rebuilding bone, experts say: Other alternatives, including Fosamax and Actonel, do a better job without the side effects.

But women need to know they're at risk for bone loss and related fractures before they can ask their doctors about those alternatives, Hays says.

Until last year's study was released, doctors - and many of their female patients - believed a combination of estrogen and progesterone would protect women from heart attacks.

The study showed that using the combination for the long-term actually increases women's risk for heart attack, stroke, blood clots and breast cancer.

"These women who've been on hormones for five, 10, 15, 20 years are stopping, and with good reason," Hays says. "But the one benefit they're not getting anymore is bone protection."

Hays recommends that women who stopped taking HRT but aren't using other bone-strengthening medications get bone-density tests "immediately" to find out if they're at risk for osteoporosis.

Estrogen protects against osteoporosis by preventing the resorption of bone, says Dr. Nelson Watts, director of the University of Cincinnati Bone Health and Osteoporosis Center.

Women should undergo bone density tests by age 65, or earlier if they have certain risk factors for osteoporosis, Watts says.

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