Discontinuation of Hormone Replacement Therapy may Lead to Rapid Bone Loss

The recent discontinuation of the Women’s Health Initiative (WHI) study in the U.S. has caused widespread concern about Hormone Replacement Therapy (HRT) amongst women and their physicians. Because of excess heart attacks, strokes, and breast cancer cases in patients on HRT (Premarin .625 mg and Provera 2.5 mg daily), the study was stopped early. However, those risks were partially offset by a reduced incidence of colon cancer and of osteoporotic fracture. Whether or not a woman should discontinue HRT should be discussed with her physician to evaluate her individual risks and benefits.

The rapid decline in estrogen levels at menopause is a key factor contributing to bone loss. Osteoporosis is caused when there is an imbalance in bone formation and bone resorbtion. Consequently more bone is broken down than is replaced resulting in net bone loss. Osteoporosis is therefore a disease that causes bones to become weaker, more brittle and prone to fracture. HRT may slow down bone loss but the benefit is lost when treatment is discontinued. Since bone loss is painless, simply stopping HRT without adopting an alternative strategy may leave women at risk of osteoporosis and fractureWomen taking HRT to treat osteoporosis, who decide to discontinue treatment, should know of other available therapies. These alternative medications include Bisphosphonates (alendronate, risedronate, etidronate), Selective Estrogen Receptor Modulator (raloxifene), and Calcitonin (nasal spray calcitonin). It is important that women discuss treatment options with their physician. The benefits and risks associated with HRT as well as other factors such as, alternative drug treatments, lifestyle, nutrition, calcium intake, and exercise should be evaluated in order to reach the best individual decision.

Approximately 200 million women worldwide suffer from osteoporosis, which afflicts an estimated one-third of women aged 60 to 70. The effect on quality of life for those who suffer osteoporotic fractures can be catastrophic. Fractures of the hip almost always require hospitalization and often results in a loss of mobility and independence. Half of those who suffer hip fractures lose the ability to walk independently, and up to one-third become completely dependent. Hip fractures also are associated with increased mortality.

The results of the WHI study are important for women. Better information on risks and benefits of a treatment being given to improve long-term health is essential. The study results are not, however, a reason for women to panic. The increased risk identified is indeed small and is not apparent before four years of treatment. Women on short term HRT for symptom relief may have significant benefits from therapy and should not be overly concerned about long-term risks.

Understanding Osteoporosis

Osteoporosis is one of the most common, yet least understood diseases among Canadians. It affects more than 2 million people in this country, but neither the severity of the disease, nor its implications on health and lifestyle are widely recognized. Osteoporosis can lead to chronic pain, disability and deformity, and complications due to fractures can even lead to death.

What exactly is osteoporosis?

Bone, like other body tissue, undergoes continuous remodeling – old bone breaks down and is replaced with new bone. For many people, as they age old bone breaks down faster than new bone is formed. If this imbalance continues for an extended period of time, bone becomes weakened, fragile and more likely to break.

Often referred to as the ‘silent thief,’ osteoporosis can progress painlessly and can remain undiagnosed until a fracture occurs.

How is osteoporosis prevented?

There are many risk factors for osteoporosis, including family history, race and gender. Smoking or a lack of physical activity can also make one person more susceptible than another. It is important to know, however, that people may have none of these risk factors, and still develop the disease.

Prevention of osteoporosis should begin early in life with a calcium-rich diet and healthy lifestyle choices. People who are concerned about developing osteoporosis should discuss their risk factors with a physician, and find out about ‘bone density’ testing.