oa Journal of Endocrinology, Metabolism and Diabetes in South Africa - Hormone therapy in postmenopausal osteoporosis: 2008 : joint consensus
Until 2002, hormone [replacement] therapy (HT) was first-line therapy for prevention (and treatment) of postmenopausal osteoporosis (PMOP). It was thought that any risks associated with HT were far outweighed by potential long-term benefits (mainly cardiovascular protection). Although there were rumblings from some smaller studies at the turn of the millennium, the Women's Health Initiative (WHI) results, published in 2002, changed the way in which we managed PMOP. In this large randomised study, there was now strong prospective evidence that HT did indeed decrease fracture risk at all major sites. However, the expected benefits in cardiovascular risk were not substantiated. Thereafter, the pendulum swung dramatically away from HT in PMOP; but newer evidence over the last 18 months is causing the pendulum to move back towards a central position. We now review the place of HT in postmenopausal osteoporosis in two parts: firstly, the accumulated evidence for bone protection and, secondly, the current benefits versus risk perspective, as well as up-to-date recommendations for its use.
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