November 2002 · Vol. 14, No. 11Treating and preventing osteoporosis:
in the wake of WHI
The recent findings regarding hormone replacement therapy aren’t the only new developments on the osteoporosis front. Here, 3 experts discuss trends in prevention, diagnosis, and treatment, as well as what’s on the horizon.
ROBERT
LINDSAY,
MD;
WULF
UTIAN,
MD;
ROBERT
WILD,
MD, MPH
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KEY POINTS
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Hormone replacement therapy is a viable option for the prevention of osteoporosis.
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The US Preventive Services Task Force recently recommended that women over the age of 65 get a bone densitometry test.
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Although bone loss is a side effect of depot medroxyprogesterone acetate (DMPA) injections and gonadotropin-releasing hormone agonists (GnRH), physicians should not halt therapy in women for whom these agents are indicated.
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Data suggest that the current vitamin D recommendation of 400 to 800 IU daily is probably inadequate.
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Many physicians need further education on the use of dual-energy x-ray absorptiometry.
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In some respects, the estrogen-progestin arm of the Women’s Health Initiative (WHI) offered hormone replacement therapy (HRT) advocates encouragement. While it is true that this particular study was terminated due to an increased number of events for breast cancer, heart attack, and stroke, it was also the first large-scale clinical trial to prove that HRT can reduce fracture occurrence.
Osteoporosis threatens the public health, particularly for women. According to the National Institutes of Health (NIH), of the 10 million Americans who suffer from osteoporosis, 8 million are women over the age of 50. In addition, an estimated 18 million women with low bone mass have yet to be diagnosed or treated.1
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