Items in AFP with MESH term: Estrogen Replacement Therapy
ABSTRACT: With growing concern about the use of hormone replacement therapy, some women are looking for alternative treatments for menopausal symptoms and preventing postmenopausal cardiovascular disease and osteoporosis. In observational trials, exercise has been associated with decreased vasomotor symptoms. One trial suggested that black cohosh may reduce menopausal symptoms. Soy has been shown to decrease vasomotor symptoms, lower lipid levels, and increase bone density. However, large amounts of soy must be consumed, and it is not clear whether soy consumption causes a decrease in cardiovascular events or fractures. The evidence for St. John's wort is equivocal. Fish oil is helpful for secondary prevention of coronary artery disease.
Diagnosis and Treatment of Osteoporosis - Article
ABSTRACT: Osteoporosis affects approximately 8 million women and 2 million men in the United States. The associated fractures are a common and preventable cause of morbidity and mortality in up to 50 percent of older women. The U.S. Preventive Services Task Force recommends using dual energy x-ray absorptiometry to screen all women 65 years and older and women 60 to 64 years of age who have increased fracture risk. Some organizations recommend considering screening in all men 70 years and older. For persons with osteoporosis diagnosed by dual energy x-ray absorptiometry or previous fragility fracture, effective first-line treatment consists of fall prevention, adequate intake of calcium (at least 1,200 mg per day) and vitamin D (at least 700 to 800 IU per day), and treatment with a bisphosphonate. Raloxifene, calcitonin, teriparatide, or hormone therapy maybe considered for certain subsets of patients.
ABSTRACT: Family physicians will frequently encounter patients with osteoporosis, a condition that is often asymptomatic until a fracture occurs. Treatment of the fracture can be initiated without further diagnostic testing. Thereafter, treatment of osteoporosis includes (1) prevention of further bone loss through weight-bearing exercise, tobacco and alcohol avoidance, hormone replacement therapy in women, and raloxifene and calcium supplementation; (2) treatment of fracture-related pain with analgesics and calcitonin; (3) building bone mass when feasible with alendronate; and (4) modifying behaviors that increase the risk of falls. Patients without fracture who are at risk for osteoporosis can also benefit from these preventive measures. Furthermore, women of all ages should be encouraged to maintain a daily calcium intake of 1,000 to 1,500 mg and to participate in weight-bearing exercise for 30 minutes three times weekly to reduce their risk of falls and fractures. Persons at risk should avoid medications known to compromise bone density, such as glucocorticoids, thyroid hormones and chronic heparin therapy.
Postmenopausal Hormone Replacement Therapy for the Primary Prevention of Chronic Conditions - U.S. Preventive Services Task Force
Hormone Therapy: Continuing Discussion and Debate - Editorials
Screening for Osteoporosis in Postmenopausal Women - Putting Prevention into Practice
ACOG Releases Guidelines for Clinical Management of Osteoporosis - Practice Guidelines
Hormone Therapy for the Prevention of Chronic Conditions in Postmenopausal Women - Putting Prevention into Practice
Hormone Therapy in Postmenopausal and Perimenopausal Women - Cochrane for Clinicians