Update on Menopausal Hormone Therapy for Fracture Prevention

AbstractPurpose of ReviewThe goal of the review is to assess the appropriateness of menopausal hormone therapy (MHT) for the primary prevention of bone loss in women at elevated risk in the early years after menopause.Recent FindingsEstrogen alone or combined with progestin to protect the uterus from cancer significantly reduces the risk of osteoporosis-related fractures. MHT increases type 1 collagen production and osteoblast survival and maintains the equilibrium between bone resorption and bone formation by modulating osteoblast/osteocyte and T cell regulation of osteoclasts. Estrogens have positive effects on muscle and cartilage. Estrogen, but not antiresorptive therapies, can attenuate the inflammatory bone-microenvironment associated with estrogen deficiency. However, already on second year of administration, MHT is associated with excess breast cancer risk, increasing steadily with duration of use.SummaryMHT should be considered in women with premature estrogen deficiency and increased risk of bone loss and osteoporotic fractures. However, MHT use for the prevention of bone loss is hindered by increase in breast cancer risk even in women younger than 60 years old or who are within 10 years of menopause onset.
Source: Current Osteoporosis Reports - Category: Orthopaedics Source Type: research

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In this study, we found that the activities of alkaline phosphatase (ALP) and mineralized nodules in MC3T3-E1 cells were both significantly increased after treatment with AG (5, 10, and 20 μM). Meanwhile, the mRNA and protein levels of osteoblastic marker genes in MC3T3-E1 cells after AG treatment were markedly increased compared with a control group. In addition, the levels of BMP-2, p-Smad1/5/9, and Runx2 were significantly elevated in AG-treated MC3T3-E1 cells. Moreover, we found that the protein levels of Erk1/2, p-Erk1/2, p38, p-p38, and p-JNK were also significantly increased in AG-treated MC3T3-E1 cells compared ...
Source: Frontiers in Endocrinology - Category: Endocrinology Source Type: research
Abstract Selective estrogen receptor modulators (SERMs) are synthetic non-steroidal agents which have variable estrogen agonist and antagonist activities in different target tissues. Tamoxifen is an anti-estrogen in the breast used for treatment and prevention of breast cancer, with estrogen agonist activity in the uterus. Raloxifene prevents and treats osteoporosis and prevents breast cancer, and can be safely combined with vaginal but not systemic estrogen. The tissue selective estrogen complex combines conjugated equine estrogens (CEE) with the SERM bazedoxifene (BZA). The five Selective Estrogen Menopause and ...
Source: Climacteric - Category: Geriatrics Authors: Tags: Climacteric Source Type: research
Conclusions: Choice of SERM, selection of doses, and clinical trial data evaluating safety and efficacy are key to ensuring safety and adequate therapeutic effect of TSECs for addressing menopausal symptoms.
Source: Menopause - Category: OBGYN Tags: Clinical Corner: Invited Review Source Type: research
CONCLUSIONS: Currently, there is insufficient high-quality evidence to inform women considering HRT after treatment for endometrial cancer. The available evidence (both the single RCT and non-randomised evidence) does not suggest significant harm, if HRT is used after surgical treatment for early-stage endometrial cancer. There is no information available regarding use of HRT in higher-stage endometrial cancer (FIGO stage II and above). The use of HRT after endometrial cancer treatment should be individualised, taking account of the woman's symptoms and preferences, and the uncertainty of evidence for and against HRT use. ...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
The pendulum has swung from one extreme to the other when it comes to hormone replacement therapy (HRT) to treat symptoms of menopause. At first, the replacement hormones—mostly a combination of estrogen and progestin to replace what the body stops making after menopause—were seen as a panacea. Doctors thought they could not only relieve hot flashes and night sweats, but also prevent chronic aging diseases like heart problems and weakening bones. But studies then found that the supplement hormones could lead to a higher risk of breast cancer—and that they didn’t protect the heart after all. In the l...
Source: TIME.com: Top Science and Health Stories - Category: Consumer Health News Authors: Tags: Uncategorized Drugs estrogen Hormone Therapy hormones for menopause hot flashes night sweats progestin Reproductive Health treating menopause Source Type: news
Menopause occurs in all women between the ages of 45 and 55 and often results in undesirable vasomotor symptoms. Hormone replacement therapy (HRT) can alleviate these symptoms, including hot flashes, difficulty sleeping, fatigue, and vaginal atrophy, and also prevents osteoporosis. PremPro, a HRT formulation that combines conjugated equine estrogens (CE) with medroxyprogesterone acetate, was found to increase the risk of breast cancer in the Women's Health Initiative (WHI) trial. Due to the perceived risk based largely on the results of the WHI trial, the number of women taking HRT has dramatically decreased. Studies sugge...
Source: Cancer Research - Category: Cancer & Oncology Authors: Tags: Poster Session Abstracts Source Type: research
Authors: Parish SJ, Gillespie JA Abstract This review describes the evolving role of oral hormone therapy (HT) for treating menopausal symptoms and preventing osteoporosis, focusing on conjugated estrogens/bazedoxifene (CE/BZA). Estrogens alleviate hot flushes and prevent bone loss associated with menopause. In nonhysterectomized women, a progestin should be added to estrogens to reduce the risk of endometrial cancer. Use of HT declined since the Women's Health Initiative (WHI) studies showed that HT does not prevent coronary heart disease (CHD) and that conjugated estrogens/medroxyprogesterone acetate increased th...
Source: Postgraduate Medicine - Category: Internal Medicine Tags: Postgrad Med Source Type: research
CONCLUSIONS: Women with intolerable menopausal symptoms may wish to weigh the benefits of symptom relief against the small absolute risk of harm arising from short-term use of low-dose HT, provided they do not have specific contraindications. HT may be unsuitable for some women, including those at increased risk of cardiovascular disease, increased risk of thromboembolic disease (such as those with obesity or a history of venous thrombosis) or increased risk of some types of cancer (such as breast cancer, in women with a uterus). The risk of endometrial cancer among women with a uterus taking oestrogen-only HT is well docu...
Source: Cochrane Database of Systematic Reviews - Category: Journals (General) Authors: Tags: Cochrane Database Syst Rev Source Type: research
Abstract Modifiable lifestyle factors may reduce the risk of developing breast cancer. Obesity is associated particularly with post-menopausal breast cancer. Diet is important, and exercise equivalent to running for up to 8 hours each week reduces the risk of breast cancer, both in its own right and through reducing obesity. Alcohol consumption may be responsible for 5.8% of breast cancers in Australia and it is recommended to reduce this to two standard drinks per day. Drinking alcohol and smoking increases the risk for breast cancer and, therefore, it is important to quit tobacco smoking. Prolonged use of combin...
Source: Med J Aust - Category: Journals (General) Authors: Tags: Med J Aust Source Type: research
In this month’s article, I explore issues relating to the health of women in emerging markets. I will recommend that pharma companies wishing to maximize the opportunity in women’s health need to start from an understanding of how women are viewed by society in these markets and challenge awareness, attitudes and access barriers that can lead to their health outcomes being sub-optimal. As a starting point, it is necessary to establish a working definition of women’s health.  This isn’t as straightforward as it might seem, as women’s health can be considered at multiple levels.  The c...
Source: EyeForPharma - Category: Pharmaceuticals Authors: Source Type: news
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