Physicians face conundrum when treating bone loss

One new study finds that fractures increased after the Women's Health Initiative cast doubt on the safety of hormone therapy.

By Susan J. Landers, AMNews staff. Nov. 20, 2006.

Washington -- Women in the earliest years of menopause -- those most in danger of rapid bone loss -- present a challenge to doctors who weigh the risks and benefits of available therapies.

The bisphosphonates and hormone therapies have long been the mainstays, but each has taken a hit, and their risk profiles have changed.

After the 2002 results of the Women's Health Initiative, hormone therapy fell from favor with the news that it caused increased risks for breast cancer, strokes and heart attacks. More recently, reports of osteonecrosis of the jaw among some bisphosphonate users raised concerns about those drugs.

Still, the fracture risks are fueling the need to protect bone health. Each year, about 1.5 million men and women have an osteoporosis-related fracture, according to a 2004 surgeon general's report. As many as 10 million Americans are estimated to have osteoporosis -- 8 million women and 2 million men, according to the National Osteoporosis Foundation.

And, although treatment remains a dilemma for physicians treating women in early menopause, the pendulum may be swinging back toward estrogen, said Wulf Utian, MD, PhD, executive director of the North American Menopause Society.

"There is certainly continued interest in hormone use for bones," he said. Debate at the society's recent conference indicated that there may be two camps forming: one that favors estrogen use and the other that favors bisphosphonates.