Osteoporosis and the Orthopaedic Surgeon: How to Prevent and Treat

John D. Kaufman, MD


Medscape Orthopaedics & Sports Medicine eJourn. 2001;5(2) 

In This Article

Prevention of Osteoporosis

Robert Lindsey, MD, discussed current concepts in the use of hormone replacement therapy (HRT) to prevent bone loss. He presented data demonstrating that previous or past estrogen use is likely to have only a modest effect on bone density, due to accelerated bone loss upon cessation of estrogen therapy. New concepts in estrogen dosing to prevent osteoporosis show that doses less than the standard 0.625 mg of Premarin may be effective for preventing skeletal osteoporosis. Data show that 70% of women who take only 0.3 mg of estrogen will not lose bone. Older studies that showed the need for 0.625 mg to prevent osteoporosis did not use calcium supplements as an adjunct to estrogen therapy.[7] Lower doses such as 0.3 mg are just as effective in preventing bone loss as 0.625 mg as long as adequate calcium and vitamin D supplements are used.[8]

Whether the progestin component of HRT has a significant impact on osteoporosis prevention was also addressed. Changes in bone density have been seen at high doses, such as 20 mg of medroxyprogesterone acetate (MPA). However, the relatively small doses of MPA commonly used today (2.5 mg per day) appear to have no effect on bone density. Data from the PEPI study show that the addition of progestins to estrogen do not lead to any further increase in bone density.[7]