Reversal of Bone Loss with Percutaneous Oestrogens
It is now accepted that oestrogen replacement therapy after the menopause is effective in preventing the rapid loss of bone which occurs following the cessation of ovarian function [1–4]. Although maintenance of bone mass is sufficient for recently postmenopausal women, it may be inadequate for woman many years past the menopause who have lost a significant proportion of their bone mass. For such women, who have already developed osteoporosis and suffered a fracture, hormone replacement is often not advised as it is considered too late to have any beneficial effect on the skeleton. Nothing will reverse the loss of height and “Dowager’s hump” characteristic of the disease, but if it is possible to increase bone density to above the “fracture threshold” oestrogen therapy should be given despite the increased incidence of side effects in patients of this age. The disadvantages of a monthly withdrawal bleed may be an acceptable price to pay if greater bone strength is achieved (Fig. 22.1).
KeywordsEstrogen Osteoporosis Testosterone Progesterone Oestradiol
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