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Current Osteoporosis Reports
Published in: Current Osteoporosis Reports 6/2019

Open Access 01-12-2019 | Breast Cancer | Therapeutics and Medical Management (S Jan De Beur and B Clarke, Section Editors)

Update on Menopausal Hormone Therapy for Fracture Prevention

Authors: Jan J. Stepan, Hana Hruskova, Miloslav Kverka

Published in: Current Osteoporosis Reports | Issue 6/2019

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Abstract

Purpose of Review

The 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 Findings

Estrogen 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.

Summary

MHT 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.
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Metadata
Title
Update on Menopausal Hormone Therapy for Fracture Prevention
Authors
Jan J. Stepan
Hana Hruskova
Miloslav Kverka
Publication date
01-12-2019
Publisher
Springer US
Published in
Current Osteoporosis Reports / Issue 6/2019
Print ISSN: 1544-1873
Electronic ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-019-00549-3

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Quality of Care in Osteoporosis (S Silverman and J Curtis, Section Editors)

Pragmatic Clinical Trials in Osteoporosis

Osteoimmunology (M Nakamura and J Lorenzo, Section Editors)

Mechanisms of Immune Evasion and Bone Tissue Colonization That Make Staphylococcus aureus the Primary Pathogen in Osteomyelitis

Bone and Diabetes (A Schwartz and P Vestergaard, Section Editors)

Effects of Diabetes on Bone Material Properties

Muscle and Bone (L Bonewald and M Hamrick, Section Editors)

Exosomes and Extracellular RNA in Muscle and Bone Aging and Crosstalk

Quality of Care in Osteoporosis (S Silverman and J Curtis, Section Editors)

Bone Health TeleECHO: a Force Multiplier to Improve the Care of Skeletal Diseases in Underserved Communities

Biomechanics (G Niebur and J Wallace, Section Editors)

Biomechanics of Osteoporotic Fracture Fixation