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Boosting
bone density in older women
HealthNews,
May
21, 2003
Hormone therapy used in tandem
with the drug Fosamax boosts bone mineral density in older women better
than either therapy alone does. That's the conclusion of a study appearing
in the May 21 issue of the Journal of the American Medical Association. Bone mineral density is a key
indicator of whether a person suffers from osteoporosis. "Hormone replacement
provides a benefit when combined with Fosamax," says study author Dr
Susan Greenspan. "For women who start out with very low bone density
or many fractures or many women who have failed on a single therapy, this
would be a good option if the primary problem was osteoporosis." Findings aren't entirely new "This confirms other data
which have shown improvements in bone density by the combination that is
superior to either of the single agents," says Dr Stephen Honig,
director of the Osteoporosis Center at the Hospital for Joint Diseases in
New York City. "There's been data out for a couple of years now that
show that combination therapy is both safe and effective." First study to look at older
women The Women's Health Initiative (WHI),
a long-term study designed partly to assess the risks and benefits of
postmenopausal hormone therapy, found an increase in heart attacks,
strokes, blood clots and breast cancer in women on hormone replacement
therapy (HRT) but a decrease in colorectal cancer and hip fractures. HRT
may also decrease the risk for type 2 diabetes. But there are several
differences between the WHI and this study, Greenspan says. "The
findings from the WHI included women aged 79 and younger, so older women
were excluded and we included them in our study. The other difference is
that that study was designed to look at general prevention and ours looked
at prevention and treatment for osteoporosis. It was specific." Breaking down osteoporosis According to the National
Osteoporosis Foundation, women are four times more likely than men to
develop the disease, which currently affects an estimated 10 million
Americans. An additional 34 million people are thought to have low bone
mass, which puts them in jeopardy of developing osteoporosis. Alendronate has a more
specific effect "It basically leads to the
osteoblasts' early death and blocks them from eating up the bones,"
says Greenspan, who is also professor of medicine and director of the
Osteoporosis Prevention and Treatment Center at the University of
Pittsburgh School of Medicine. The study methodology The women were randomly assigned
to receive HRT (with or without progesterone) alone, Fosamax alone, both
together or neither. All the participants were also given calcium and
vitamin D supplements. Osteoporosis can either be
measured by bone density levels or by the number of fractures a person
sustains. The researchers opted to study the former, because of the time
it would take to look at fractures. Generally speaking, the lower the bone
mineral density, the more likely you are to fracture a bone. Bone density higher in women
on combination therapy As always, the choice of a
particular therapy is a highly individual one. "There is no reason to
suppose that the risk [of HRT] would differ substantially with the
addition of a bisphosphonate [such as Fosamax] to the hormone
regimen," the study authors write. "The main results of this
study can help answer the question of whether the potential risk of
hormone treatment is worth the estimated eight percent reduction in
fracture risk when combination therapy is used compared with Fosamax
alone." Weigh up the risks of HRT for
each individual Copyright
© 2002 Global Action on Aging
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