Is BHRT the key to prevention?

Abstract
Introduction
First line agents |
Alendronate (Fosamax) |
Zoledronic acid (Reclast) |
|
Risedronate (Actonel) |
|
Denosumab (Prolia) | |
Second and third line agents |
Ibandronate (Boniva) |
Raloxifene (Evista) | |
Most severe cases or failure of past therapies | Teriparatide (Forteo) |
Last line of therapy | Calcitonin |
No combination therapy |
1. Eating a diet rich in fruits and vegetables |
2. Intake of adequate calcium and vitamin D |
3. Engaging in regular weight-bearing exercise |
4. Stopping smoking |
5. Avoiding excessive alcohol consumption |
6. Avoiding high intake of vitamin A |
aSource: The National Osteoporosis Foundation.1 |
Table 3. FDA-approved Bioidentical Hormone Productsa |
|
Composition and Application |
Product Name |
Oral 17β-estradiol |
Estrace Various generics |
17β-estradiol patch |
Alora Climara Estraderm Menostar Minivelle Vivelle Vivelle-dot Various generics |
17β-estradiol gel |
Divigel EstroGel Elestrin |
17β-estradiol topical emulsion |
Estrasorb |
17β-estradiol transdermal spray |
Evamist |
17β-estradiol vaginal cream |
Estrace vaginal cream |
17β-estradiol vaginal ring |
Estring |
Estradiol acetate vaginal ring |
Femring |
Estradiol vaginal tablet |
Vagifem |
Oral 17β-estradiol + synthetic progestin |
Activella Angeliq Prefest |
Transdermal 17β-estradiol + synthetic progestin |
CombiPatch Climara Pro |
Oral micronized progesterone |
Prometrium |
aSource: The North American Menopause Society.73 |
Effects of Bioidentical Hormones on Bone
Estradiol
Table 4. Trials of 17β-estradiol and Bone Mineral Density |
|||||||
|
Type, Dose, and Regimen |
|
|||||
Source |
Design |
No. of Patients |
Estrogen |
Progestogen |
Length of Trial |
Results |
|
Al-Azzawi et al,37 2005 |
RCT |
174 |
TV estradiol: 7.5 μg/d, 50 μg/d, 1000 μg/d |
None |
96 wk |
Lumbar BMD increase of 0.3%, 2.7%,a and 3.3%a |
|
Ettinger et al,28 2004 |
Placebo-controlled RCT |
417 |
TD patch estradiol: 14 μg/d |
None |
2 y |
Lumbar BMD increase of 2.6%a; hip BMD increase of 0.4%a |
|
Farr et al,24 2013 |
Placebo-controlled RCT |
76 |
Oral CEE: 0.45 mg/d
|
None |
4 y |
Change in BMD did not differ between CEE-treated group and TD estradiol group |
|
TD estradiol: (50 μg/d) |
MP |
||||||
Gambacciani et al,21 2008 |
Open trial |
Data not available |
Oral estradiol: 1 mg/d, 0.5 mg/d
|
Norethisterone acetate: 0.5 mg/d, 0.25 mg/d |
2 y |
BMD increase ranged from +1.8%a in the femoral neck of the ultra low–dose group to +5.2%a in spine of low-dose group |
|
Greenwald et al,22 2005 |
Placebo-controlled RCT |
189 |
Oral estradiol: 0.25 mg/d, 0.5 mg/d, 1 mg/d, 2 mg/d |
Norethindrone acetate: 0 mg/d, 0.25 mg/d, 1 mg/d |
2 y |
All doses of oral estradiol prevented bone lossb |
|
Mizunuma et al,20 2010 |
Placebo-controlled RCT |
309 |
Oral estradiol: 0.5 mg/d, 1 mg/d |
None or levonorgestrel |
2 y |
BMD of 10%b in 1 mg/d group; BMD increase of 8%b in 0.5 mg/d group |
|
Prestwood et al,19 2003 |
Placebo-controlled RCT |
167 |
Oral estradiol: 0.25 mg/d |
None or MP |
3 y |
BMD increased by 2.6%b in the femoral neck, 3.6%b in the hip, 2.8%b in the spine, and 1.2%b total body |
|
Salminen et al,36 2007 |
RCT |
115 |
TV estradiol: 7.5 μg/d |
None |
2 y |
Small but nonsignificant increase in hip and lumbar BMD in treatment group |
|
Schaefers et al,29 2009 |
RCT |
500 |
TD patch estradiol: 14 μg/d; raloxifene: 60 mg/d |
None |
2 y |
TD estradiol increased BMD by 2.4% (95% CI:1.9-2.9), comparable to raloxifene |
|
Stanosz et al,25 2009 |
Placebo-controlled RCT |
75 |
Oral estradiol and estriol: varying doses; TD patch estradiol: varying doses |
Levonorgestrel |
1 y |
Greatest increase in BMD in TD group (+3.8%)b |
|
Tuppurainen et al,18 2010 |
Placebo-controlled RCT |
167 |
Oral estradiol: 2 mg/d |
Norethisterone: 1 mg/d |
5 y |
Treatment increased BMD by 4.2%b in lumbar spine and 1.3%b in femoral neck |
|
Warming et al,26 2005 |
Placebo-controlled RCT |
212 |
TD patch estradiol: 45 μg/d |
Levonorgestrel |
2 y |
TD estradiol increased BMD by 8%b in the spine, 6%b in the hip, and 3%b total body |
|
Yang et al,33 2007 |
RCT |
120 |
TD gel estradiol: 0.75 mg, 1.5 mg, 3 mg/d; oral estriol: 2 mg/d |
None |
1 y |
Significant increaseb in BMD in all groups except the lowest dose (0.75 mg). All doses of TD estradiol prevented loss of BMD |
|
Abbreviations: BMD, bone mineral density; CI, confidence interval; MP, micronized progesterone; RCT, randomized clinical trial; TD, transdermal; TV, transvaginal. aResults reached statistical significance (P<.05) in comparison to baseline bResults reached statistical significance (P<.05) in comparison to controls
|

Estriol
Estrone
Progesterone
Testosterone
DHEA
Safety of Bioidentical Hormones
Conclusion

References
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