Is There A Place for Oestrogens in Primary Prevention of Osteoporosis?

Estrogen Replacement Therapy (ERT) and Hormone Replacement Therapy (HRT) result both in a significant reduction of fracture risk. For the Swiss (SMG), the European (EMAS) and the International (IMS) Menopause Societies, prevention of osteoporosis remains one of the well-established benefits of ERT and HRT and therefore where indicated a first line treatment for fracture prevention in the peri-and early postmenopause. In presence of severe climacteric symptoms, ERT and HRT are uncontested the most efficient therapeutic principal, and the main indication for hormone administration. If estrogens are used for the treatment of the climacteric syndrome, fracture prevention is an evidence-based positive side effect. Each ERT/HRT has to be individualized. It should not be continued for a longer period of time than necessary. If indicated, ERT and HRT can be continued for more than the customary 3-5 years. In precocious (before the age of 40 years) and early (before the age of 45 years) menopause, there is an absolute indication for ERT or HRT. Women suffering from premature ovarian insufficiency usually need higher dosages than women with timely natural menopause. For reasons of osteoporosis prevention, ERT/HRT should be continued at least until the normal physiological menopause age (51-52 years) is reached. When ERT/HRT is started within 10 years after menopause or before the age of 60 years, the benefits outweigh the risks. In younger postmenopausal women, this fact has to be considered systematically when the treatment for climacteric symptoms is chosen in presence of an increased risk for osteoporosis.