Individualizing therapy to prevent long-term consequences of estrogen deficiency in postmenopausal women.

Abstract

MANY postmenopausal women are concerned about the long-term consequences of estrogen deficiency. Hormone replacement therapy (HRT) prevents the accelerated bone loss that occurs in women after menopause^1-3 and may decrease the risk of developing coronary heart disease (CHD),^1,4 but also appears to increase the risk of breast and endometrial cancer.^5,6 With the recent approval by the Food and Drug Administration of alendronate sodium and raloxifene hydrochloride therapy, postmenopausal women now have new treatment options to consider. Though not as thoroughly studied as HRT, both alendronate therapy^7,8 and raloxifene therapy (B. Ettinger, MD, unpublished data, 1998) decrease the risk of vertebral fractures without the cancer risks associated with HRT. However, they also lack some of HRT's benefits. Raloxifene, a nonsteroidal compound that has mixed estrogenic and antiestrogenic properties,^9-12 lowers serum total cholesterol levels,¹³ does not increase the risk of endometrial cancer,¹⁴ and may decrease the risk of breast cancer.¹⁵ Alendronate, a bisphosphonate, inhibits bone resorption but has no known impact on the incidence of CHD and breast or endometrial cancer.