OSTEOPOROSIS-MANAGEMENT (ESTROGEN)

SUMMARY

1. Mechanism of action: suppresses IL-6 secretion with inhibition of osteoclast recruitment, decreased bone resorption, increased calcium absorption from the gut.

2. Benefits: preserves bone mass at multiple skeletal sites, decreased incidence of fracture, ~50% risk reduction of vertebral & 60% reduction of hip/wrist fractures, prevents vasomotor symptoms of menopause.

3. Dosing regimens: 0.625 mg per day to 1.25 mg per day conjugated estrogen cycled or continuous with progesterone 2.5 to 10 mg; transdermal estradiol: 0.05 to 0.10 mg weekly.

4. Maintain therapy 10 to 20 years after onset of postmenopausal symptoms.

5. Intact uterus: use progesterone to decrease buildup of endometrium. If patient has had a hysterectomy, she may use estrogen only.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].