 Posted 08/06/2010 11:52:59
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| National Osteoporosis Society Policy on Hormone Replacement Therapy for the Treatment and Prevention of Osteoporosis As recently as two decades ago, Hormone Replacement Therapy (HRT) was the only treatment available for osteoporosis and was prescribed for post-menopausal women to raise the level of the hormone oestrogen after the menopause. However, over the last twenty years, the range of treatments for osteoporosis has greatly increased and we have a far better understanding of the effects of the long-term use of HRT. Following the high-profile reporting of side effects (such as stroke, breast cancer and heart disease) in the Women’s Health Initiative (WHI) trial many doctors and women have moved away from using HRT. However, HRT has been shown to increase bone density and reduce the risk of fracture and can successfully relieve menopausal symptoms such as hot flushes, vaginal dryness and loss of libido. We feel that the role of HRT in the management of osteoporosis needs to be clarified. Recent reanalysis of the under 60’s age group in the WHI study, new data on the potential long-term side-effects of bisphosphonates and the production of unworkable NICE guidance have all influenced the development of our policy. We have developed a policy on HRT with our scientific advisors and would now like to open the issue up for wider stakeholder input. We would welcome your views and opinions. Please discuss them here, but to be formally considered as part of the consultation process they need to be submitted on the consultation response form. You can download the policy and consultation response form at www.nos.org.uk/consultation Thank you.
Claire Bowring
Medical Policy Officer
National Osteoporosis Society
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Posted 14/06/2010 17:48:47
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| I am new to the site, in fact this is my first post. I found out I had osteoporosis a few months ago and am 54 yrs old and still feel young! Having been prescribed Actonel and Adcal, I have since researched Actonel and am very alarmed at what I have read. I already have reflux problems and have come to the decision, I do not want to take bisphosphonates. I felt I had nowhere to turn until I read your document on HRT. Yes, I know there are risks attached to HRT but weighing everything up I would rather feel well on HRT, than suffering stomach problems and even worse on Actonel. There even seems to be a question mark over their long term use, with possible worsening of the fragility of the bones, not to mention the risk of serious jaw problems. I would feel happier taking my chances with HRT, whilst feeling healthy and well, than risking damaging my body with biophosphates.
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Posted 14/06/2010 18:12:16
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Hi Heather,
Welcome to the forum ! I was diagnosed with osteoporosis when I was 53, although I would have had it many years previously. And I feel young - I'm 57 now and I feel fitter than ever !
There are other medications besides bisphosphonates ! I have a history of hiatus hernia and duodenal ulcer so the bisphophonates are contraindicated and I was put straight on Strontium Ranelate which is a totally different kind of medication: www.wikipedia.org/wiki/Strontium_ranelate I'm happy to say I have never had any side effects and my bone density is increasing on follow up DEXA scan.
I also do weight bearing exercise which helps increase bone density: weight lifting twice a week, a specific technique called SuperSlow, and walking a few miles every day. And I do a few gentle exercises on a vibration platform. I also take a high dose of vitamin D3, 2000IU per day. I get bad side effects from calcium supplements so I'm unable to take them, so I try and make sure my diet is high in calcium and gives an alkaline load which helps stop loss of bone density too ! So you see why I feel fitter than ever and that's despite also getting diagnoses of diabetes and a heart defect very soon after my osteoporosis diagnosis !
Osteoporosis - Strontium Ranelate, Dekristol vitamin D3 20,000 IU/week, weight lifting, walking and vibration platform exercise, alkaline loaded diet, vitamin K2 MK-7 100mcg/d, K2 MK-4 5mg/d. Diabetes - Repaglinide, low carb diet and exercise. Congenital heart defect - Omacor and CoQ10
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Posted 14/06/2010 19:37:00
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| Hi Annabel Thank you for your encouraging reply. I will check out the web site for "Strontium Ranelate" with interest. I want to start doing some weight bearing exercise too, at the moment I walk my dog a few miles every day. Best Wishes Heather
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Posted 15/06/2010 09:20:11
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| Thanks for your response Heather. If you have any concerns or questions with regard to HRT, we have a Helpline staffed by nurses who will be able to offer you advice and support. You can get in touch with them by calling 0845 450 0230 (or 01761 472721), or by emailing them. Please could all responses to the topic be relevant to the subject matter, so that it will be easier for Claire to collate them. Thank you.
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James Hobbs
Electronic Communications Officer
National Osteoporosis Society
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Posted 15/06/2010 16:48:47
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| Hello Heather welcome to the site. My GP refuses to prescribe HRT. I think it is the advice he has been given. And I know of others who have been taken off it because of risks. I think it is to do with age. Which is unfortuante for me as I had bad and very bad reactions to 4 of the Osteoporosis drugs. I found this site helpful for patients comments on some of the drugs www.askapatient.com It is an American site, but people from uk also give their input.
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Posted 15/06/2010 17:45:48
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Claire Bowring (08/06/2010)
We have developeda policy on HRTwith our scientific advisors and would now like to open the issue up for wider stakeholder input. We would welcome your views and opinions. Please discuss them here
A close friend of mine was prescribed HRT for osteoporosis and developed breast cancer. Thankfully after radiation therapy and chemotherapy she recovered and has stayed cancer free, but now she refuses to take any medication at all for her osteoporosis so put off was she by the experience.
If I had to change the osteoporosis medication I'm on for some reason (Protelos), I have to say I would be extremely hesitant to use HRT.
Osteoporosis - Strontium Ranelate, Dekristol vitamin D3 20,000 IU/week, weight lifting, walking and vibration platform exercise, alkaline loaded diet, vitamin K2 MK-7 100mcg/d, K2 MK-4 5mg/d. Diabetes - Repaglinide, low carb diet and exercise. Congenital heart defect - Omacor and CoQ10
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Posted 16/06/2010 23:50:13
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| I do understand that having a friend going through such an awful illness as a result of taking HRT, would certainly put you off considering it, as an option to treat Osteoporosis. I know people however, who have been on HRT since the age of 50 and are now in their 60's, without any problems, perhaps they were just lucky. There seems to be some evidence, that if you are under the age of 60 the risks are less. All the osteoporosis drugs appear to have bad side effects, even Strontium Ranelate is said to increase the risk of having a stroke. I really appreiate your comment and must confess to still feeling confused about the whole iisue.
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Posted 16/06/2010 23:52:01
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| Many thanks James that would be really helpful.
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Posted 17/06/2010 07:49:40
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Heather (16/06/2010)
There seems to be someevidence, that if you are under the age of 60 the risks are less
My friend was in her mid 40's at the time 
All the osteoporosis drugsappear to havebad side effects
All medications can have side effects. I got bad side effects from calcium supplements, so bad I was referred to a gastroenterologist and had to undergo colonoscopy, endoscopy and other tests. My consultant says I must not take calcium supplements !
even Strontium Ranelateis said to increase the risk of having a stroke
Strontium Ranleate was shown to slightly increase the risk of deep vein thrombosis (clots, not stroke) but this risk was less than the risk of deep vein thrombosis that HRT has ! And it was only slightly more, well less than 1% more from what I remember than those in the placebo group got - the fact is that post menopausal women are at risk of deep vein thrombosis even if they take nothing !
I find one has to look at the data very carefully to weed out exactly what it means and then work out the risk. And of course discuss this all with a doctor if you can and if he/she will take the time. There is also the risk of doing nothing which may mean fractures which can be as life threatening as blood clots and cancer There's an awful lot to think about.
Osteoporosis - Strontium Ranelate, Dekristol vitamin D3 20,000 IU/week, weight lifting, walking and vibration platform exercise, alkaline loaded diet, vitamin K2 MK-7 100mcg/d, K2 MK-4 5mg/d. Diabetes - Repaglinide, low carb diet and exercise. Congenital heart defect - Omacor and CoQ10
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