Estrogen is not first-line therapy for osteoporosis
One of the principal findings of the WHI is that estrogen reduces the risk of fracture. Dr. Schiff noted, however, that estrogen should not be prescribed for that indication, as a host of other medications are available that lack the risks of estrogen therapy. Those medications include alendronate and the other bisphosphonates; raloxifene; and zoledronic acid.
What’s the bottom line?
There is no single “right” answer to the question of when estrogen therapy is appropriate. Each case should be individualized, Dr. Schiff said. If a patient is healthy, recently menopausal, and bothered by moderate or severe vasomotor flushes or urogenital symptoms, then estrogen is one option that should be presented, along with its benefits and risks. Ultimately, it is the patient, in partnership with her physician, who must decide for or against estrogen therapy.
CASE: Resolved
This patient may not require estrogen, although it is certainly an option. Although she is young, symptomatic, and recently menopausal, her vasomotor symptoms are mild. Because her symptoms are not severe, time alone may be sufficient “treatment,” or she may want to try a simple lifestyle adjustment such as the wearing of layers of clothing that can be removed when a vasomotor flush occurs.
If vaginal atrophy is a problem, local estrogen or a topical vaginal agent such as Replens may provide relief.