Treatment To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: An Update
Benefits: Menopausal Hormone Therapy
In studies of postmenopausal women in general, MHT reduces the risk of vertebral, nonvertebral, and hip fractures. The strength of evidence for this finding is high. However, in postmenopausal women with established osteoporosis, MHT does not reduce fracture risk significantly. The strength of evidence for this conclusion is moderate. No differences in comparative effectiveness have been shown between bisphosphonates and MHT in preventing fractures (Strength of Evidence: Moderate). In addition, no differences in fracture incidence have been shown between patients treated with MHT and raloxifene or vitamin D (Strength of Evidence: Low).
As a footnote to this evidence, it is important to note that the Women’s Health Initiative (WHI) reported serious adverse events associated with MHT, such that routine use of hormone replacement therapy in postmenopausal women is now discouraged.
Keywords: bisphosphonates | bone density | comparative effectiveness | fracture | hip | hormone therapy | low bone density | nonvertebral | osteopenia | osteoporosis | postmenopausal | raloxifene | risk | skeletal | vertebral | vitamin D | bone
- Newberry SJ, Crandall CC, Gellad WG, et al. Treatment To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: An Update to the 2007 Report. Comparative Effectiveness Review No. 53 (Prepared by the Southern California Evidence-based Practice Center under Contract No. HHSA 290-2007-10062-I). Rockville, MD: Agency for Healthcare Research and Quality; February 2012. AHRQ Publication No. 12-EHC023-EF. Available at www.effectivehealthcare.ahrq.gov/reports/lbd.cfm.
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