[Hormone replacement therapy in the prevention of osteoporosis. Evolution of therapeutic methods]

ESTABLISHED FACTS: Many studies have evidenced that hormone replacement therapy can help prevent post-menopausal osteoporosis and osteoporotic fractures in menopaused women. Thanks to recent advances in pharmacology, hormone replacement therapy can now closely mimic ovarian physiology and thus eliminate most of the contraindications related to metabolic disorders. UNRESOLVED QUESTIONS: The need for prolonged treatment to reach optimal efficacy raises the problems of safety and compliance. This is particularly true for the prevention of fractures of the femoral neck which usually occur in older women, suggesting it could be useful to revisit the estrogen strategy. NEW COMPOUNDS: The action of selective estrogen receptor modulators (SERM) depends on the target organ. They have an estrogen agonist effect on bone and lipid metabolism but no such effect on the uterus. SERMs could offer new therapeutic opportunities for the prevention of post-menopausal osteoporosis.