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Published on: August 13, 2019
Osteoporosis and cardiovascular disease: benefit-risk of hormone replacement therapy
A Sammartino1, D Cirillo, V D Mandato
1Department of Obstetrics and Gynecology, University of Naples Federico II, Naples, Italy. lidiasamma@tin.it
Insights
Hormone replacement therapy (HRT) use in post-menopausal women requires careful consideration due to cardiovascular disease (CVD) risks. Individualized treatment plans are essential for managing both CVD and osteoporosis risks.
Area of Science:
- Reproductive Endocrinology
- Cardiovascular Health
- Geriatric Medicine
Background:
- Post-menopausal osteoporosis and cardiovascular disease (CVD) are significant health concerns for older women.
- Early menopause increases CVD risk, while later menopause correlates with longer survival.
- Hormone replacement therapy (HRT) was previously recommended for CVD risk reduction in post-menopausal women.
Purpose of the Study:
- To re-evaluate the role of HRT in post-menopausal women considering recent trial data.
- To assess the risk-benefit ratio of HRT for cardiovascular and osteoporosis prevention.
- To guide individualized treatment strategies for middle-aged women.
Main Methods:
- Review of recent clinical trials, including the Women's Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS) I and II.
- Analysis of CVD and fracture risk data associated with HRT.
- Evaluation of factors influencing HRT risk-benefit profiles.
Main Results:
- WHI and HERS trials indicated increased CVD and stroke risks with HRT, not fully offset by fracture reduction.
- These findings necessitate a reconsideration of HRT's application in post-menopausal women.
- Specific patient profiles may exist where HRT offers a favorable risk-benefit ratio.
Conclusions:
- HRT use in post-menopausal women should be individualized, particularly for symptomatic individuals.
- Prevention programs for cardiovascular and osteoporosis risks are crucial for middle-aged women.
- Current evidence suggests a shift away from general HRT recommendations towards tailored approaches.
Abstract:
Post-menopausal osteoporosis represents a major public health problem. Osteoporotic fractures in older women constitute a major cause of disability, mortality and economic burden. Cardiovascular disease (CVD) is the primary cause of death in women in westernized countries, with more than one in two women dying from CVD. In literature it is well established that an early menopause increases the risk of CVD and that a later menopause is associated with longer overall survival. Until a few years ago, in the management guidelines, a combination of lifestyle and use of hormonal replacement therapy (HRT) was suggested to reduce the CVD risk in post-menopausal women. However, recent studies such as the Women's Health Initiative (WHI) trial and the Heart and Estrogen/Progestin Replacement Study (HERS) I and II has forced practitioners to reconsider their options for prevention of CVD in post-menopausal women. The increased risk of CVD and stroke which were not counterbalanced by the smaller reduction in numbers of hip fractures in the WHI and in the HERS I-II suggest new characteristics of women in which HRT could possibly exert a favourable risk/benefit ratio. The use of HRT in post-menopausal women might be considered in symptomatic women and it might be individualized for each patients. Therefore, for cardiovascular and osteoporosis risk, regular prevention programmes should serve the needs of middle-aged women.
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