Postmenopausal osteoporosis: the role of estrogens

In 1980, the combined incidences of vertebral and hip fractures necessitating hospitalization of women living in Knox County, Tennessee nearly doubled each five years after the age of 50. These data led us to review the pathogenesis, diagnostic methods, and therapeutic measures used to control or minimize the occurrence of postmenopausal osteoporosis. Postmenopausal diminution in estrogen metabolism appears to be the most important cause of osteoporosis. Other contributory factors include an early menopause, low body weight, lack of sufficient exercise, poor nutrition, and excessive use of alcohol, coffee, and tobacco. Absorptiometric studies, which have minimal radiation risk, are one of the more reliable methods to identify women with osteoporosis, whereas ordinary roentgenographic methods are relatively inaccurate for this purpose. Therapeutically, we recommend cyclic estrogen combined with a progestogen, the latter drug given for ten days each month to minimize the chance of endometrial or mammary carcinoma, particularly if estrogen is to be given for five years or more. In addition, particular attention should be given to good nutrition, including 1 to 2 gm of calcium salts taken each evening, and adequate exercise. Intake of coffee and alcoholic beverages and use of cigarettes should be discontinued or minimized.