Osteoporosis

Women with menopausal symptoms have a lot more choices for treatment than they've had in the past. Things have certainly improved since the fifties, when one doctor recommended women with hot flushes go out and buy themselves a new hat!

These days, the standard prescription is hormone replacement therapy, or HRT. As the name suggests, it 'puts back' some of the hormones the ovaries have stopped producing. The basic formula is a combination of oestrogens and progestin (a synthetic form of progesterone). It can be taken in the form of pills, patches, gels, or implants, and at different dosages depending on the individual woman's needs.

Taking HRT for reasons other than symptom relief means taking it long-term, possibly for the rest of your life. But this is where the picture of risks and benefits gets more murky. The reasons HRT may be recommended are to prevent osteoporosis and heart disease. The major down-side is a probable small increase in the risk of breast cancer.


Osteoporosis

Osteoporosis is a condition characterised by weak, fragile bones that puts many older women (and some men) at high risk of fracture. Bone is a living tissue which is constantly being broken down and renewed; osteoporosis occurs when renewal does not keep up with breakdown, so that the bone gradually becomes less dense.

Women are more vulnerable to osteoporosis after menopause, because oestrogen helps control the balance between bone breakdown and formation. As oestrogen levels fall, bone breakdown speeds up while formation slows slightly, leading to higher overall rates of bone loss. The results of the Melbourne Women's Midlife Health Study showed that women lost an average of 2 per cent of their bone mass annually during the menopausal transition, and 1 per cent each year after that.

"Given women are going to live thirty or forty years after menopause, thatís a lot of bone mass to lose," says Professor Lorraine Dennerstein, head of the study. Women at highest risk of osteoporosis, she says, include those with a family history of the disease, those who've had eating disorders, those who've taken steroids for asthma or other conditions, smokers, and heavy drinkers. Women reach peak bone mass during their twenties, so exercise and dietary calcium are important during childhood and adolescence, when bone mass is being built up.

If you are at risk of osteoporosis (as shown by a bone density test), there is good evidence that hormone replacement therapy will help maintain bone and therefore lower your risk of a fracture. However, the benefit only lasts for as long as you stay on the medication.

"Itís like being on the pill," says Associate Professor Sue Davis of the Jean Hailes Foundation. "As long as you take it you donít get pregnant; you stop, you get pregnant. Itís no different. When you stop, the bone breakdown starts again."But, she adds, that doesn't mean you have to stay on the same medication for the rest of your life. New anti-osteoporosis drugs are coming on to the market which will give women more options for preventing and treating the disease.