Bone health and aging: implications for menopause

Women experience many symptoms and face numerous health issues as they go through menopause, including increased risk for osteoporotic fracture, cardiovascular disease, urogenital disorders, and cognitive decline-all related to diminishing estrogen levels in the body. Osteoporosis is one major health condition that contributes to excess morbidity and mortality in women after menopause; the risk for osteoporosis increases with age. Before the Women's Health Initiative (WHI) trial, hormone therapy (HT) was prescribed commonly for symptoms of menopause, and there was also evidence that HT protected against osteoporosis. In the WHI trial, however, in which risks versus benefits of HT were prospectively evaluated, overall health risks exceeded benefits, with the beneficial effects seen only in the decreased incidence of hip fractures and colon cancer [1]. The role of HT in menopausal women is unclear at this time, although many women may require it to reduce menopausal symptoms. Osteoporosis may be an area where the benefit of using HT may outweigh the risks in a select group of women. Further, because lower than usual doses of estrogen have been shown to reduce menopausal symptoms and to protect bone, additional research will likely expand physicians' current knowledge of the use of HT in menopausal women. This article reviews the use of low-dose estrogen to promote bone health in postmenopausal women.