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Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis?

(2020) OSTEOPOROSIS INTERNATIONAL. 31(12). p.2271-2286
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Abstract
We provide an evidence base and guidance for the use of menopausal hormone therapy (MHT) for the maintenance of skeletal health and prevention of future fractures in recently menopausal women. Despite controversy over associated side effects, which has limited its use in recent decades, the potential role for MHT soon after menopause in the management of postmenopausal osteoporosis is increasingly recognized. We present a narrative review of the benefits versus risks of using MHT in the management of postmenopausal osteoporosis. Current literature suggests robust anti-fracture efficacy of MHT in patients unselected for low BMD, regardless of concomitant use with progestogens, but with limited evidence of persisting skeletal benefits following cessation of therapy. Side effects include cardiovascular events, thromboembolic disease, stroke and breast cancer, but the benefit-risk profile differs according to the use of opposed versus unopposed oestrogens, type of oestrogen/progestogen, dose and route of delivery and, for cardiovascular events, timing of MHT use. Overall, the benefit-risk profile supports MHT treatment in women who have recently (< 10 years) become menopausal, who have menopausal symptoms and who are less than 60 years old, with a low baseline risk for adverse events. MHT should be considered as an option for the maintenance of skeletal health in women, specifically as an additional benefit in the context of treatment of menopausal symptoms, when commenced at the menopause, or shortly thereafter, in the context of a personalized benefit-risk evaluation.
Keywords
Cardiovascular, Epidemiology, Hormone therapy, Menopause, Osteoporosis, Safety, ESTROGEN PLUS PROGESTIN, CORONARY-HEART-DISEASE, REPLACEMENT THERAPY, COST-EFFECTIVENESS, HEALTH OUTCOMES, HIP FRACTURE, WOMEN, RISK, ATHEROSCLEROSIS, PREVENTION

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MLA
Rozenberg, S., et al. “Is There a Role for Menopausal Hormone Therapy in the Management of Postmenopausal Osteoporosis?” OSTEOPOROSIS INTERNATIONAL, vol. 31, no. 12, 2020, pp. 2271–86, doi:10.1007/s00198-020-05497-8.
APA
Rozenberg, S., Al-Daghri, N., Aubertin-Leheudre, M., Brandi, M.-L., Cano, A., Collins, P., … Harvey, N. C. (2020). Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis? OSTEOPOROSIS INTERNATIONAL, 31(12), 2271–2286. https://doi.org/10.1007/s00198-020-05497-8
Chicago author-date
Rozenberg, S., N. Al-Daghri, M. Aubertin-Leheudre, M. -L. Brandi, A. Cano, P. Collins, C. Cooper, et al. 2020. “Is There a Role for Menopausal Hormone Therapy in the Management of Postmenopausal Osteoporosis?” OSTEOPOROSIS INTERNATIONAL 31 (12): 2271–86. https://doi.org/10.1007/s00198-020-05497-8.
Chicago author-date (all authors)
Rozenberg, S., N. Al-Daghri, M. Aubertin-Leheudre, M. -L. Brandi, A. Cano, P. Collins, C. Cooper, A. R. Genazzani, T. Hillard, J. A. Kanis, Jean Kaufman, I. Lambrinoudaki, A. Laslop, E. McCloskey, S. Palacios, D. Prieto-Alhambra, J. -Y. Reginster, R. Rizzoli, G. Rosano, F. Tremollieres, and N. C. Harvey. 2020. “Is There a Role for Menopausal Hormone Therapy in the Management of Postmenopausal Osteoporosis?” OSTEOPOROSIS INTERNATIONAL 31 (12): 2271–2286. doi:10.1007/s00198-020-05497-8.
Vancouver
1.
Rozenberg S, Al-Daghri N, Aubertin-Leheudre M, Brandi M-L, Cano A, Collins P, et al. Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis? OSTEOPOROSIS INTERNATIONAL. 2020;31(12):2271–86.
IEEE
[1]
S. Rozenberg et al., “Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis?,” OSTEOPOROSIS INTERNATIONAL, vol. 31, no. 12, pp. 2271–2286, 2020.
@article{8698874,
  abstract     = {{We provide an evidence base and guidance for the use of menopausal hormone therapy (MHT) for the maintenance of skeletal health and prevention of future fractures in recently menopausal women. Despite controversy over associated side effects, which has limited its use in recent decades, the potential role for MHT soon after menopause in the management of postmenopausal osteoporosis is increasingly recognized. We present a narrative review of the benefits versus risks of using MHT in the management of postmenopausal osteoporosis. Current literature suggests robust anti-fracture efficacy of MHT in patients unselected for low BMD, regardless of concomitant use with progestogens, but with limited evidence of persisting skeletal benefits following cessation of therapy. Side effects include cardiovascular events, thromboembolic disease, stroke and breast cancer, but the benefit-risk profile differs according to the use of opposed versus unopposed oestrogens, type of oestrogen/progestogen, dose and route of delivery and, for cardiovascular events, timing of MHT use. Overall, the benefit-risk profile supports MHT treatment in women who have recently (< 10 years) become menopausal, who have menopausal symptoms and who are less than 60 years old, with a low baseline risk for adverse events. MHT should be considered as an option for the maintenance of skeletal health in women, specifically as an additional benefit in the context of treatment of menopausal symptoms, when commenced at the menopause, or shortly thereafter, in the context of a personalized benefit-risk evaluation.}},
  author       = {{Rozenberg, S. and Al-Daghri, N. and Aubertin-Leheudre, M. and Brandi, M. -L. and Cano, A. and Collins, P. and Cooper, C. and Genazzani, A. R. and Hillard, T. and Kanis, J. A. and Kaufman, Jean and Lambrinoudaki, I. and Laslop, A. and McCloskey, E. and Palacios, S. and Prieto-Alhambra, D. and Reginster, J. -Y. and Rizzoli, R. and Rosano, G. and Tremollieres, F. and Harvey, N. C.}},
  issn         = {{0937-941X}},
  journal      = {{OSTEOPOROSIS INTERNATIONAL}},
  keywords     = {{Cardiovascular,Epidemiology,Hormone therapy,Menopause,Osteoporosis,Safety,ESTROGEN PLUS PROGESTIN,CORONARY-HEART-DISEASE,REPLACEMENT THERAPY,COST-EFFECTIVENESS,HEALTH OUTCOMES,HIP FRACTURE,WOMEN,RISK,ATHEROSCLEROSIS,PREVENTION}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{2271--2286}},
  title        = {{Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis?}},
  url          = {{http://dx.doi.org/10.1007/s00198-020-05497-8}},
  volume       = {{31}},
  year         = {{2020}},
}

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