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November 6, 1996

Boning Up on Estrogen: New Options, New Concerns

JAMA. 1996;276(17):1430-1432. doi:10.1001/jama.1996.03540170074037

POSTMENOPAUSAL osteoporosis is due primarily to the accelerated bone loss that occurs in the years following menopause. Estrogen replacement effectively abrogates this increase in bone breakdown and appears to decrease fracture rates.1-4 Despite the development of several promising alternatives, estrogen remains the standard for treatment of postmenopausal osteoporosis and the only drug with labeling approval for its prevention.5 Long-term adherence to oral hormone replacement therapy (HRT), however, is poor. In 1 recent study, fewer than 25% of women reported that they still used HRT 2 years after initiation of treatment.6 A practical limitation of HRT is that the intermittent administration of a progestational agent with estrogen to women with a uterus is accompanied by the return of regular uterine bleeding in nearly 75% of individuals.7 Many postmenopausal women find such bleeding unacceptable. An alternative regimen that employs the daily use of both a progestin and an