Senile (type II) osteoporosis: pathogenesis and prevention of estrogen deficiency-related bone loss at the proximal femur.

Abstract

Fractures of the proximal femur are associated with considerable morbidity and mortality. The residual effects of estrogen deficiency-related bone loss (partially) account for the higher incidence of hip fracture in elderly women compared to elderly men. This accelerated phase of postmenopausal bone loss can be prevented by estrogen substitution therapy. However, when estrogen substitution is discontinued, bone density declines at a rate similar to the perimenopausal one. In line with these densitometric data, several studies have provided evidence that the protective effect of estrogen therapy on hip fracture incidence does not persist after discontinuation of substitution. To prevent hip fractures in old age, estrogen treatment may have to be initiated perimenopausally and never discontinued. At present, however, such a strategy cannot be recommended as it has not been settled yet whether the benefits of estrogen substitution outweigh the risks.