Abstract

Two decades of experience leave no doubt that sustained administration of estrogen to menopausal women conserves bone throughout the skeleton. Such conservation should theoretically protect against osteoporotic fracture, and, indeed, epidemiological studies support the view that long-term estrogen replacement does afford women such protection. On the other hand, uncertainty remains about many aspects of this issue. Questions persist regarding the therapeutic schedule itself: the type, dose, and mode of administration of estrogen that is optimal. Other questions concern the individuals who will receive estrogen: the age at which treatment begins, its duration, and the consequence of adding progestins to the treatment regimen. The level of uncertainty for these questions grows considerably when the end point is fracture protection rather than bone mass. In this chapter, I discuss the therapeutic use of estrogen to prevent or treat osteoporosis.

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