HORMONE REPLACEMENT FOR EARLY AND LATE PR EVENTION OF POSTMENOPAUSAL OSTEOPOROSIS

Osteoporosis is one of the main features of the ageing process and the cost of health care for osteoporosis-related fractures and their comp lications is a major incentive for prevention, particularly in develop ed countries with a continuously ageing population. The earliest strat egies for prevention in menopaused women were based on the anti-osteoc lastic effect of hormone replacement therapy. Several epidemiological studies have provided proof of its efficacy showing that in treated po pulations, there is a significant reduction in osteoporosis-related fr actures of about 50%, whatever the site of fracture. Although the effe cts of hormone replacement therapy in the prevention of post-menopausa l osteoporosis have been well established, three problems remain. Firs t, what is the degree of efficacy if replacement therapy is started la te? Second, what is the effect in patients who have already suffered a n osteoporotic fracture? Third, and most importantly, what is the opti mal duration of treatment for effective prevention in a given populati on particularly at risk of hip fracture? These questions suggest new s trategies for preventive hormone replacement are needed.