Hormone replacement therapy for the prevention of osteoporosis: changing therapeutic schemes

Established facts: Many studies have evidenced that hormone replacement the rapy can help prevent post-menopausal osteoporosis and osteoporotic fractur es in menopaused women;Thanks to recent advances in pharmacology, hormone r eplacement therapy can now closely mimic ovarian physiology and thus elimin ate most of the contraindications related to metabolic disorders. Unresolved questions: The need for prolonged treatment to reach optimal eff icacy raises the problems of safety and compliance. This is particularly tr ue for the prevention of fractures of the femoral neck which usually occur in older women, suggesting it could be useful to revisit the estrogen strat egy. New compounds: The action of selective estrogen receptor modulators (SERM) depends on the target organ. They have an estrogen agonist effect on bone a nd lipid metabolism but no such effect on the uterus. SERMs could offer new therapeutic opportunities for the prevention of post-menopausal osteoporos is.