Assessment of fracture risk and its application to screening for postmenopausal osteoporos

Design of the Women's Health Initiative clinical trial and observational study

▪Purpose:To critically review the risks and benefits of hormone therapy for asymptomatic postmenopausal women who are considering long-term hormone therapy to prevent disease or to prolong...

Hormone Therapy To Prevent Disease and Prolong Life in Postmenopausal Women

The criteria required for an effective screening strategy for osteoporosis are largely met in Caucasian women. The disease is common and readily diagnosed by the measurement of bone mineral with single- or dual-energy absorptiometry. Such measurements have high specificity but lower sensitivity, so that the value of the technique is greater for those identified as being at higher risk. Against this background there is little evidence that osteoporosis can usefully be tackled by a public health policy to influence risk factors such as smoking, exercise and nutrition. This suggests that it is appropriate to consider targetting of treatment with agents affecting bone metabolism to susceptible individuals. Since the main benefits of the use of hormone replacement therapy (HRT) are probably on cardiovascular morbidity, the major role for selective screening is to direct non-HRT interventions. An appropriate time to consider screening and intervention is at the menopause, but screening at later ages is also worthy of consideration. Since the cost of screening is low and that of bone-active drugs is high, the selective use of screening techniques will improve the cost-benefit ratio of intervention.

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Papers

Estrogen replacement therapy II: a prospective study in the relationship to carcinoma and cardiovascular and metabolic problems.

Estrogen replacement therapy I: a 10-year prospective study in the relationship to osteoporosis.

Incidence of breast cancer in a 22-year study of women receiving estrogen-progestin replacement therapy.