Osteoporosis and cardiovascular disease: benefit-risk of hormone replacement therapy.
Post-menopausal osteoporosis represents a major public health problem. Osteoporotic fractures in older women constitute a major cause of disability, mortality and economic burden. Cardiovascular disease (CVD) is the primary cause of death in women in westernized countries, with more than one in two women dying from CVD. In literature it is well established that an early menopause increases the risk of CVD and that a later menopause is associated with longer overall survival. Until a few years ago, in the management guidelines, a combination of lifestyle and use of hormonal replacement therapy (HRT) was suggested to reduce the CVD risk in post-menopausal women. However, recent studies such as the Women's Health Initiative (WHI) trial and the Heart and Estrogen/Progestin Replacement Study (HERS) I and II has forced practitioners to reconsider their options for prevention of CVD in post-menopausal women. The increased risk of CVD and stroke which were not counterbalanced by the smaller reduction in numbers of hip fractures in the WHI and in the HERS I-II suggest new characteristics of women in which HRT could possibly exert a favourable risk/benefit ratio. The use of HRT in post-menopausal women might be considered in symptomatic women and it might be individualized for each patients. Therefore, for cardiovascular and osteoporosis risk, regular prevention programmes should serve the needs of middle-aged women.
Sammartino
A
A
Department of Obstetrics and Gynecology, University of Naples Federico II, Naples, Italy. lidiasamma@tin.it
Cirillo
D
D
Mandato
V D
VD
Di Carlo
C
C
Nappi
C
C
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000097:blood; D015519:Bone Density / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology* / Q000517:prevention & control; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006620:Hip Fractures / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology* / Q000517:prevention & control; D011372:Progestins / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors
D004967:Estrogens; D011372:Progestins