Do estrogen or selective estrogen receptor modulators improve quality of life for women with postmenopausal osteoporosis?
Osteoporotic fractures result in significant deficits in health-related quality of life (HRQOL). The accumulation of deficits resulting from osteoporosis and fractures is now recognized as a major cause of reduced HRQOL in women after the menopause and in later life. Some of these same postmenopausal women may also have deficits in HRQOL related to vasomotor symptoms during the menopausal transition. Although estrogen therapy has not been shown to improve overall HRQOL in late postmenopausal women in randomized, controlled trials, it may improve menopausal symptoms. In contrast, selective estrogen receptor modulators (SERMs) such as raloxifene may increase vasomotor symptoms. Although estrogen is not indicated for the primary prevention of osteoporosis, estrogen therapy may be considered for the postmenopausal woman at risk of osteoporotic fracture who is symptomatic and who is not at high risk of breast cancer or cardiovascular events. Raloxifene decreases risk of invasive breast cancer and may be considered in women at high risk of breast cancer. Decision making about osteoporosis treatment should also consider the impact of the treatment on HRQOL.
Gold
Deborah T
DT
Department of Psychiatry, Center for the Study of Aging and Human Development, Box 3003, Duke University Medical Center, Durham, NC 27710, USA. dtg@geri.duke.edu
Silverman
Stuart L
SL
D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology / Q000628:therapy; D004967:Estrogens / Q000009:adverse effects / Q000627:therapeutic use*; D005221:Fatigue / Q000209:etiology / Q000628:therapy; D005260:Female; D005598:Fractures, Spontaneous / Q000517:prevention & control; D006620:Hip Fractures / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000453:epidemiology; D017698:Postmenopause / Q000187:drug effects* / Q000523:psychology; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D020849:Raloxifene Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D020845:Selective Estrogen Receptor Modulators / Q000009:adverse effects / Q000627:therapeutic use*; D016103:Spinal Fractures / Q000517:prevention & control; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
D004967:Estrogens; D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen; D020849:Raloxifene Hydrochloride