But Many Who Stop Estrogen Don't Get Other Bone Protection
More than half of women think hormone replacement therapy (HRT) is worth the risk. But many women who stop HRT aren't getting needed bone protection, a pharmacy survey shows.
By now, almost everyone knows that combination HRT with Prempro or Premphase means increased risk of breast cancer, heart disease, stroke, and blood clots. The risk is small but statistically significant. It appeared to outweigh the drugs' benefits: fewer bone fractures, fewer colon cancers, and fewer menopausal symptoms.
The news led many women to drop HRT. How many? Raulo S. Frear, PharmD, and colleagues took a look. The researchers work for Express Scripts Inc., a pharmacy benefit management company. Using the company's data, they looked at prescription patterns before and after the results of the two most recent large U.S. trials on HRT became public.
57% of women on Prempro or Premphase continued their treatment.
36% of women stopped using Prempro or Premphase.
22.6% of women stopped taking estrogens altogether and did not start taking drugs to prevent bone loss.
"The number remaining on estrogen is high," Frear tells WebMD. "In the future, people will continue to use these drugs, although maybe more for the short term to get through hot flashes and other really bad symptoms of menopause."
What alarms Frear is how many women stopped taking estrogen and did not start taking drugs to prevent osteoporosis. Drugs commonly prescribed for this are the Fosamax , Actonel, and Evista, which prevent bone absorption.
"There are great drugs for the prevention and actual treatment of osteoporosis," Frear says. "We hope those women simply discontinued estrogen on their own and that when they go back to their doctors they will get a prescription for osteoporosis."
That's extremely important, says Lawrence Phillips, MD, professor of endocrinology at Emory University School of Medicine. Phillips headed the Emory arm of the Women's Health Initiative (WHI), one of the major HRT studies. His remarks to WebMD reflect his own expert opinion but are not official WHI statements.
"Since postmenopausal women are at increased risk of osteoporosis, especially if they don't take estrogen, it is alarming if they are stopping HRT and are not replacing it with anything," Phillips says. "The risk of a fracture goes up year after year after year. ... It is likely that many postmenopausal women will need at least one drug to help decrease the risk of osteoporosis."
Phillips notes that there are several factors involved:
Data suggest that the increased risk of heart problems linked to HRT may be most likely to happen in the first years of treatment. Women who have taken HRT for five to 10 years without problems may have a lower risk of heart disease.
HRT lowers a woman's risk of bone fracture and improves her blood-fat profile.
HRT increases a woman's risk of breast cancer, and this risk increases with each year of treatment.
"Any woman who goes off HRT needs to work with her doctor to assess her risk of osteoporosis and to see if her lipids are placing her at risk of cardiovascular problems," Phillips says. "Doctors may need to consider treating the individual with medication -- separate medicines in this case -- to decrease a woman's risk of fracture and lipid-related cardiovascular disease."
So what does Phillips tell his menopausal and postmenopausal patients?
"I am proactive in my practice. I am switching women from Prempro and Premphase to other estrogens, especially an estrogen patch," he says. "But there aren't a lot of substitutes for the oral progestin. I am switching patients from the MPA progestin that was in Provera and Prempro to a more natural form of progestin, Prometrium, which still has to be taken as a pill."
Source: WebMD Medical News
Monday, January 13, 2003