Dear Dr. Roach: I am a petite 80-year-old woman with a history of osteoporosis. I have never had children and have an intact uterus. My primary care physician does not believe in prescribing hormone replacement therapy (HRT) for someone my age due to the risk of cancer, yet I have been reading that HRT therapy is now being done for women with a history like mine.
I have a friend who is seeing a doctor at the University of California, San Diego, for this condition and is being treated with an HRT patch. Her bone health has improved dramatically with no adverse side effects. What is the current guidance on HRT and the cancer risk for older women like myself?
Anon.
Estrogen is effective for the prevention of osteoporosis but is not as effective as other agents in treating established osteoporosis. In women with intact uteri, estrogen must be given with a progestin. This combination not only puts women at a higher risk for breast cancer, it also increases her risk of heart attack, stroke and blood clots.
The balance of risks and benefits in an 80-year-old woman, in my opinion, doesn’t make estrogen the best choice. The long-term safety data on bisphosphonates like alendronate (Fosamax) is excellent when the drug is prescribed and monitored appropriately to a person who needs it.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
