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Ask the Medical Expert Archives 2000-2004

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November 2000

Q. My mother is 76 years old, she has never been on HRT. She has been diagnosed with severe osteoporosis of the lower back and hip. Is HRT out of the question for someone to begin at age 76? Is there a site that would give me more info about the benefits of someone her age to start HRT?

A. Osteoporosis (thinning of the bones) is defined as a significant reduction in bone mass such that the risk of fracture is significantly increased. One of the chief risk factors for development of Osteoporosis is Estrogen deficiency due to Menopause. Other risk factors include being Caucasian, thin, smoking, being sedentary, alcohol abuse, inadequate Calcium or Vitamin D intake, and Family history.

Although the greatest benefits of Estrogen (Hormone Replacement Therapy: HRT) are mostly realized earlier around Menopause, there is still some benefit to bone density even when beginning HRT in the elderly. Therefore, assuming your mom does not have contraindications to HRT such as breast Cancer or blood clotting disorder, it would be reasonable to consider treatment with HRT. For those women who choose not to take HRT, there is a medication Evista that has been shown to help preserve bone mass and similar to HRT has a beneficial effect on serum cholesterol. There are also some other medications that can be used in conjunction with HRT to increase bone density further. Actonel or Fosomax is a type of biphosphonate that can be effective. Also, there is a nasal spray Miacalcin, that contains the hormone Calcitonin that helps to build bone mass. Of course, adequate Calcium (500mg elemental calcium 3 times/day) and Vitamin D intake (800 IU/day) is very important. Checking periodic Bone Density tests (DEXA scans) are a good way to follow response to therapy. Your Mom's physician should be able to help guide her with the above options.

Hope this helps.

Ref: The National Osteoporosis Foundation: 1-800-223-9994

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