Skeletal consequences of hormone therapy discontinuance: a systematic review.
Level 1 - systematic review of randomized trials
Systematic review of randomized controlled trials
PubMed 16433935 · doi:10.1097/01.ogx.0000189152.95070.f8
What was done
A systematic review was conducted using MEDLINE, EMBASE, and additional published and unpublished sources to identify randomized controlled trials that evaluated bone mineral density (BMD) and bone turnover markers following the discontinuation of postmenopausal hormone therapy, as well as treatment options to mitigate post-discontinuation bone loss.
What was found
Eleven randomized controlled trials met inclusion criteria. In all 11 studies, stopping hormone therapy led to rapid bone loss, with BMD decreases ranging from 2.3% to 6.2% in the first year and rapid elevations in bone turnover markers. Only 2 studies evaluated therapeutic options after discontinuation; both demonstrated that alendronate significantly increased spine, hip, and total body BMD compared to placebo in women with low bone density who had stopped hormone therapy within the prior 3 months.
Why it matters
This review highlights that bone loss accelerates quickly after stopping postmenopausal hormone therapy, underscoring the necessity of patient counseling and consideration of alternative bone-preserving treatments like alendronate.
Limits
Only 2 of the 11 identified trials evaluated pharmacological interventions to prevent bone loss following discontinuation. The abstract does not report pooled meta-analytic effect estimates, participant totals, or clinical fracture outcomes.
Cited by
- supports Ceasing estrogen replacement therapy results in a rapid decline in bone mineral density because estrogen is the primary transducing signal that couples mechanical bone loading to osteoblast and osteoclast activity.