Hrt Side Effects

Seniors World Chronicle: MALAYSIA: These old bones of mine

MRS WLL, a 60-year-old Chinese woman, sees her general practitioner for her annual check up. She has been in good general health for the past several years. She experienced menopause in her early 50s and was given hormone replacement therapy (HRT) for her menopausal symptoms; and for the prevention of osteoporosis. She is currently not on any chronic medications. The most common fractures associated with osteoporosis occur at the hip, spine and wrist. Worldwide, the incidence of hip fractures is increasing dramatically. It has been estimated that by the year 2050, the incidence of hip fractures will reach 3.25 million in Asia due to an increase in the elderly population. In the United States, approximately 1.5 million fractures are attributed to osteoporosis. In Malaysia, it is estimated that by year 2020, about 3.3 million Malaysians will be above 65 years of age. Urbanisation and extended life expectancy contribute to the increased incidence of osteoporosis. Hip fractures due to osteoporosis affected 88 men and 218 women per 100,000 in Malaysia. Of these patients, 63% were Chinese, 20% were Malays and 13% were Indians. No Malaysian data was available on the incidence of other types of fracture due to osteoporosis. In Malaysia, the median age for menopause is 50.7 years old versus 51.4 years for women of European origin. In addition, with the extended lifespan, women are currently living an average of 30 years after commencement of menopause. Therefore, it is expected that the number of women who would suffer from osteoporosis due to menopause would increase. Ethnicity: Being Caucasian or Asian increases the risk of osteoporosis. In the US, hip fracture rates for Caucasian women were 1.5 to four times higher than Afro-American women. This difference may be attributed to structural differences, such as greater peak bone mass, a slower rate of bone loss after menopause and better quality of bone micro architecture in Afro-American women. It is still not clear whether these are purely due to genetic differences or predispositions. ● Bisphosphonates - Bisphosphonates (such as alendronate, risedronate, ibandronate or zoledronate) are currently the first choice of treatment for osteoporosis. Bisphosphonates need to be taken in a specific manner and for at least a year to be effective in maintaining and improving bone mineral density (BMD) and to protect the patient against fracture.

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