83y Old Woman On Long-Term Hormone Replacement Therapy (HRT) for Osteoporosis (OP) Management: n of 1, Revisiting the Role of HRT in OP Management

Document Type

Conference Proceeding

Publication Date

10-22-2025

Publication Title

J Endocr Soc

Keywords

bisphosphonic acid derivative, calcium, medroxyprogesterone acetate, raloxifene, vitamin D, aged, blood clot, bone density, bone turnover, breast cancer, case report, cerebrovascular accident, clinical trial, conference abstract, disease severity, drug combination, drug megadose, drug therapy, dyspareunia, female, femoral neck, follow up, healthy life expectancy, heart infarction, hormone substitution, hot flush, human, long term care, low drug dose, lumbar spine, mammography, menopause, mental instability, osteopenia, osteoporosis, Papanicolaou test, postmenopause, postmenopause osteoporosis, prevention, side effect, spotting, vaginal dryness

Abstract

Introduction: Hormone replacement therapy (HRT) is currently approved only for the prevention of osteoporosis in postmenopausal women based on Women's Health Initiative (WHI) Trial results. Prior to 1995, HRT was the only effective therapy for prevention and treatment of OP. HRT has been shown to prevent post-menopausal bone loss, increase bone density, and reduce the risk of OP fractures. Thus, HRT can be an effective alternative therapy in selected patients, especially in the 10-15 years after menopause onset. Case presentation: We present the case of an 83y woman who has been on low-dose HRT (0.45 mg/ 1.5mg) with conjugated estrogen and medroxyprogesterone acetate for OP management for at least 20 years. She was unable to tolerate bisphosphonates and raloxifene due to side effects and hence preferred to continue HRT. She has been closely monitored with regular follow-ups. Due to the risks associated with prolonged HRT, an attempt to discontinue therapy was associated with vaginal dryness, dyspareunia, hot flashes and mood instability. Additionally, her CTX (ref. range 104-1,008 pg/mL) levels rose from 134 pg/mL to 575 pg/mL, indicating increase bone turnover. After further thorough discussion of the risks and benefits, a shared decision was made to continue HRT, reflecting the patient's strong preference to maintain the therapy. Fortunately, she did not experience any complications besides occasional spotting. Never had blood clots, stroke, breast cancer, or heart attack. While on HRT, her bone density was well preserved and stable in the osteopenic range both at the lumbar spine and femoral neck. During her longterm treatment, she maintained a healthy intake of calcium and vitamin D, and regularly received mammograms and Pap smears as part of her routine care. Conclusions: The use of HRT beyond age 65 carries implications that depend on factors such as the type of therapy, the route of administration, and the dosage. Lower doses are generally associated with a reduced risk profile compared to medium or high doses, while vaginal or transdermal forms are often favored over oral preparations. Decisions about HRT should take into account the patient's overall health, life expectancy, personal preferences, and symptom severity. Ongoing evaluations and collaborative decision-making are essential to ensure the therapy continues to be suitable and beneficial for the specific group of women who either cannot tolerate or prefer not to use bisphosphonates.

Volume

9

First Page

A340

Last Page

A341

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