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[Dandelion]

Hi,
The section that Sarah2 refers to in the Nick Paney (and others) done on behalf of The British Menopause Society and Women's Health Concerns says:

Osteoporosis
HRT is effective in preserving bone density and preventing
osteoporosis in both spine and hip, as well as
reducing the risk of osteoporosis-related fractures.
HRT is the first-line therapeutic intervention for the
prevention and treatment of osteoporosis in women
with POI and menopausal women below 60 years, particularly
those with menopausal symptoms.
Initiating HRT after the age of 60 years for the sole
purpose of the prevention of osteoporotic fractures is
not recommended.
The bone-protective effect of oestrogen is doserelated.
Recent studies have shown a bone-preserving
effect even with relatively low doses.
The bone preserving effect of HRT on bone mineral
density declines after discontinuation of treatment.
Some studies have shown that the use of HRT for a
few years around the menopause may provide a longterm
protective effect many years after stopping HRT.

Hi

Thank you.

[Sarah2]

luby- just to clarify that statement from the BMS- he's saying it is first line therapy for women with low bone density AND meno symptoms. NICE does not recommend HRT as a first line treatment solely for bones but if given for menopause symptoms then the bonus is HRT will help bones. There are clearly some differing views on this, but most GPs will not- because of the guidelines- give HRT just for bone density UNLESS there are other reasons why a patient cannot take other drugs for osteoporosis. [Note osteoporosis- treatment is not always needed or given for the precursor- osteopenia.)

[Rowan]

Estrogen and progesterone and testosterone are needed to maintain bone density. HRT or estrogen alone along with other bone maintaining, diet,exercise and supplements, far better then the drugs prescribed with their awful side effects ( some can not tolerate them and can cause jawbone crumbling) as HRT has been revised now I think that it will be looked at again for a first line treatment. My GP prescribes my patch for bone density, I have just got another six months prescription.

I have mixed views about Nick Panay as he endorsed Femarelle ( which contains Soya and Linseed) which makes an awful lot of claims and is very expensive, you can get it in Holland&Barrett.

http://www.youtube.com/watch?v=kicVSLQdCbg

Menostar is a 0.014 estrogen patch that is marketed for bone health and progestin is not necessary ( not available here though I do keep asking my GP about it) I would advice cutting 25 patch in  half or quarter  or try to keep it on for a week or more, even one week on one week off, the ultra dose patch is not designed to combat menopause symptoms,   using progesterone every now and then ( say every three months) for a "progesterone challenge" if you are post menopause to see if you bleed.

Some info about maintaining bone density.

http://www.drnorthrup.com/womenshealth/healthcenter/topic_details.php'topic_id=60

[Sarah2]

This thread now has 2 topics .....

might be helpful to start  a new one for the valium...??/

----------------------------
Edit by Emma
This topic has been split and the valium posts have been moved to
http://www.menopausematters.co.uk/forum/index.php/topic,23712.0.html
----------------------------

There are very few if any drs who will give you oestrogen for bone health unless you cannot take other drugs.
It's against prescribing rules in the UK.

Likewise you would not be able to take oestrogen only HRT even at a very low dose without a progestogen.

Tibolone is licensed as an HRT for bone health and has the same risks as oestrogen only HRT but is not recommended for anyone over 60 due to risk of stroke and heart disease.

[Emma]

This topic has been split and the valium posts have been moved to
http://www.menopausematters.co.uk/forum/index.php/topic,23712.0.html

[Rowan]

Sorry don't agree  http://www.medicines.org.uk/guides/evorel/hormone%20replacement%20therapy/evorel%2025%20patches

There are ladies here who use estrogen and use progesterone every three months, there are also ladies who use HRT for bone health ( osteoporosis) as well as for menopause.

http://www.health.harvard.edu/newsweek/Ultra-low_dose_estrogen_patch_improves_bone.htm

http://clinicaltrials.gov/show/NCT00310531

I have never had a doctor tell me I could not have my patch.

After my DEXA scan it was proposed  that I took HRT along with Calcichew D3 I get both on prescription. I do not have ostesporosis, but am small boned. That was over 10 years aso and after recent tests I have been told my bones are very good so it has done its job..

[Sarah2]

If you read the NICE guidelines HRT is only licensed for bone density IF other treatments are not suitable because of for example problems with side effects such as digestion.

This is from the NOS website on HRT and bone health:

There is a range of treatments licensed for the
prevention and treatment of osteoporosis all
with their own benefits and risks. HRT should be
considered for women younger than 60 in which
the benefits outweigh the risks especially for those
who cannot tolerate other osteoporosis treatments,
or who have other reasons for wishing to take
HRT; and recommended as a treatment option for
osteoporosis in women who have undergone an
early menopause


The links you have left here are
- information in a pack of the product, and not meant to be prescribing info for drs- they are an overview of that the product can be used for in context of a patient.
- the other two are from the USA and may not apply to the UK- prescribing rules are not the same.

[Rowan]

Then you are saying my GP is wrong to prescribe me my patch for my bones?

I am sure she knows what she is doing, she regards me as an intelligent woman who is knowledgeable  and knows I look after my health and am aware of the pros and cons of HRT and ERT. she is one of the enlightened doctors who lets me make up my own mind how long I want to keep using the patch.

I would never take any of the bone density drugs and the have to take proton pump inhibitors to counteract the damage some of them can do the gastric system, to me it would be estrogen as  first choice. I feel very sad that these drugs are the first choice now for ladies who have osteoporosis.

I use my patch to prevent my bone density from thinning along with the maintenance of skin etc. I use supplements, diet and exercise too.

I really am not to worried about NICE guidelines, my doctor prescribing the low dose patch is good enough for me. If Menostar was available in the UK I would use it, even if I still had a womb.

We obviously have very different opinions on things and that's OK but I don't relish having to defend myself for thinking "outside the box" each time I post, it gets tedious.

[Rowan]

That is so sad Stellajane, lets hope there is a review and we go back to how osteosporosis was treated, I remember reading quite a while ago about the Head of the Osteosporosis society resigned over the current thinking about how osteosporosis would be treated.

The details are very hazy, and I might not have got them exactly right but it always stuck in my mind. but I expect someone may know about it.

[Hurdity]

I'm not quite sure what the argument is here? Just a wee bit confused.....

There is no question that the relationship between bone loss and oestrogen is dose dependent.

That is to say - yes it has been shown that a small amount of oestrogen will prevent some bone loss, but the  greater the dose ( up to a certain point) the greater that effect will be. A while ago I read the stats on it, in a published paper and as always it's down to percentages of women showing percentages of bone loss. Can't lay my hands on it at the moment.

So yes a menostar patch or smaller will likely have some beneficial effect, but not as much as a 50 mcg patch which you will see from the menu is the licensed dose for prevention of oesteoporosis.

Re the NICE guidelines - I haven't looked at these for a while but these do become outdated, and as new information becomes available, specialists, and some GPs use this knowledge to prescribe differently. The NICE menopause guidelines are a good example - they are way out of date and are being updated (due in 2015) right now.

To me the NOS guidelines extract quoted below imply that HRT is beneficial as a prevention for osteoporosis, for women under 60. Taking it for prevention surely does not require a prior investigation to determine bone density?

Hurdity x

[Sarah2]

No one is arguing- just discussing.

Have you been diagnosed with osteoporosis or are you at high risk?

I don't know anyone who takes HRT for bone density problems without having been flagged up as  high risk, or been diagnosed with low bone density through a scan. The NHS does not offer preventative medicine sadly, nor do they offer scans for bone density unless there is a hereditary link. Any dr who is doing this is going against the grain.

I don't know why this is becoming an argument- I am not saying your dr should or should not do whatever, I'm discussing the guidelines.

A close friend of mine has a mother who is crippled with osteoporosis- started in her 50s. My friend requested a scan when she was in her late 40s and was diagnosed with osteopenia. She used HRT for a short time but it was not prescribed for her bones- she was given calcium supplements on prescription/Vit D. This is through a very snr consultant ( rheumatologist) at a London NHS hospital. Her next bone scan showed an increase, but the one after that showed a decrease. She is taking Tibolone which is a HRT which does not affect the lining of the uterus because she has a large fibroid. The Tibolone is for her bones as she does not have any menopausal symptoms.


This is the full page from the NOS website.

http://www.nos.org.uk/document.doc?id=823

[Rowan]

I had my DEXA scan because I was fine boned, very slim and under five foot, no heredity reasons, this was in the nineties things were different then. it was discovered I had slightly low readings in the  osteopenia  range of my hip and  it was advised that I take HRT, I still have copies in the results and  a copy of the letter written to my doctor at the time, advising me to take HRT, that was before my hysterectomy.

DEZA scans were considered gold standard then to help diagnose and treat osteoporosis just like mammograms are. I
My bone density is normal now.

DEXA scans are not prescribed now I expect because of costs.

[Rowan]

Originally I am sure that it was Prof John Studs' speciality, I first read his books back in the nineties before he had a website and went into privately prescribing hormones.

Back in the day I also had bone scan on wrist and heel this was at an osteopath, a lady used his rooms in the evenings, they were normal.

If ladies are not on HRT or ERT I would advice taking  and Vitamin C ( to increase collagen) and Boron 3mgs, this will help with bones and joints and have an estrogenic effect ( google it) Foods that are high in this are Apples, prunes and raisons. Don't take Boron if you are on estrogen though.

Some info on Brittle bones, note the date of the article 2001 when HRT or estrogen was the guideline for osteoporosis treatment, before the now debunked WHI results came out, and now have been revised.

http://news.bbc.co.uk/1/hi/health/1268201.stm

[Sarah2]

The reason small women are more at risk is that you need to load your bones over a lifetime to build up the bone. They say ( somewhere) that you need a minimum weight of around 9st.

I know quite a few women ( friends) who have had back pain due to degenerating collagen in between the discs. They can treat this by surgery and put 'cement' in to build up the gap.

There is some disagreement over the actual benefits of bisphosphonates - they make bones dense but this can also mean the osteoblasts/osteoclasts do not turn over as they should- there is no breakdown of old cells and replacement with new cells,so the bone is in fact old and 'dead', which for some women means they are more brittle in structure.

There are now newer treatments including an annual injection, which avoids the side effects of oral bisphosphonates, but this is only suitable for people with osteoporosis not osteopenia.


After the WHI and MW studies were published, it became harder to prescribe HRT just for bones.  The prescribing rules state there has to be a risk factor or existing evidence of bone density issues, post menopause, or inability to tolerate other treatments.

The bottom line is that more/all women should receive DEXA scans in mid life ( more deaths from complications of osteoporosis/ hip fractures than breast cancer)  and either treatment or diet/ education about bones and not wait until they are in their 70s and older and break a hip. But the NHS is not interested in or able to afford mass screening as prevention for this.