There was a time thirty years ago where HRT was the only available treatment for the treatment and prevention of osteoporosis. Physicians were never comfortable with hormone therapy because they have little experience from this treatment so they welcomed the arrival of bisphosphonates, PTH, Strontium etc, or non-hormonal preparations with frequent side-effects. The bad news from the 2002 Women’s Health Initiative was welcomed by osteoporosis doctors because it justified their refusal to use oestrogens, but over the last ten years all of the problems from this study has been corrected. Even the authors are now queuing up to apologise for the damage that they have done to millions of middle-aged women who have been denied the treatment for their menopausal symptoms and above all therapy for the treatment and for the prevention of osteoporosis.

Authors are now queuing up to apologise for the damage that they have done to millions of middle-aged women

Osteoporosis occurs at times of oestrogen deficiency such as premature menopause, early hysterectomy and oophorectomy, anorexia and in very thin women who not only have little fat to produces oestrogen, but often miss their periods and lose the ovarian supply of oestrogens. We now know that the safest way to give oestrogens is by the transdermal route in the form of gels or patches or occasionally implants as these do not produce any of the excess thrombosis that occurs with oral oestrogens. We know that we should avoid daily progestogen because that is the single risk factor for any increase in breast cancer. Women having transdermal oestradiol and merely seven days of a mild natural progesterone have considerable protection and effective treatment for low bone density without the side-effects or oral oestrogens whether it is in HRT or the birth-control pill. Such long-term therapy improves mood, energy, and libido and removes the one in three risk of elderly, or not so elderly women developing an osteoporotic fracture. Apart from being safe it is also very inexpensive and should be first choice for the prevention and treatment of osteoporosis in women. It is hard to understand why any other non-hormonal treatment is regarded as suitable for this problem which is called by long-term oestrogen deficiency.