The effects of oestrogen deficiency on the skeleton and its prevention.

Increased bone resorption following the menopause leads to accelerated bone loss and is a major contributory factor to subsequent osteoporosis. It is well recognised that an early menopause or prolonged amenorrhoea from whatever cause are also major risk factors for osteoporosis. The alterations in skeletal metabolism following oestrogen deficiency are inhibited by oestrogen replacement, and bone loss can be prevented. However, oestrogen therapy may often not be appropriate because of clinical contraindications, side effects or patient concerns regarding the risk of breast cancer. There is increasing evidence that bisphosphonates are effective in inhibiting bone resorption and these compounds are generally well tolerated. At the present time, for the prevention of bone loss related to hypo-oestrogenism, the main options for therapy are likely to be oestrogen replacement or treatment with bisphosphonates.