HRT is safe and vital in treatment and prevention of osteoporosis, says expert

Irish GPs need to get the message that short-term Hormone Replacement Therapy (HRT) is safe to prescribe to their patients and is vital in the prevention and treatment of osteoporosis, a conference in Dublin heard at the weekend.

Cork GP Dr Mary O'Flynn pointed out that the prescription rate for oestrogen for HRT had fallen dramatically in the wake of the American Women's Health Initiative (WHI) study which condemned the use of the therapy.

"We now realise that the WHI was a seriously flawed study that included women up to the age of 75 who were put on high doses of a drug not used in this part of the world when they did not need it. The women involved were never screened for cardiovascular disease, smoking or high blood pressure," she said.

Dr O'Flynn, who was addressing the annual meeting of the Osteoporosis Society of Ireland, on the topic of Hormones and Bones, The WHIs and Wherefores, said it had been recognised for years that oestrogen was a very effective bone-sparing therapy in terms of the treatment and prevention of osteoporosis.

She is now optimistic that the revelation that the WHI was a flawed study and that HRT is safe given to the right patient in the right dose will lead to a swing back towards an increase in the prescribing of HRT by GPs.

"I think the most important message I want to try to get through to my GP colleagues is that oestrogen is safe. One of the things that actually came out of the WHI and the UK's Million Women Study is that short-term oestrogen is safe and I think it's horrendous that many GPs are still afraid to prescribe it."

She pointed out that oestrogen used to be the cheapest prevention for osteoporosis, but it had become very expensive to prescribe as a result of all the media hysteria created in the wake of the WHI.

GPs often had to spend a half an hour reassuring their patients about the safety of HRT and they still often changed their minds and came back again for further advice so it had become very time consuming to prescribe HRT.

"We now know that HRT is safe and in fact, unopposed oestrogen (i.e. oestrogen-only HRT) was found to reduce the risk of breast cancer . . . Oestrogen has been in use as HRT since 1940 so there has been 64 years of research into the side effects of particular doses for certain periods of time."

Dr O'Flynn highlighted the fact that many women who gave up their HRT after the findings of the WHI turned instead to "natural" products such as black cohosh which were in fact phyto-oestrogens - there was no way of knowing what dose of plant oestrogen was in these non-regulated products or the long-term side effects.

One in five Irish women with post-menopausal osteoporosis can suffer another vertebral fracture within a year of their first fracture.

The current cost of osteoporosis to the Irish economy is €412 million, according to Dr O'Flynn and this is expected to increase to over €530 million by 2010.