Osteoporosis is the most common bone disease that will increase the chance of having a broken bone. About 4-6 million women in the United States have it and it is a common disease that mostly affects women over the age of 50. Half of the women in this age group will have a broken bone due to osteoporosis in their lifetime. Anyone can develop osteoporosis but women who have reached menopause have the highest risk of getting this disease. Other common risks include small body size, having Caucasian or Asian heritage, drinking too much alcohol, smoking cigarettes, a diet low in calcium and vitamin D, and being on certain medicines for a long time like steroids (such as prednisone). The first signs you can see are often "shrinking" or having a bone break easily. There are tests that can measure how solid your bones are. If you are not sure whether or not you have osteoporosis, talk to you doctor to find out if these tests are right for you.

What is HRT?
If you are a woman who has reached menopause, your body does not make enough of an important hormone called estrogen. This can lead to osteoporosis and bone loss. Hormone replacement therapy (HRT) is the phrase used when a woman takes hormone pills that contain estrogen or the combination of estrogen/progesterone after menopause. There are two types of HRT. Most women who have had a hysterectomy or their uterus removed use estrogen alone (Premarin®) and women who have not had a hysterectomy would use the combined estrogen and progesterone (Prempro®). You should not take estrogen alone if you have not had a hysterectomy because it can raise your chance of getting cancer in the lining of your uterus. HRT can relieve the symptoms of menopause (such as hot flashes and night sweats) and lower the risk of osteoporosis, colon and rectal cancer. They are the most common hormones prescribed to women past menopause.

What are the problems with HRT?
Recently, using hormones to prevent osteoporosis has been found to have serious, and much talked about, side effects. There has been a lot of questions since a study published in the Journal of the American Medical Association in July 2002 showed that using the combined estrogen/progesterone pill for about five years could increase the risk of breast cancer, stroke, heart attack and blood clots. There was no increase seen in women using the product that contained only estrogen. The study with the combined hormone pill was stopped early because of these risks.

Many women use HRT for a short time to treat the symptoms of menopause. If you have been using it for 2-3 years, studies have not found a link to breast cancer, stroke, heart attack and blood clots. There are other options you can try and you can always talk to your doctor about them.

Women who are taking the combined hormone for osteoporosis should talk to their doctors about stopping this medicine. It is important to know that you should not stop taking the pill on your own. Your doctor will talk with you about the other options available. If you are stopping HRT, there are other medicines that help stop your bones from breaking down. Some examples of these are Fosamax®, Evista® and many more. Your doctor will help you decide which is best for you depending on your health history.

What are my other options?
There are many choices besides HRT to prevent or treat osteoporosis. This advice is important for all women, not only those over the age of 50. Taking care of your bones as early as your 20's can help prevent problems later. Some important things to remember that will help protect your bones:

• Keep physically active with weight bearing exercises such as walking, jogging, dancing or light weight lifting (be sure to contact you doctor before starting any exercise program).
• Take a Calcium + Vitamin D supplement (ask your doctor or pharmacist what dose is right for you)
• Eat foods that have a lot of calcium: low-fat dairy food, salmon, sardines, dark-green leafy vegetables and calcium-rich orange juice
• Your body makes enough vitamin D by spending 20 minutes a day in the sun. You can also eat foods that have a lot of vitamin D: eggs, sardines, salmon, liver, cereal and milk.
• Quit smoking
• Limit the amount of alcohol you drink

Important Questions to Ask
It is important to remember that if you have been taking the combined estrogen/progesterone pill to prevent osteoporosis you need to talk with your doctor about stopping this medicine. Here are some questions you might want to ask:

• Why am I taking HRT?
• Have I been taking the combined hormone pill?
• Should I stop taking it and if so, how?
• Is there something else I can use for osteoporosis? What are the side effects of these other options?
• Should I have a mammogram?

Remember, your healthcare providers are available to help answer your questions, so be sure to contact them if you have any questions.

National Osteoporosis foundation website: http://www.nof.org