علاج هشاشة العظام لدى النساء بعد انقطاع الطمث دون سن الستين مع أعراض حركية وعائية أو خطر مرتفع لسرطان الثدي

References

DOI: 10.1136/bmj‐2024-081250

The use of HRT or tibolone is currently limited to women <60 years with vasomotor or genitourinary symptoms of menopause or for the treatment of osteoporosis in postmenopausal women in whom non-estrogen drugs are not considered to be appropriate.

Indications for their use may include postmenopausal women with low risk of venous thromboembolism for whom non-estrogens are not appropriate and who have high risk of breast cancer (raloxifene and lasofoxifene) or significant vasomotor symptoms (bazedoxifene with conjugated estrogen).

Second line therapies: HRT for postmenopausal women <60 years with vasomotor symptoms, SERMs if high risk of breast cancer, SERMs and ibandronate for vertebral fracture prevention only.

Selective estrogen receptor modulators (SERMs) such as raloxifene and bazedoxifene have the additional benefit of exerting estrogen receptor antagonistic or neutral effects in the breast and endometrium.

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