Although different studies seem to suggest a cut-off dosage for osteoporosis prevention, it is not clear if the elderly women need a standard dose or if a lower dosage can be effective in preventing bone loss. Low dose estrogens, associated with low dose progestin and calcium supplements are able to suppress bone turnover and preserve or even increase bone mineral density. Definite answers in terms of minimum effective dosages, timing and duration for fracture prevention are needed and thus long-term prospective, controlled studies are urgently needed. In addition, low dose estrogens can help in cutting the dosages of different atiresorptive drugs in order to prevent postmenopausal osteoporosis. Again, controlled trials are needed to confirm preliminary data obtained in longitudinal, not randomized clinical observations.
Cardiovascular disease is the leading cause of death among postmenopausal women.
The effects of different progestogens on these processes are still debated. No prospective, randomized, controlled study has proven that low dose HRT can reduce cardiovascular events. However, prospective clinical data are not yet available and further studies are needed to determine if lower doses of different HRT schedules can influence cancer incidence and survival. We believe that lower estrogen and progestin dose can blunt the incidence of side effect, minimize the possible risks and increase the compliance and well being in treated postmenopausal women. We need data from long-term, controlled, prospective studies on the effects of different HRT doses and schedules on cancer, CVD and osteoporotic fracture risk.