Many, many studies have been done and are under way addressing this issue, but briefly, we are convinced that HRT has a beneficial effect on bone, which we think translates into a decreased risk of fractures as a woman ages. Felicia Cosman, MD, clinical director of the National Osteoporosis Foundation, agrees with Zieman. What we don't know is if that actually results in fewer fractures. Studies looking at the hip, however, may not have shown an effect because of characteristics of women who participated in the trial. I remain convinced that HRT does help protect bone, and I recommend it to my patients.
Many doctors also prescribe hormone replacement therapy to reduce a woman's risk of heart disease.
Thus we began replacing estrogens on the assumption that that would have an impact on these two diseases. Unfortunately, many studies have failed to show a benefit of HRT in women who already have heart disease. It's been viewed as a rather old-fashioned concept that women should start HRT at the time of menopause, because studies have shown a beneficial effect even when HRT is started when women are in their 60s or beyond. I think we're now coming to believe that early introduction of HRT will have the biggest impact on outcome, but this is a study that clearly needs to be done. Some studies have shown an increase in breast cancer in women taking the therapy.