Estrogen therapy is especially recommended for women whose ovaries have been removed before the age of 50. In particular, estrogen replacement should be considered for women who have multiple osteoporosis risk factors such as early menopause, family history of osteoporosis, family history of osteoporosis or below normal bone mass for their age. It has been shown to reduce the fractures with osteoporosis. This medication may cause hot flashes that are normally treated with estrogens. It has the advantage that it does not appear to cause any significant uterine or breast abnormalities.
Studies are still on going to determine if there is a beneficial effect for breast malignancy.
Biophosphates can also reduce spine and hip fractures. They are uncommon side effects, but predominantly the medication is difficult to take because of the development of heartburn and nausea. It needs to be taken on an empty stomach with a full glass of water the first thing in the morning. Then it is important to sit up right for at least one half hour to an hour before food or beverages can be taken. It is particularly useful in women that are at least 5 years beyond menopause.