Osteoporosis (cont.)

The crowning of Evista, a custom-designed estrogen, as the next wonder drug is well underway. For example, the respected health writer Jane E. Brody did a piece about Evista entitled "Study Finds a New Estrogen Offers Benefit Without Risk" in The New York Times (Dec. 4).

Benefit without risk? That is the issue MedicineNet wishes to consider here for our viewers. Is it true or false? Is Evista a Fountain of Youth or, at least, a Fountain of Wellness for women?

First, a little background. As a woman enters menopause, her ovaries stop producing estrogen. Low levels of estrogen can cause a number of health problems. These include thinning and weakening of bones (osteoporosis), and increased blood levels of total and LDL cholesterol (the "bad cholesterol") with increased risks of atherosclerosis and heart attacks.

With life expectancy continuing to increase, women will soon spend fully one third of their lives after their menopause being deficient in estrogen. "The human and economic costs of this increased longevity in an estrogen- deficient state are substantial," as Dr. G. El-Hajj Fuleihan noted in an editorial in The New England Journal of Medicine (Dec. 4). These projected costs include an increase in cardiovascular problems, a leading cause of disease and death among postmenopausal women, and a marked rise in fractures due to osteoporosis that account for much morbidity and mortality after the menopause.

Osteoporosis affects millions of Americans. Some sources say "19 million" while others say "more than 28 million." In any case, a multitude of people in the U.S. (and many other countries) have osteoporosis, and the large majority of them are women. There are men with osteoporosis but far fewer. For that reason, we are going to focus here exclusively on women.

A woman can lose a quarter of her bone mass in the five years after her menopause. This loss weakens bones and sets the stage for painful fractures. These fractures can occur with minimal stress or trauma. According to the National Osteoporosis Foundation, the excess mortality rate during the year following a hip fracture is 20%. And a woman's risk of a hip fracture (a risk largely attributable to osteoporosis) is equal to her combined risk of breast, uterine, and ovarian cancer.

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