Late prevention of hip fractures with hormone replacement therapy

HRT should remain the treatment of choice for late prevention of hip fracture in most women with osteoporosis. This is particularly so as there is no good evidence that alternative treatments are superior to HRT in their skeletal effects, and the action of HRT on the cardiovascular system could be especially important in elderly women. HRT formulations which do not produce regular uterine bleeding may prove more useful in these elderly women, although it has yet to be established whether such formulations also provide the same cardiovascular benefit as standard HRT. The ideal treatment would be a formulation which would protect not only the skeleton and cardiovascular system, but also the endometrium and breast against cancer. The development of selective oestrogen receptor modulators (SERMs) may eventually lead to the achievement of this goal.