Author(s): Syed Mohammad Mazhar Uddin, Aatera Haq, Haris sheikh, Uzair Yaqoob*, Bushra zafar sayeed
Estrogen therapy has been taken as a settled approach for both prevention and treatment of
osteoporosis, especially in post-menopausal women as well as for the treatment of symptoms
associated with menopause. Recent studies suggest that nuclear factor kappa-B ligand/receptor
activator of nuclear factor kappa-B/osteoprotegerin system plays a significant role in osteoclastic
activity regulation, with receptor activator of nuclear factor kappa-B ligand signaling in
the presence of macrophage colony stimulating factor leading to increase in osteoclastic
differentiation and functioning while osteoprotegerin neutralizing receptor activator of nuclear
factor kappa-B ligand. Estrogen acts by increasing osteoprotegerin levels, and decreasing
macrophage colony stimulating factor and receptor activator of nuclear factor kappa-B, thereby
reducing bone resorption. Furthermore, estrogen is also known to be causing increased calcium
absorption. The use of estrogen therapy in patients of osteoporosis is also considered to be
highly cost effective. On the negative side, studies have shown that oral estrogen therapy can
lead to complications like cholelithiasis, thrombophlebitis and pulmonary embolism, the most
detrimental being endometrial cancer. But studies have shown that it can be virtually eliminated
with the addition of progesterone in the cyclic combined regimen. Majority of beneficial effects
occur with long term use of estrogen therapy, but the compliance by most of women appears to
be poor. Additional studies should therefore be conducted to evaluate in detail the causes of non-
compliance and strategies to improve compliance. The benefit of quality of life improvement
with estrogen therapy should be taken into account and further evaluated via studies.