Letters to the Editor
Preventive Approach Should Be Strengthened
Bones that have undergone resorption can be rebuilt only with great difficulty. The drugs have adverse effects and are costly. It is regrettable that Thomasius et al in their article did not mention that hormone replacement therapy is an effective prophylactic therapeutic option in women, up to 75% of whom are affected (1). Only Tables 1 and 2 of the article mention estrogens, among others, although in their anti-resorptive effects they are ranked as a triple “A”—notably equal to bisphosphonates and antibodies, which have more adverse effects, represent a burden to the patient, and are more expensive. But the approach should be a different one if the Deutsches Ärzteblatt regards itself as the CME publication for the private practices of primary care physicians, specialists in internal medicine, and orthopedic surgeons. In clinical practice, osteoporosis should not only be the focus after a fracture has occurred. The main risk factors are female sex, a family history (!), underweight, light/white skin, current or past nicotine misuse.
But such women do not attend doctors’ practices, saying “I am at risk for osteoporosis,” but they complain of hot flushes/flashes, disrupted sleep, paroxysmal tachycardia, panic attacks, anxiety disorders, to name just the most common symptoms. If the treating primary care physician then considers a referral to a gynecologist and the patient is put on low-dose, nature-identical transdermal hormone replacement (instead of being referred to a cardiologist, psychiatrist, sleep medicine specialist, etc) then this woman will be receiving comprehensive care and the risk of osteoporosis will be notably lowered. The other measures mentioned in the article (calcium, vitamin D, and exercise) obviously still apply.
DOI: 10.3238/arztebl.m2025.0039
Dr. med. Cordula Stening
Frauenarztpraxis Sentruper Höhe
Münster
dr.stening@t-online.de
Conflict of interest statement
The author declares that no conflict of interest exists.
| 1. | Thomasius F, Kurth A, Baum E, Drey M, Maus U, Schmidmaier R: Clinical practice guideline: The diagnosis and treatment of osteoporosis. Dtsch Arztebl Int 2025; 122: 12–8 CrossRef MEDLINE VOLLTEXT |
