In Reply

Letters to the Editor regarding the article Clinical Practice Guideline: The Diagnosis and Treatment of Osteoporosis by Friederike Thomasius, Andreas Kurth, Erika Baum, Michael Drey, Uwe Maus and Ralf Schmidmaier in issue 1/2025

Dr Stening’s letter to the editor regarding the benefits of estrogen therapy in the treatment of osteoporosis raises two aspects that are expanded on in the long version of the S3 clinical practice guideline on the diagnosis and treatment of osteoporosis (AWMF 183–001) (1).

One aspect is the networked different disciplines for optimizing the care of patients with osteoporosis, which includes educating women with menopausal symptoms about the different treatment options or referring them appropriately. The other aspect relates to the benefit of hormone therapy—estrogen monotherapy or estrogen-progestogen therapy in postmenopausal women with menopausal/climacteric symptoms. Lowering the fracture risk is a positive additional benefit of postmenopausal hormone therapy and not its indication. Estradiol-based postmenopausal hormone therapy at standard dosage (estrogens and if the patient still has a womb in combination with progestogens) that was initiated for another indication (for example, vasomotor symptoms) may be considered fracture-risk-lowering osteoporosis treatment. As a rule, no additional specific osteoporosis treatment is then required.

As regards details about the benefits and risks of such treatment, we refer readers to the S3 clinical practice guidelines on peri- and postmenopausal diagnosis and interventions under the aegis of the German Society for Gynecology and Obstetrics (AWMF registry number 016–062) (2). Furthermore: if women are taking tibolone for postmenopausal symptoms, this has also been confirmed to have a protective effect regarding fractures (3).

DOI: 10.3238/arztebl.m2025.0040

On behalf of the authors

Dr. med. Friederike Thomasius

Frankfurter Homon & Osteoporose-Zentrum

Clinical Osteology

Frankfurt am Main

Conflict of interest statement

FT has received consultancy fees from Amgen, UCB, and Theramex. She has been awarded funds for lecture fees from Abbvie, Alexion, Amgen, Coliquio, Das Fortbildungskolleg (Medical Training College), OSTAK, Stadapharm, Theramex, and UCB. She received reimbursement of travel expenses from UCB, Theramex, and Stadapharm. She is president of the German Society for Osteology and chair of the Guidelines Commission of the DVO.

References

1. AWMF Leitlinien-Register 183/001: Dachverband der Deutschsprachigen Wissenschaftlichen Osteologischen Gesellschaften e.V. DVO (2023): S3 Leitlinie zur Prophylaxe, Diagnostik und Therapie der OSTEOPOROSE bei postmenopausalen Frauen und bei Männern ab dem 50. Lebensjahr des DVO—Langfassung, Kurzfassung, Anwenderversion, Leitlinienreport https://register.awmf.org/de/leitlinien/detail/183-001 (last accessed on 17 February 2025).

2. AWMF Leitlinie-Register 016–062: Deutsche Gesellschaft für Gynäkologie und Geburtshilfe DGGG (2020, in Überarbeitung): S3 Leitlinie zur Peri- und Postmenopause –Diagnostik und Interventionen-Langfassung und Addendum. https://register.awmf.org/assets/guidelines/015-062l_S3_HT_Peri-Postmenopause-Diagnostik-Interventionen_2021-01.pdf (last accessed on 17 February 2025).

3. Cummings SR, Ettinger B, Delmas PD, et al.: LIFT trial investigators. The effects of tibolone in older postmenopausal women. N Engl J Med 2008; 359: 697–708

4. 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