Abstract
The adjective disingenuous suggests a lack of candour or even the withholding of facts, a suggestion which I must deny. The paragraph from my Personal View selected by Dr Bowring et al., my colleagues from the National Osteoporosis Society (NOS), is at fault in only one respect in that it understates the problem. 1 Hormone replacement therapy (HRT) in its various forms has not featured in the NOS international conference for the last two (maybe more) occasions in spite of my many, no doubt irritating, complaints about this omission.
I have not anywhere suggested that the NOS discouraged companies from having trade stands! Why should that happen? Conferences need the revenue and physicians need to learn about HRT even if it is not on the programme. However, companies will feature their more profitable new drugs and will not bother to display hormonal preparations to bone physicians who have no interest in this therapy even if it might be regarded by some as first-choice therapy for women under the age of 60. 2 This was the essence of my angry personal view. I am happy to pick a fight with physicians but not my friends at the NOS.
Nevertheless, I must continue my defence of the under 60s who are now invariably given bisphosphonates as first-choice therapy for many years. This drug causes oesophageal and gastric ulceration requiring proton pump inhibitors, which further reduce bone density. It produces abnormal bone histology, osteonecrosis of the jaw and subtrochanteric femoral fractures. I must ask how many more complications must be described before physicians reconsider the long-term use of bisphosphonates in this age group and move towards estrogens with their considerable skeletal and non-skeletal benefits?
By chance there is in this issue of Menopause International a review by Brincat's team showing the protective effects of estrogens on the intevertebral discs that make up 25% of the length of the vertebral column. Bisphosphonates offer no such protection. 3