Osteoporosis in Black Women

Q.I’m a 42-year-old black woman who entered menopause at a very early age. I just stopped hormone replacement therapy after eight years. Do I really need HRT? I hated the side effects and risks of taking it. I know of no black women who have osteoporosis. What is the incidence of osteoporosis in black women?

A. The incidence of osteoporosis in black women is much lower than in white or Asian women, but it does occur. Still, prevention of osteoporosis is only one of the benefits of hormone replacement therapy (HRT). Prevention of heart disease is the biggest benefit. Blacks have a higher incidence of heart disease, and lower detection and treatment rates, than do whites. About 45 percent of postmenopausal women die from heart disease, it is estimated that 50 percent of deaths from heart disease might be prevented by hormone replacement therapy!

Also, recent studies have suggested that estrogen decreases the risk of developing adult-onset diabetes, as well as the severity of that condition. This is another disease more common in blacks.

If you are having side effects, you should discuss them with your gynecologist. Most side effects of hormones are annoying rather than serious — breast tenderness, bloating, irritability, bleeding — and can be minimized or even eliminated altogether by adjustments in dose or formulation. The risk of developing breast cancer as a result of hormone replacement therapy is low; one study estimated that if 100,000 postmenopausal women were on HRT, 18 would die of breast cancer they developed as a result of estrogen, BUT 525 or so would not die from complications of fractures and about 5,600 would not die from heart disease! I think those numbers speak for themselves.

HRT is not for everyone, but just about everyone should seriously consider it. Careful consideration should be given to benefits and risks. Even without HRT, there are alternatives for coping with menopausal symptoms, such as hot flashes, and other treatments to decrease risk of osteoporosis. Heart-disease risk may be modified by lifestyle changes such as exercise and a healthy diet. But in terms of the widest range of benefits at little risk — the most bang for your buck as it were — HRT can’t be beat. As I’ve said many times before, this is an individual decision and your personal risk factors and needs must be taken into account; only you and your own doctor can do this.

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