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I have had rheumatoid arthritis for 10 years. As I go through menopause my symptoms are worse and now I have osteoporosis on top of everything else. I know there are dangers from taking hormone replacement but would it help both my arthritis and the osteoporosis? Would the risks be worth it?

In the past, hormone replacement therapy (HRT) was used to control the symptoms of menopause. One of the advantages of this treatment was the improved bone mineral density. The result was fewer bone fractures. Even women with reduced bone density from taking corticosteroids for their RA were helped by HRT.

But several studies showed that HRT increased the risk of cancer, heart attacks, and strokes in postmenopausal women. Other drugs for osteoporosis have replaced the use of HRT for many women. You may have heard of Fosamax (alendronate) or Actonel (risedronate). These are drugs called bisphosphonates most commonly used to strengthen bone and treat osteoporosis.

The use of HRT (estrogen) is still considered for some patients. You may be a good candidate for estrogen therapy if you have tried bisphosphonate without success and/or if you have severe menopausal symptoms. Some women use a drug called raloxifene to manage osteoporosis. This is a selective estrogen receptor modulator (SERM). It's only half as good as estrogen or bisphosphonates in managing osteoporosis.

It's best to review all your options with your doctor. Your age, menstrual status, and any other risk factors must be reviewed in any decision you make. Careful counsel about the risks and benefits of each treatment option must be given.

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