- Discussion:
    - for most postmenopausal women with osteoporosis, estrogen therapy also should be instituted at a dose of 0.625 mg of conjugated estrogen per day or its equivalent;
    - administration of estrogen by transdermal patch is effective and may result in more stable plasma estrogen concentrations;
    - at menopause, bone turnover increases, w/ greater increase in bone resorption than in bone formation;
    - accelerated bone loss that results diminishes exponentially with time;
           - most bone is lost during the first 3 to 6 years after menopause, but some loss related to low estrogen levels may continue for up to 20 years;
    - if begun soon after menopause, estrogen therapy prevents early phase of bone loss and decreases the incidence of subsequent osteoporosis related fractures by about 50 percent;
    - in women with established osteoporosis, estrogen therapy is still effective;
         - there is a reduction in hip and wrist frx in women whose estrogen replacement was begun within a few years of menopause;
         - even when started as late as 6 years after menopause, estrogen replacement prevents further loss of bone mass but does not restore it to premenopausal levels;
    - there is no convincing evidence that estrogen benefits women over the age of 75 years;

- Dosing:
    - Estrogen Protocol for Osteoporosis:
         #1 (for women w/ a uterus w/o vaginal withdrawl bleeding - 60%)
             - Premarin 0.625 mg PO qd
             - Provera 2.5 mg PO qd
         #2 (for women w/ a uterus and w/ withdrawl bleeding - 40%)
             - Premarin 0.625 mg PO qd for 20 days.
             - Provera 10 mg PO qd 10 days.
         #3 (for women w/o a uterus)
             - Premarin 0.625 mg PO qd for 25 days.
             - then nothing for 5 days.