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Re: Fosamax PLUS estrogen?From: charlie chambers (cchamber@ic.owatonna.mn.us)Tue Jul 29 08:32:10 1997
As to Fosamax and HRT, I know of no data to support the combined use. Therefore, I would likely consider this if I had a patient with significantly high risk for bone fracture. But otherwise, I would consider HRT, weight bearing exercise, and Ca to be excellent prevention. As to the patient with rash on different regimens of topical estrogen, why not give her oral? I don't place anyone on the patch unless that just won't take pills which at age 50 I don't find. Plus, they are taking provera part or most of the month anyway. In addition, until I see "clinical data" supporting topical estrogens effect on cardiovascular disease, I plan to stick to oral estrogens only. If my patient is going to use a med for many years, and bleed vaginally, I want her to get as much benefit as possible. With regards to breast feeding, I think encouragment is fine and well, but there is fine line between encouragement and harassment. I know you say all patients have breast fed that ped or didn't breast feed gave you their negative feedback. I have a friend who had difficult breast feeding. She contacted me because she was in tears from a lactation advisor convincing her what a horrible mother she was to stop breast feeding. All in all, I favor any encouragement, but let's not forget the patient's desires in the interim.
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