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Tibolone and bone density

Postmenopausal women may use hormone replacement therapy to combat climacteric symptoms of flushing, mood changes and loss of libido. Particularly if they are younger, regimens containing oestrogens which result in regular vaginal bleeding may be appropriate. Older women starting hormone replacement therapy and who may not have been exposed to oestrogens for many years probably find vaginal bleeding and breast fullness accompanying oestrogen inappropriate. 'I can't be doing with that!' was one response Bandolier has come across.

Data on the newer versions of hormone replacement therapy have yet to appear on Bandolier's desk, but there is a systematic review of tibolone, a steroid with mixed effects on tissues [1] and with which vaginal bleeding is rare. Long-term studies on the effects of tibolone on fracture rates have not been done, but effects on the surrogate measure of bone mineral density show increases of the same magnitude as with alendronate.


The review sought all clinical studies which examined effects of tibolone on climacteric symptoms, bone, breast, endometrium, metabolism and the vagina, as well as in add-back therapy in endometriosis using a variety of strategies.


Four randomised and one non-randomised study examined bone mineral density in the lumbar spine, and the Figure shows percentage changes for the usual dose of 2.5 mg a day and in placebo or no treatment controls over two years. These and other studies also showed increases in bone mineral density at other sites, like phalanges, and the hip.

Tibolone was also effective in combating flushes, in increasing libido, and in reducing symptoms of vaginal dryness.


The main indications for tibolone seem to be for women more than one year after their last menstruation. A hormone replacement therapy with little oestrogenic effect on the breast and endometrium, but with powerful effects on bone, might also be an option in older women to reduce bone loss and help prevent fractures.


  1. RA Moore. Livial: a review of clinical studies. British Journal of Obstetrics and Gynaecology 1999 106 Suppl 19: 1-21.

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