By the middle of the 20th century, it was well recognized that elderly
women frequently developed severe osteoporosis, resulting in a life complicated
by constant back pain and repeated fractures. By the 1970s and 1980s, it became
clear that use of estrogenic substances at or near the time of menopause could
prevent or treat osteoporosis, and these drugs became widely prescribed and
taken. Even before the bone-sparing effects of estrogen were known, these
agents were used extensively for the treatment of menopausal symptoms, primarily
vasomotor instability and vaginal atrophy.1
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