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Proposed mechanism for estrogen replacement and the incidence of BPPV. Aging causes estrogen deficiency in para-menopausal and post-menopausal women. Estrogen replacement may reduce to progression of osteoporosis, and at the same time, possibly reduce BPP formation. The disruption of inner ear otoconia biogenesis homeostasis, possibly caused by reduced autophagic activities, may cause enlargement of calcium crystals in the inner ears, leading to BPPV formation.
