Before the Women's Health Initiativ...

Before the Women's Health Initiative was published in July 2002 more than 11 million post-menopausal women in the United States relied forward hormone therapy (HT), but now a substantial proportion of these women have stopped this therapy. HT increases and maintains bone mass and contracts the incidence of fractures. Bone los and fracture rates are believed to accelerate rapidly forward discontinuation of HT. Yates and colleagues used data from a longitudinal cogitation started in 1997 to meditation hip fracture rates after discontinuation of HT

They studied postmenopausal women 50 years and older who had no history of osteoporosis or use of osteoporosis-specific therapies other than HT More than 200000 women were recruited at 4,236 primary care physicians from first to last the United States. Extensive medical and personal data were assembleed from each participant as part of intake assessment that included bone mineral density measurement. Approximately united year later, data were gathered again, but this questionnaire included information in succession any new fractures. Women with four or more fractures during the year were exclud because these were believed to give an account of traumatic rather than osteoporotic fractures.

Data were available for 140584 women The majority (92 percent) of the women were white, and the mean age and carcass mass index (BMI) were 638 years and 277 kg by m2, respectively. The average bone mineral density T score was -082 About undivided half of the women smok and about the same in four women reported that her mother had incurred a fracture. Overall, 48 percent were using HT at the beginning of the research and 14 percent reported prior use.

Analysis of the data gathered at the beginning of the investigation showed significant associations between duration and recency of HT and the T score, BMI, health status, previous fracture, maternal fracture history, and steroid use. During the studious mood 269 women reported a strange hip fracture. The rate of recently made known hip fractures was similar in women who had discontinued HT and in those who had not at all used the therapy. The unadjusted rate for women who had not ever used or had discontinued HT was approximately three times that for general HT users. After adjustment for age, BMI, previous fracture, health status, maternal fracture, and steroid use, the rate of hip fracture in rife HT users remained significantly lower--about 40 percent lower than in women who had not at all used HT. Hip fracture rates were highest in women who had discontinued HT within five years, however the fracture risk was not related to duration of therapy.

The authors gather that the protective effects of HT against hip fracture are dissipated rapidly when therapy is discontinued and that late discontinuation of HT may place a postmenopausal woman at increased risk of hip fracture.

Yates J et al. Rapid los of hip fracture protection after estrogen cessation: evidence from the national osteoporosis risk assessment. Obstet Gynecol March 2004;103:440-6

EDITOR'S NOTE: While the lay and medical pres continue to emphasize the potential adverse validitys of HT, this study reminds us of its substantial benefits. Ideally, the decision to use HT is a carefully considered individual choice made on a well-informed woman. Unfortunately, millions of women have discontinued HT without physician consultation, thus missing the opportunity to benefit from an alter-native preventive regimen for osteoporosis. Family physicians are in a position to obstruct a potential epidemic of osteoporosis-related pathology in baby boomer which could overwhelm families and health and social ser-vices. This epidemic could be firing materialed from two sources--women entering menopause who are not getting bone-preserving treatments and women already in menopause who are losing protection as they discontinue HT.--A.D.W.

COPYRIGHT 2005 American Academy of Family Physicians

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