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Fillers POEM

No long-term benefit shown for bones after HRT

BMJ 2004; 329 doi: (Published 01 July 2004) Cite this as: BMJ 2004;329:0-f

Question Does hormone replacement therapy (HRT) continue to provide protection from hip fractures after the treatment is stopped?

Synopsis The national osteoporosis risk assessment (NORA) study began in 1997 as a longitudinal observational study of postmenopausal women aged over 50 at study entry. It includes 140 584 women, of whom 48% were taking hormone therapy at study entry and an additional 14% had used postmenopausal oestrogen in the past. Ninety two per cent of the women were white. A total of 53 737 women never used hormone therapy, 8723 had stopped taking it within the last five years, and 10 151 had stopped more than five years ago; the rest of the women were currently using hormone therapy. Unadjusted hip fracture rates per 1000 women per year were 2.24, 2.17, 2.51, and 0.81, respectively. After adjustments for factors including age and race, only the current users had significantly different hip fracture rate (odds ratio 0.60; 95% confidence interval, 0.44 to 0.82; P < 0.001).

Bottom line Women taking short term hormone therapy for symptom relief cannot expect long term bone protection. The risk of hip fracture is at least as great for women who stop postmenopausal hormone therapy as that of women who have never used it. The loss of protection occurs within five years of stopping treatment.

Level of evidence 1b (see Individual inception cohort study with > 80% follow up; or a clinical rule not validated on a second set of patients.

Yates J, Barrett-Connor E, Barlas S, Chen YT, Miller PD, Siris ES. Rapid loss of hip fracture protection after estrogen cessation: evidence from the national osteoporosis risk assessment. Obstet Gynecol 2004;103: 440-6

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  • * Patient-Oriented Evidence that Matters. See editorial (BMJ 2002;325: 983)

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