Increases in Hip Fractures After Stopping Estrogen

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Increases in Hip Fractures After Stopping Estrogen

Since the Women’s Health Initiative report, millions of women have discontinued post-menopausal hormone replacement therapy (HRT), raising some concerns. The National Osteoporosis Risk Assessment (NORA) evaluated the association between HRT cessation and hip fracture risk in 140,584 postmenopausal American women. Hip fractures are the most devastating, costly, and reliably reported events to measure osteoporosis.

All participants were at least 50 years old, were postmenopausal, and had no previous diagnosis of osteoporosis. Baseline and 12-month follow-up questionnaires assessed use of HRT and incident hip fractures. Hip fractures were reported by 269 women. Consistent with the WHI, women in NORA who were currently on HRT had a 40% lower incidence of hip fractures compared with those who never used HRT. Women who stopped using HRT more than 5 years earlier had similar hip fracture risk to “never users”, as expected. However, surprisingly, women who had discontinued HRT within the previous 5 years had an increased hip fracture odds ratio of 1.65 relative to never users of HRT.

Estrogen use initially increases, and later maintains, bone mass,   reducing the incidence of fractures, including hip fractures, even in a population not selected for low bone mass. This study showed that rapid bone loss follows estrogen discontinuation, such that bone mineral density approached the pretreatment level within 2 years after estrogen withdrawal. In addition, because during the early phase of estrogen withdrawal, the rate of bone resorption substantially exceeds that of bone formation, not only are individual trabeculae at high risk of loss from osteoclastic resorption, but repair of partly transected trabeculae may be incomplete.

Obstet Gynecol . 2004 Mar;103(3):440-6

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