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New JAMA Study Supports Early Use of HRT

A recent article in the Journal of the American Medical Association (6/13/01) reaffirmed the importance of early menopausal hormone replacement therapy (HRT) to prevent fractures related to osteoporosis.  This comprehensive analysis of 22 randomized controlled trials concluded that postmenopausal women taking HRT, especially women under age 60, had fewer non-spinal fractures than those who did not.

It is not clear why this analysis did not include data on vertebral, or spinal, fractures.  Unlike hip fractures, which tend to occur after age 65, the risk for spinal fractures increases as soon as a woman enters menopause. (The average age at menopause is 51.) As a result, spinal fractures are more common in the age group typically receiving HRT.  Many other studies have shown that estrogen reduces the risk of spinal fractures, which may be associated with disfigurement and disability.

HRT is FDA-approved to prevent and manage osteoporosis and these findings support this.  This study demonstrated that the greatest benefit of estrogen in osteoporosis protection is early on in menopause.  This is consistent with other findings that up to 20% of a women's expected lifetime bone loss occurs in the first 5 to 7 years after menopause. 

This does not mean that estrogen doesn't continue to help women who are over age 60, just that they benefit less than women who start HRT younger.  The study concluded that there was a 33% risk reduction in nonvertebral fractures in women who took estrogen when they were under 60 years old.  Women who were over 60 had a 12% risk reduction.

According to Sandra Raymond, Executive Director of the National Osteoporosis Foundation, this kind of information can be confusing and it does little to help women evaluate their treatment options for osteoporosis.  The NOF states,  "The most important thing for women to know is that their doctor is their greatest ally in weighing the benefits and risks of HRT."

For more information on osteoporosis, click here.

Created: 6/17/2001  -  Donnica Moore, M.D.

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