(Hormone replacement therapy and risk of hip facture: population based case-control study)
(Hormone replacement therapy again)
Menopause is accompanied by accelerated bone loss and by an increase in fractures, such as those of the hip. In the past many studies have shown that hormone replacement therapy (HRT) can reduce bone loss and diminish the risk of hip fracture however, questions surrounding the dose and duration of the therapy have, until now, been unanswered.
In this week's BMJ Dr Karl MichaÎlsson et al from Sweden present their findings which suggest that substantial hip fracture protection only exists if women are taking HRT or have done so recently (within five years) and the greatest gain is found in those women who have been taking it for a long period of time. They found that even those women who had started taking HRT several years after their menopause had reaped the benefit.
MichaÎlsson et al also found that lower doses of oestrogen were permitted by the inclusion of progestins within the treatment and that the protectiveness of HRT was unrelated to how it was taken (through skin patches or orally).
In a linked editorial in this week's BMJ, Professor Kay-Tee Khaw from the Gerontology Unit at the University of Cambridge, notes that HRT is increasingly advocated not just for short term treatment of menopausal symptoms but as long term prophylactic therapy against heart disease, osteoporosis and even Alzheimer's Disease. She tentatively warns that clinicians need to consider the long-term risk versus benefit balance for each individual patient as she believes that the benefits of HRT may vary in different cases. Khaw concludes that clinicians and patients should instead concentrate on more major determinants of women's' health, such as diet, exercise and lifestyle.
Contact:
Dr Karl MichaÎlsson, Senior Registrar, Department of Orthopaedics, University Hospital, S-751 85 Uppsala, Sweden Karl.Michaelsson@ortopedi.uu.se
Professor Kay-Tee Khaw, Professor of Clinical Gerontology, Clinical Gerontology Unit, University of Cambridge, Addenbrookes Hospital, Cambridge kk101@medschl.cam.ac.uk