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Fracture Incidence in Relation to the Pattern of Use of Hormone Therapy in Postmenopausal Women
Emily Banks, MBBS, PhD;
Valerie Beral, MD;
Gillian Reeves, PhD;
Angela Balkwill, MSc;
Isobel Barnes, MSc; for the Million Women Study Collaborators
JAMA. 2004;291:2212-2220.
Context Evidence is limited on the effects of different patterns of use of postmenopausal hormone therapy on fracture incidence and particularly on the effects of ceasing use.
Objective To investigate the effect of different patterns of hormone therapy use on fracture incidence.
Design, Setting, and Participants Prospective study of 138 737 postmenopausal women aged 50 to 69 years recruited from the UK general population in 1996-1998 (the Million Women Study) and followed up for 1.9 to 3.9 years (average, 2.8 years) for fracture incidence.
Main Outcome Measure Adjusted relative risk (RR) for incident fracture (except fracture of the fingers, toes, and ribs) in hormone therapy users compared with never users at baseline.
Results A total of 5197 women (3.7%) reported 1 or more fractures, 79% resulting from falls. Current users of hormone therapy at baseline had a significantly reduced incidence of fracture (RR, 0.62; 95% confidence interval [CI], 0.58-0.66; P<.001). This protection was evident soon after hormone therapy began, and the RR decreased with increasing duration of use (P = .001). Among current users at baseline the RR of fracture did not vary significantly according to whether estrogen-only, estrogen-progestin, or other types of hormones were used (RR [95% CI], 0.64 [0.58-0.71], 0.58 [0.53-0.64], and 0.67 [0.56-0.80], respectively; P = .19), nor did it vary significantly according to estrogen dose or estrogen or progestin constituents. The RR associated with current use of hormone therapy did not vary significantly according to 11 personal characteristics of study participants, including their age at menopause, body mass index, and physical activity. Past users of hormone therapy at baseline experienced no significant protection against fractures (RR, 1.07; 95% CI, 0.99-1.15); incidence rates returned to those of never-users within about a year of ceasing use.
Conclusions All types of hormone therapy studied confer substantial protection against fracture while they are used. This protection appears rapidly after use commences and wears off rapidly after use ceases. The older women are, the greater is their absolute reduction in fracture incidence while using hormone therapy.
Author Affiliations: Cancer Research UK Epidemiology Unit, Radcliffe Infirmary, Oxford (Drs Banks, Beral, and Reeves, and Ms Balkwill), and School of Applied Statistics, University of Reading, Reading, (Ms Barnes), England. Dr Banks is now with the National Centre for Epidemiology and Population Health, Australian National University, Canberra.
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