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How Good Is the Evidence?

Deborah Grady, MD,MPH; Steven R. Cummings, MD

JAMA. 2001;285:2909-2910.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Estrogen has been used for many years to prevent bone loss and fractures in postmenopausal women. Support for this practice comes from 2 lines of evidence. First, observational studies consistently suggest that postmenopausal hormone therapy reduces the risk of hip and other types of fracture.^1-2 However, observational studies are susceptible to selection bias and confounding. This may be especially true of studies of hormone therapy because users tend to be healthier, wealthier, and more active than nonusers.³ Even if observational studies are qualitatively correct, they may overestimate the degree of risk reduction attributed to hormone therapy.

Second, randomized trials have consistently shown that estrogen prevents postmenopausal bone loss.^4-5 However, change in bone density is an imperfect predictor of reduction in risk of nonspine fractures. For example, calcium with vitamin D decreases the risk of fracture despite having little or no effect on bone . . . [Full Text of this Article]

Author Affiliations: Department of Epidemiology and Biostatistics and Department of Medicine, University of California, San Francisco.

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