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To the Editor: Dr Villareal and colleagues¹ found that frail elderly women who received 9 months of hormone replacement therapy (HRT) had significantly increased bone mineral density. Although the authors excluded women with active serious illness, they did not indicate whether they excluded women with a history of coronary artery disease (CAD). The Heart and Estrogen/Progestin Replacement Study (HERS)² reported that women with coronary artery disease are at increased risk for cardiovascular events in the first year of HRT. However, Villareal et al followed up their patients for only 9 months. Given the high prevalence of CAD in older women (33% in women older than 65 years),³ alternatives to estrogen for bone health, such as bisphosphonates, are appropriate for many patients.

AUTHOR INFORMATION
Disclaimer: The views expressed in this letter are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government.

LT Sharon B. Reed, MC,USNR; Michele F. Bellantoni, MD
Division of Geriatric Medicine
Johns Hopkins University School of Medicine
Baltimore, Md

1. Villareal DT, Binder EF, Williams D, Schechtman KB, Yarasheski KE, Kohrt WM. Bone mineral density response to estrogen replacement in frail elderly women: a randomized controlled trial. JAMA. 2001;286:815-820. FREE FULL TEXT 2. Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA. 1998;280:605-613. FREE FULL TEXT 3. Wegner NK. Coronary heart disease: an older woman's major health risk. BMJ. 1997;315:1085-1090. FREE FULL TEXT

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RELATED ARTICLE

Bone Mineral Density Response to Estrogen Replacement in Frail Elderly Women: A Randomized Controlled Trial
Dennis T. Villareal, Ellen F. Binder, Daniel B. Williams, Kenneth B. Schechtman, Kevin E. Yarasheski, and Wendy M. Kohrt
JAMA. 2001;286(7):815-820.
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