Skip to main content
SpringerLink
Log in

Fracture protection provided by long-term estrogen treatment

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

The objective of the study was to determine the incidence rate of osteoporotic fractures among elderly women who had long-term postmenopausal estrogen replacement therapy (ERT) and to compare this with the incidence rate in women who had not used estrogen. In a previous retrospective cohort study based on medical record review in 1982, we showed that long-term ERT was associated with lower incidence of wrist and vertebral fractures. We have extended our follow-up of 490 women by adding a mean 8 years to the observation period, which more than triples the number of osteoporotic fractures. At the Kaiser Permanente Medical Center, San Francisco, a large health maintenance organization, a review of computer pharmacy records from 1968 through 1971 identified 245 postmenopausal women; all had begun estrogen within 3 years of menopause and had used estrogen for at least 5 years. From the same pharmacy records, 245 age-matched postmenopausal non-users were identified. Among estrogen users, mean length of use was 17.0 years, mean follow-up after treatment was 7.3 years and mean dose of conjugated oral estrogen was 0.9 mg daily. We found statistically significant reduction in the incidence of wrist and vertebral fractures in users compared with non-users. The age-adjusted incidence ratios (95% confidence intervals for wrist fractures were 0.55 (0.32–0.92) and for vertebral fractures were 0.57 (0.41 –0.80). These results were not statistically significantly altered after adjustment for age of menopause, body mass index and smoking. It is concluded that long-term ERT confers statistically significant protection against wrist and vertebral fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Christiansen C, Christensen MS, Transbøl I. Bone mass in postmenopausal women after withdrawal of oestrogen/gestagen replacement therapy. Lancet 1981;1:459–61.

    Google Scholar 

  2. Hutchinson TA, Polansky SM, Feinstein AR. Post-menopausal oestrogens protect against fractures of hip and distal radius: a case-control study. Lancet 1979;2:705–9.

    Google Scholar 

  3. Weiss NS, Ure CL, Ballard JH, Williams AR, Daling JR. Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med 1980;303:1195–8.

    Google Scholar 

  4. Johnson RE, Splecht EE. The risk of hip fractures in postmenopausal females with or without estrogen drug exposure. Am J Public Health 1981;71:138–44.

    Google Scholar 

  5. Paganini-Hill A, Ross RK, Gerkins VR, Henderson BE, Arthur M, Mack TM. Menopausal estrogen therapy and hip fractures. Ann Intern Med 1981;95:28–31.

    Google Scholar 

  6. Ettinger B, Genant HK, Cann CE. Long-term estrogen replacement therapy prevents bone loss and fractures. Ann Intern Med 1985;102:319–24.

    Google Scholar 

  7. Kiel DP, Felson DT, Anderson JJ, Wilson PWF, Moskowitz MA. Hip fracture and the use of estrogens in postmenopausal women: the Framingham study. N Engl J Med 1987;317:1169–74.

    Google Scholar 

  8. Naessén T, Persson I, Adami H-O, Bergström R, Bergkvist L. Hormone replacement therapy and the risk for first hip fracture: a prospective, population-based cohort study. Ann Intern Med 1990;113:95–103.

    Google Scholar 

  9. Paganini-Hill A, Chao A, Ross RK, Henderson BE. Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology 1991;2:16–25.

    Google Scholar 

  10. Lindsay R, Hart DM, Forrest C, Baird C. Prevention of spinal osteoporosis in oophorectomised women. Lancet 1980;2:1151–4.

    Google Scholar 

  11. Hollingshead AB, Redlich FC. Social class and mental illness: a community study. New York: Wiley, 1958.

    Google Scholar 

  12. Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research: principles and quantitative methods. Belmont, CA: Lifetime Learning Publications, 1982:351.

    Google Scholar 

  13. Hammond CB, Jelovsek FR, Lee KL, Creasman WT, Parker RT. Effects of long-term estrogen replacement therapy. I. Metabolic effects. Am J Obstet Gynecol 1979;133:525–36.

    Google Scholar 

  14. Barrett-Connor E. Postmenopausal estrogen and prevention bias. Ann Intern Med 1991;115:455–6.

    Google Scholar 

  15. Kiel DP, Baron JA, Anderson JJ, Hannan MT, Felson DT. Smoking eliminates the protective effect of oral estrogens on the risk for hip fracture among women. Ann Intern Med 1992;116:716–21.

    Google Scholar 

  16. Cauley JA, Seeley DG, Ensrud K, Black D, Cummings SR, and the Study of Osteoporotic Fractures Research Group. Hormone replacement therapy (HRT) and fracture risk in elderly women [abstract]. Presented at the Fourth International Symposium on Osteoporosis, Hong Kong, 27 March–2 April 1993.

  17. Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985;7:178–208.

    Google Scholar 

  18. Felson DT, Zhang Y, Hannan MT, Kiel DP, Wilson PWF, Anderson J. The effect of postmenopausal estrogen therapy on bone density in elderly women. N Engl J Med 1993;329:1141–6.

    Google Scholar 

  19. Johnston CC Jr, Hui SL, Longcope C. Oestrogen and calcium in the management of osteoporosis. In: Dixon A St J, Russell RGG, Stamp TCB, editors. Osteoporosis: a multi-disciplinary problem. London: Academic Press, 1983:223–9. (Royal Society of Medicine International Congress and Symposium Series no. 55.)

    Google Scholar 

  20. Rozenberg S, Gevers R, Peretz A, Vandromme J, Robyn C, Ham H. Decrease of bone mineral density during estrogen substitution therapy. Maturitas 1993;17:205–10.

    Google Scholar 

  21. Cooper C, Atkinson EJ, O'Fallon WM, Melton LJ III. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-189. J Bone Miner Res 1992;7:221–7.

    Google Scholar 

  22. Owen RA, Melton LJ III, Johnson KA, Ilstrup DM, Riggs BL. Incidence of Colles' fracture in a North American community. Am J Public Health 1982;72:605–7.

    Google Scholar 

  23. Nevitt MC, Cummings SR, and the Study of Osteoporotic Fractures Research Group. Falls and fractures in older women. In: Vellas B, Toupet M, Rubenstein L, Albarède JL, Christen Y, editors. Falls, balance and gait disorders in the elderly. Paris: Elsevier, 1992:69–80.

    Google Scholar 

  24. Grady D, Rubin SM, Petitti DB, Fox CS, Black D, Ettinger B, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 1992;117:1016–41.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Washington School of Medicine, Seattle, Washington

    P. Maxim

  2. Division of Research, Kaiser Permanente Medical Care Program, 3505 Broadway, 13th floor, 94611, Oakland, CA, USA

    B. Ettinger MD

  3. Information Technology Services, University of California Medical Center, San Francisco, California, USA

    G. M. Spitalny

Authors
  1. P. Maxim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Ettinger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. M. Spitalny
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maxim, P., Ettinger, B. & Spitalny, G.M. Fracture protection provided by long-term estrogen treatment. Osteoporosis Int 5, 23–29 (1995). https://doi.org/10.1007/BF01623654

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01623654

Keywords

Search

Navigation