Hormones Boost Bone in First 3 Years, Not After
By Suzanne Rostler
NEW YORK (Reuters Health)
While hormone replacement therapy (HRT)
initially strengthens bones in postmenopausal women, taking the drugs for
more than 3 years does not make bones even stronger, researchers report.
What's more, women who stop taking hormones do lose bone density, but no
more rapidly than women who never took hormones, according to the report in
the March 25th issue of the Archives of Internal Medicine.
The findings contradict the belief that long-term use of HRT will continue
to build bone indefinitely into postmenopausal years.
It was also feared that women who stopped HRT might have an accelerated
rate of bone loss compared with never-users, possibly leading to increased
risk of hip fractures, the researchers explain. Yet, studies have shown
that women who take HRT for a long time--even up to 10 years--and then stop
the drugs are no less likely to break a hip than women who have never taken
The research findings are good news for women who want to benefit from
HRT's ability to reduce the risk of osteoporosis but not raise their risk
of breast cancer, Dr. Mark Espeland, a study author, told Reuters Health.
Some previous studies have suggested that long-term use of HRT might
increase the risk of breast cancer, the authors note, but those studies
have been inconclusive.
In the current study, the researchers followed up on a group of women who
took part in a 3-year study of HRT. The investigators found that the rate
of bone loss was equal among a group of nearly 500 postmenopausal women who
stopped HRT before or after the 3-year study, and a group of women who did
not use HRT. Women in all groups lost about 1% of their bone mineral
density in the first year and about half that much annually in the
Bone density was not found to increase in women who continued HRT after the
study. Those who took HRT gained about 3% bone mineral density in the spine
and 1.5% in the hip in the first year, and continued to gain slightly in
the following 2 years. However, no further gain or loss was seen in women
who continued to take the hormones after the trial ended, the report
"In summary, HRT for approximately 7 years did not provide further bone
mineral density benefit beyond that accrued at 3 years," according to Dr.
Gail A. Greendale from the University of California, Los Angeles, and
colleagues. "Our results suggest that women who stop HRT may resume bone
loss, but that it will not be at a very rapid rate."
The investigators measured bone mineral density in the hip and spine in 495
women aged 45 to 64 years over the 3-year study period, and again about 4
years after the study had ended.
The findings may help women to decide whether to use HRT during menopause,
when a natural decline in estrogen can cause hot flashes and other
symptoms, as well as an increase in risk of osteoporosis and other chronic
disorders. While HRT, which contains synthetic forms of estrogen and
progesterone, may lower the risk of these diseases, the health effects of
long-term use are less clear.
"The concern about cumulative risk as a function of long-term HRT has
fueled efforts to maximize potential benefits and minimize possible risks,"
the study authors write.
"Understanding what happens to bone when women stop HRT would provide part
of the answer to this complex problem," they explain.
Although pharmaceutical companies donated the medication used in the trial,
the study was funded by grants from the National Heart, Lung and Blood
Institute and other federal agencies.
SOURCE: Archives of Internal Medicine 2002;162:665-672.
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