Hormones & Bones

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 drugs.

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 following years.

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 indicates.

"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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