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Osteoporosis and Fractures in Postmenopausal Women Using Estrogen
Heidi D. Nelson, MD, MPH;
Joanne Rizzo, MA;
Emily Harris, PhD;
Jane Cauley, DrPH;
Kristine Ensrud, MD, MPH;
Douglas C. Bauer, MD;
Eric Orwoll, MD;
for the Study of Osteoporotic Fractures Research Group
Arch Intern Med. 2002;162:2278-2284.
Background Previous studies demonstrate that postmenopausal women who use estrogen are somewhat protected from bone loss and fractures compared with nonusers, but the extent to which estrogen users remain at risk for osteoporosis and fractures is uncertain.
Objective To determine long-term probabilities for incident fractures among postmenopausal estrogen users.
Methods We examined data from the Study of Osteoporotic Fractures, a prospective cohort study with 10 years of follow-up (1986-1999). This cohort includes 8816 women 65 years and older from community settings in 4 areas of the United States.
Main Outcome Measures Hip, wrist, vertebral, and nonvertebral fractures.
Results At baseline, using criteria developed by the World Health Organization, 40% of continuous estrogen users were osteopenic and 13% were osteoporotic at the hip or spine. Although women currently using estrogen lost less bone density than past users or those who never used estrogen, all user groups on average lost bone from the hip and calcaneus. During 10 years of observation, the adjusted probability of nonvertebral fractures was 19.6% for continuous estrogen users, similar to current partial users and lower than past users and those who never used estrogen (P<.05). These comparisons were similar for hip, wrist, and vertebral fractures.
Conclusions Although estrogen use is associated with reduced prevalence of low bone density, less bone loss, and lower probabilities for fractures, osteoporosis and fractures are common in older women who used estrogen continuously since menopause. Estrogen users should be considered in strategies designed to detect, prevent, and treat osteoporosis.
From the Departments of Medical Informatics and Outcomes Research (Dr Nelson) and Medicine (Drs Nelson and Orwoll), Oregon Health and Science University, Portland; the Medical Service, Veterans Affairs Medical Center, Portland (Dr Nelson); the Center for Health Research, Northwest Kaiser Permanente, Portland (Ms Rizzo and Dr Harris); the Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Cauley); the Department of Internal Medicine and Epidemiology, University of Minnesota, Minneapolis (Dr Ensrud); and the Department of Epidemiology and Biostatistics, University of California, San Francisco (Dr Bauer).
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