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Volume 329:1141-1146 October 14, 1993 Number 16 Next

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ABSTRACT

Background Estrogen therapy prevents bone loss in postmenopausal women who take it early in the postmenopausal period. The risk of fracture is highest much later in life, however. We studied whether bone mass in elderly women was affected by earlier estrogen use and how long women needed to take estrogen for it to have a beneficial effect on bone density later in life.

Methods In 1988 and 1989, we measured bone mineral density at the femur, spine, shaft of the radius, and ultradistal radius in 670 white women in the Framingham Study cohort (mean age, 76 years; range, 68 to 96). These women had been followed prospectively through menopause and had been asked repeatedly about estrogen therapy. After excluding women who began taking estrogen after a fracture, we investigated whether postmenopausal estrogen therapy affected bone density; in these analyses we adjusted for age, weight, height, cigarette smoking, physical activity, and age at menopause.

Results A total of 212 women (31.6 percent) had received estrogen therapy (mean estimated duration of treatment, 5 years). Only women who had taken estrogen for 7 to 9 years or for 10 or more years had significantly higher bone mineral density than women who had not taken estrogen (7 to 9 years of treatment, P<0.05 at sites in the femur and the spine; 10 years, P<0.05 at all sites except the spine).

In the women less than 75 years of age who had taken estrogen for seven or more years, the bone density was, averaging all sites, 11.2 percent greater than in women who had never received estrogen. Among women 75 years of age and older in whom the duration of therapy was comparable, bone density was only 3.2 percent higher than in women who had never taken estrogen.

Conclusions For long-term preservation of bone mineral density, women should take estrogen for at least seven years after menopause. Even this duration of therapy may have little residual effect on bone density among women 75 years of age and older, who have the highest risk of fracture.

Source Information

From the Boston University Arthritis Center, Boston (D.T.F., Y.Z., M.T.H., J.J.A.); the Departments of Medicine, Boston City Hospital and University Hospital, Boston (D.T.F.); Hebrew Rehabilitation Center for Aged, Boston (D.P.K.); and the Framingham Study, Framingham, Mass. (P.W.F.W.).

Address reprint requests to Dr. Felson at A203, Boston University School of Medicine, Arthritis Center, 80 E. Concord St., Boston, MA 02118.

Full Text of this Article

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Effect of Estrogen Therapy on Bone Density in Elderly Women
Kanis J. A., Stevenson J. C., Seeman E., Felson D. T., Zhang Y.
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N Engl J Med 1994; 330:715-716, Mar 10, 1994. Correspondence

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• McPherson, K. (1995). Breast cancer and hormonal supplements in postmenopausal women. BMJ 311: 699-700 [Full Text]  
• Colditz, G. A., Hankinson, S. E., Hunter, D. J., Willett, W. C., Manson, J. E., Stampfer, M. J., Hennekens, C., Rosner, B., Speizer, F. E. (1995). The Use of Estrogens and Progestins and the Risk of Breast Cancer in Postmenopausal Women. NEJM 332: 1589-1593 [Abstract] [Full Text]  
• Grisso, J. A., Kelsey, J. L., Strom, B. L., O'Brien, L. A., Maislin, G., LaPann, K., Samelson, L., Hoffman, S., Northeast Hip Fracture Study Group, (1994). Risk Factors for Hip Fracture in Black Women. NEJM 330: 1555-1559 [Abstract] [Full Text]  
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