Hormonal replacement therapy reduces forearm fracture incidence in recent postmenopausal women - results of the Danish Osteoporosis Prevention Study.
OBJECTIVE
To study the fracture reducing potential of hormonal replacement therapy (HRT) in recent postmenopausal women in a primary preventive scenario.


METHODS
Prospective controlled comprehensive cohort trial: 2016 healthy women aged 45-58 years, from three to 24 months past last menstrual bleeding were recruited from a random sample of the background population. Mean age was 50. 8+/-2.8 years, and the number of person years followed was 9335.3. There were two main study arms: a randomised arm (randomised to HRT; n=502, or not; n=504) and a non-randomised arm (on HRT; n=221, or not; n=789 by own choice). First line HRT was oral sequential oestradiol/norethisterone in women with intact uterus and oral continuous oestradiol in hysterectomised women.


RESULTS
After five years, a total of 156 fractures were sustained by 140 women. There were 51 forearm fractures in 51 women. By intention-to-treat analysis (n=2016), overall fracture risk was borderline statistically significantly reduced (RR=0.73, 95% CI: 0.50-1.05), and forearm fracture risk was significantly reduced (RR=0.45, 95% CI: 0.22-0.90) with HRT. Restricting the analysis to women who had adhered to their initial allocation of either HRT (n=395) or no HRT (n=977) showed a significant reduction in both the overall fracture risk (RR=0.61, 95% CI: 0.39-0.97) and the risk of forearm fractures (RR=0.24, 95% CI: 0.09-0.69). Compliance with HRT was 65% after five years.


CONCLUSIONS
It is possible to reduce the number of forearm fractures and possibly the total number of fractures in recent postmenopausal women by use of HRT as primary prevention.
Mosekilde
L
L
Department of Endocrinology and Metabolism, The Osteoporosis Clinic, Aarhus Amtssygehus, Aarhus University Hospital, Tage Hansens Gade 2, DK-8000 C, Aarhus, Denmark.
Beck-Nielsen
H
H
Sørensen
O H
OH
Nielsen
S P
SP
Charles
P
P
Vestergaard
P
P
Hermann
A P
AP
Gram
J
J
Hansen
T B
TB
Abrahamsen
B
B
Ebbesen
E N
EN
Stilgren
L
L
Jensen
L B
LB
Brot
C
C
Hansen
B
B
Tofteng
C L
CL
Eiken
P
P
Kolthoff
N
N
D000367:Age Factors; D015992:Body Mass Index; D015519:Bone Density; D015331:Cohort Studies; D004967:Estrogens / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005543:Forearm Injuries / Q000453:epidemiology / Q000517:prevention & control*; D050723:Fractures, Bone / Q000453:epidemiology / Q000517:prevention & control*; D020249:Hormone Replacement Therapy; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology / Q000628:therapy*; D010349:Patient Compliance; D017698:Postmenopause; D011374:Progesterone / Q000008:administration & dosage / Q000627:therapeutic use*; D012044:Regression Analysis; D012307:Risk Factors
D004967:Estrogens; D011374:Progesterone