title: Bone loss and wrist fractures after withdrawal of hormone therapy: The 15-year follow-up of the OSTPRE cohort.
abstract: BACKGROUND
  Long-term bone mineral density (BMD) or fracture incidence changes after withdrawal of postmenopausal hormone therapy (HT) are not well known.
  
  
  OBJECTIVE
  To study long-term postmenopausal bone loss and incidence of wrist fracture in respect to duration and withdrawal of self-reported HT.
  
  
  METHODS
  A 15-year follow-up of the population-based prospective OSTPRE cohort in Kuopio, Finland.
  
  
  METHODS
  Women (mean baseline age 53.4 years, range 48.1-59.6) were divided into four groups based on duration of HT: (1) never users (non-HT); (2) those who had used HT only throughout the 1st 5-year period (HT5); (3) throughout the first 10-years (HT10); (4) those who used HT throughout the entire 15-year follow-up (HT15).
  
  
  METHODS
  Femoral (n=857) and spinal (n=599) BMD measurements with dual X-ray absorptiometry (DXA) were carried out at 5-year intervals in 1989-2004. Wrist fracture incidence in 1989-2004 was studied in a population of 5119 women.
  
  
  RESULTS
  The adjusted spinal BMD (L2-L4) changes by HT use during the entire 15-year follow-up were -4.8% for non-HT (p<0.0001), -4.2% for HT5 (p=0.003), +0.02% for HT10 (p>0.05) and +3.2% for HT15 (p<0.0001) groups. The respective femoral bone losses were -8.6% for non-HT (p<0.0001), -7.9% for HT5 (p<0.0001), -2.5% for HT10 (p=0.010) and -0.2% for HT15 (p>0.05) groups. Comparing to non-HT group the risk of wrist fracture was reduced by 33% (p=0.045) in HT10 group and by 63% (p<0.0001) in HT15 group during the 15-year follow-up.
  
  
  CONCLUSIONS
  Long-term HT-use protects from bone loss. Thus, it reduces the incidence of osteopenia, osteoporosis and wrist fractures. Still, HT-use of less than 5 years did not have long-term bone protective effects, but a larger sample size is needed to confirm this result.
authors: Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, 70211 Kuopio, Finland. Electronic address: jtsaarel@student.uef.fi.
authors: Jarmo
authors: J
authors: Saarelainen
authors: Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, 70211 Kuopio, Finland.
authors: Saara
authors: S
authors: Hassi
authors: Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, 70211 Kuopio, Finland; Department of Psychiatry, Lapland Hospital District, 96101 Rovaniemi, Finland.
authors: Risto
authors: R
authors: Honkanen
authors: Department of Psychiatry, Lapland Hospital District, 96101 Rovaniemi, Finland; Institute of Clinical Medicine, Psychiatry, UEF, 70210 Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, 70029 Kuopio, Finland.
authors: Heli
authors: H
authors: Koivumaa-Honkanen
authors: Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, 70211 Kuopio, Finland; Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, 70029 Kuopio, Finland.
authors: Joonas
authors: J
authors: Sirola
authors: Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, 70211 Kuopio, Finland; Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, 70029 Kuopio, Finland.
authors: Heikki
authors: H
authors: Kröger
authors: Department of Obstetrics and Gynaecology, Kuopio University Hospital, 70029 Kuopio, Finland.
authors: Marja H
authors: MH
authors: Komulainen
authors: Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, 70211 Kuopio, Finland; Department of Obstetrics and Gynaecology, Kuopio University Hospital, 70029 Kuopio, Finland.
authors: Marjo
authors: M
authors: Tuppurainen
mesh_terms: D015502:Absorptiometry, Photon; D015519:Bone Density; D015914:Estrogen Replacement Therapy; D005260:Female; D005269:Femur; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology*; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D011446:Prospective Studies; D013997:Time Factors; D028761:Withholding Treatment; D014954:Wrist Injuries / Q000453:epidemiology*
keywords: Bone mineral density; Cohort study; Hormone therapy; Longitudinal; Postmenopausal; Wrist fracture