Maximizing the Benefit of Estrogen Therapy for Prevention of Osteoporosis

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Abstract
Postmenopausal hormone therapy to prevent osteoporosis is commonly started during menopause and often discontinued within 5–10 years. This approach may preserve bone density during use, but there is evidence that it does not preserve bone density or protect against osteoporotic fractures that occur late in life. We used data on the effects of hormone therapy on bone density and the association of bone density and fracture risk to estimate and compare the expected benefits of beginning therapy at menopause and continuing for the remainder of life, beginning therapy at menopause and stopping at age 65, and beginning hormone therapy at age 65 and continuing for the remainder of life. Compared to never users, women who use estrogen continuously beginning at menopause are predicted to have about 22% higher mean bone density between ages 75 and 85 and to reduce their risk of fracture about 73%. In contrast, women who begin therapy at menopause but stop at age 65 are predicted to have only about 8% higher mean bone density and to reduce their risk of fractures about 23% compared to never users. Those who start using estrogen at age 65 are predicted to have 14–19% higher mean bone density than never users and to reduce fracture risk 57–69%. Beginning hormone therapy later in life may provide almost as much protection against osteoporotic fractures as starting at menopause and would halve the period of hormone exposure, reducing the potential risks of very long-term estrogen therapy.

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