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New insights into hormone replacement therapy for preventing fractures

A new study has found that women’s fracture risk and history of falls do not alter hormone replacement therapy’s ability to help prevent new broken bones.

Southampton researcher Prof Nicholas Harvey has been involved in large-scale research which has gained important new insights into the role of hormone replacement therapy (HRT) for preventing osteoporotic fractures in postmenopausal women.

The results are published in the journal Osteoporosis International.

Preventing weak bones

HRT is a treatment given to relieve symptoms of the menopause. It replaces hormones that reduce to a lower level around the menopause. It can relieve symptoms such as hot flushes, night sweats and mood swings.

HRT can help prevent thinning of the bones (osteoporosis), a condition which is more common after the menopause. HRT has previously been shown to reduce the risk of osteoporotic fractures in postmenopausal women.

Before this study there was little information on whether this benefit is dependent on a woman’s risk of fracture and falls, both of which are important questions in terms of clinical use.

This research has provided important new evidence suggesting that HRT can reduce fracture risk in postmenopausal women regardless of how high their baseline fracture risk is, and of whether they have a history of falling.

Large-scale analysis

In this collaborative study, led from the University of Gothenburg, Sweden and Australian Catholic University, Melbourne, Australia, researchers analysed the results from two Women's Health Initiative hormone therapy trials. Overall, 25,389 women aged 50-79 years who had been through the menopause took part in these.

Each trial assessed a different type of HRT – in one trial (in which the women had previously had a hysterectomy) it was just conjugated equine estrogen (CEE), while in the other (in which women had not had a hysterectomy) it was a combination of CEE and medroxyprogesterone acetate. In both trials, half the women had the treatment, and the other half had a placebo for comparison.

The women were all asked to complete a questionnaire at the start. This asked them about any falls they’d had over the last 12 months and any clinical risk factors they have for osteoporosis. This information was used to calculate their fracture risk at baseline using the global standard FRAX® fracture risk assessment tool.

They then recorded any bone fractures the women had for between two and six years afterwards. As has been previously shown, women taking HRT had significantly fewer fractures than those taking the placebo. HRT reduced the risk of any fracture by 28%, a major osteoporotic fracture by 40% and a hip fracture by 34%. In the present study, researchers found that these known benefits did not depend upon baseline FRAX® score or history of falls.

Prof Nicholas Harvey, Professor of Rheumatology and Clinical Epidemiology, and Deputy Director of the University of Southampton’s MRC Lifecourse epidemiology Centre, said: “Whilst this analysis is consistent with the established role of HRT in fracture prevention, importantly, it tells us that the effect of HRT on fracture risk is similar, regardless of baseline fracture risk or history of falling.

“These findings help us to better understand both the role of HRT in maintaining bone health in postmenopausal women, and also inform approaches to incorporation of falls in fracture risk assessment.”

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