Skip to main content

Advertisement

SpringerLink
Log in

Hormone replacement therapy and risk for foot, distal forearm, proximal humerus, and pelvis fractures

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

This case-control epidemiologic study examines the relationship between hormone replacement therapy (HRT) and risk for fractures of four sites among women 45 years of age and older. From October 1996 to May 2001, incident patients with distal forearm (n=744), foot (n=618), proximal humerus (n=331), and pelvis (n=109) fractures were recruited from five Kaiser Permanente Medical Centers in northern California. Controls (n=1617) were selected at random from the same five medical centers over the same time period within strata defined by 5-year age group, gender, and white versus nonwhite or unknown recorded race/ethnicity. Trained interviewers collected information using a standardized questionnaire. Compared with postmenopausal women who never used HRT, postmenopausal women currently using HRT for at least 3 months had a decreased risk of fracture at the distal forearm (adjusted OR=0.55, 95% CI: 0.43, 0.72), proximal humerus (adjusted OR=0.51, 95% CI: 0.36, 0.74), and pelvis (adjusted OR=0.51, 95% CI: 0.27, 0.95), but not the foot (adjusted OR=1.05, 95% CI: 0.81, 1.35). Past use of HRT for more than 7 years also appeared to be associated with a reduced risk of fracture at the distal forearm and proximal humerus. The longer a woman went without HRT after her last menstrual period, the greater her risk of fracture in the distal forearm, proximal humerus, and pelvis. The findings of this study support long-term, current use of HRT for the prevention of osteoporotic fractures, but other risks and benefits also need to be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.

Similar content being viewed by others

References

  1. Cauley JA, Salamone LM (2001) Postmenopausal endogenous and exogenous hormones, degree of obesity, thiazide diuretics, and risk of osteoporosis. In: Marcus R, Feldman D, Kelsey JL (eds) Osteoporosis, 2nd edn, Vol 1. Academic Press, San Diego, pp 741–769

  2. Mosekilde L, Beck-Nielsen H, Sorensen OH, Nielsen SP, Charles P, Vestergaard P, Hermann AP, Gram J, Hansen TB, Abrahamsen B, Ebbesen EN, Stilgren L, Jensen LB, Brot C, Hansen B, Tofteng CL, Eiken P, Kolthoff N (2000) Hormone replacement therapy reduces forearm fracture incidence in recent postmenopausal women—results of the Danish Osteoporosis Prevention Study. Maturitas 36:181–193

    Google Scholar 

  3. Writing Group for the Women's Health Initiative Investigators (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principle results from the Women's Health Initiative randomized controlled trial. JAMA 288:321–333

    Google Scholar 

  4. Torgerson DJ, Bell-Syer SEM (2001) Hormone replacement therapy and prevention of nonvertebral fractures: a meta-analysis of randomized trials. JAMA 285:2891–2897

    Google Scholar 

  5. Hully S, Furberg C, Barrett-Connor E, Cauley J, Grady D, Haskell W et al (2002) Noncardiovascular disease outcomes during 6.8 years of hormone therapy: the Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 288:58–66

    Google Scholar 

  6. Cauley JA, Seeley DG, Ensrud K, Ettinger B, Black D, Cummings SR, Study of Osteoporotic Fractures Research Group (1995) Estrogen replacement therapy and fractures in older women. Ann Intern Med 122:9–16

    Google Scholar 

  7. Kelsey JL, Browner WS, Seeley DG, Nevitt MC, Cummings SR (1992) Risk factors for fractures of the distal forearm and proximal humerus. Am J Epidemiol 135:477–489

    Google Scholar 

  8. Weiss NS, Ure CL, Ballard JH, Williams AR, Daling JR (1980) Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med 303:1195–1198

    Google Scholar 

  9. Williams AR, Weiss NS, Ure CL, Ballard J, Daling JR (1982) Effect of weight, smoking, and estrogen use on the risk of hip and forearm fractures in postmenopausal women. Obstet Gynecol 60:695–699

    Google Scholar 

  10. Melton LJ III, Crowton CS, O'Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporosis Int 9:29–37

    Google Scholar 

  11. Seeley, DG, Kelsey J, Jergas M, Nevitt MC (1996) Predictors of ankle and foot fractures in older women. J Bone Miner Res 11:1347–1355

    Google Scholar 

  12. Lindsay R, Cosman F (2001) Estrogens and osteoporosis. In: Marcus R, Feldman D, Kelsey JL (eds) Osteoporosis, 2nd edn, Vol 2. Academic Press, San Diego, pp 577–601

  13. Riggs BL, Khosla S, Melton JL III (2001) The type I/type II model for involutional osteoporosis. In: Marcus R, Feldman D, Kelsey JL (eds) Osteoporosis, 2nd edn, Vol 2. Academic Press, San Diego, pp 49–58

  14. WHO (1992) International Statistical Classification of Diseases and Health Related Problems, 10th revision, Vol 1. World Health Organization, Geneva

  15. Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H (1983) Validation of a short orientation-memory-concentration test of cognitive impairment. Am J Psychiatry 140:734–739

    Google Scholar 

  16. Gold EB, Bromberger J, Crawford S, Samuels S, Greendale GA, Harlow SD, Skurnick J (2001) Factors associated with age at natural menopause in a multi-ethnic sample of midlife women. Am J Epidemiol 153:865–874

    Google Scholar 

  17. Gallagher JC (1996) Estrogen: prevention and treatment of osteoporosis. In: Marcus R, Feldman D, Kelsey JL (eds) Osteoporosis. Academic Press, San Diego, pp 1191–1208

  18. Quigley MET, Martin PL, Burnier AM, Brooks P (1987) Estrogen therapy arrests bone loss in elderly women. Am J Obstet Gynecol 156:1516–1523

    Google Scholar 

  19. Tremollieres FA, Pouilles JM, Ribot C (2001) Withdrawal of hormone replacement therapy is associated with significant vertebral bone loss in postmenopausal women. Osteoporosis Int 2001:385–390

  20. Hadji P, Hars O, Schuler M, Block K, Wuster C, Emons G, Schulz K (2000) Assessment by quantitative ultrasonometry of the effects of hormone replacement therapy on bone mass. Am J Obstet Gynecol 182:529–534

    Google Scholar 

  21. Weiss M, Ben Shlomo A, Hagag P, Rapoport M, Ish-Shalom S (2000) Effect of estrogen therapy on speed of sound at multiple skeletal sites. Maturitas 35:237–243

    Google Scholar 

  22. Matthews KA, Kuller LH, Wing RR, Meilahn EN, Plantinga P (1996) Prior to use of estrogen replacement therapy, are users healthier than nonusers? Am J Epidemiol 143:971–978

    Google Scholar 

  23. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. N Engl J Med 332:767–773

    Google Scholar 

Download references

Acknowledgements

Supported by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (RO1 AR42421 and T32 AR07588). We thank Beverly Peters and Luisa Hamilton for project management, Michael Sorel for computing and database management, and Carolyn Salazar for medical record abstraction.

Author information

Authors and Affiliations

  1. Division of Epidemiology, Stanford University School of Medicine, Stanford, California, USA

    Theresa H. M. Keegan, Geetha Gopalakrishnan & Jennifer L. Kelsey

  2. Division of Research, Kaiser Permanente Medical Care Program, Oakland, California, USA

    Stephen Sidney & Charles P. Quesenberry Jr.

Authors
  1. Theresa H. M. Keegan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Geetha Gopalakrishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen Sidney
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Charles P. Quesenberry Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer L. Kelsey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Theresa H. M. Keegan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Keegan, T.H.M., Gopalakrishnan, G., Sidney, S. et al. Hormone replacement therapy and risk for foot, distal forearm, proximal humerus, and pelvis fractures. Osteoporos Int 14, 469–475 (2003). https://doi.org/10.1007/s00198-003-1379-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-003-1379-2

Keywords

Search

Navigation