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SUMMARY Fifty-two mature female rats on a controlled diet were studied to compare the effects of oophorectomy, and hormone replacement therapy after oophorectomy, on femoral morphology and mineral content. Oophorectomy was followed by the development of osteoporosis after 11 months of observation. This was characterized by a reduction in ash per unit length of bone and a diminution of mid-shaft femoral cortical width. The administration of a progestogen (9 μg ethynodiol diacetate/rat/day) for 10 months after oophorectomy prevented the reduction in ash per unit length from occurring, whereas an oestrogen (0·9 μg mestranol/rat/day) had no significant effect on either parameter of osteoporosis. The progestogen appeared to produce this effect by a relative increase in periosteal new bone formation at the expense of increased loss of bone from the endosteal surface.

A prospective study of fractures of the femoral neck was conducted over 12 months in order to ascertain the relevance of generalised osteoporosis as determined by metacarpal morphometry. A series of some 200 women sustaining a fracture of the femoral neck after minor trauma had bone mass measurements similar to those of a control population of normal women, and 16% were not osteoporotic. A history of previous fractures was documented in one third of the women, but this was unrelated to the presence or severity of osteoporosis, although over half of the fractures had occurred within the previous four years. Trochanteric fractures were seen more commonly in severely osteoporotic women (p <0 005), whereas cervical fractures predominated in those who were not osteoporotic.These findings support the hypothesis that postural instability is the major determinant for femoral neck fracture and that generalised osteoporosis, rather than being a prerequisite for fracture, merely determines the type of fracture sustained.

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