Menopausal Estrogen Therapy and Hip Fractures

Abstract

The association between menopausal estrogen therapy and hip fracture was studied in a retirement community. Ninety-one hip fracture cases during a 5-year period in female residents under age 80 were compared to age-and race-matched community controls. Estrogen use was recorded from the medical records of the outpatient care facility and personal interviews. The estimated risk ratio for use of oral estrogens in excess of 60 months was 0.42. This protective effect was largely limited to oophorectomized women for whom the risk ratio for a comparable duration of use was 0.14; the risk significantly decreased with increased duration, but no such trend existed with increased dosage. Diabetes mellitus, low Quetelet's index, tallness, prolonged immobilization or physical inactivity, use of corticosteroids, early age at menopause, low levels of sunlight exposure, and heavy cigarette smoking were each independent risk factors for hip fracture but none confounded the observed association with estrogen use.

Epidemiology of osteoporosis in urbanized Asian populations

“…The relative risk for hip fracture was almost twice as high among women who performed outdoor loadbearing activities less than once a day compared with subjects who performed these activities every day (Table 3). These findings concur with the results of crosssectional studies conducted in Caucasian populations living in the United Kingdom [16] and United States [17]. Moreover, a 14-year prospective study in the United Kingdom has confirmed the relationship between lack of activity and hip fracture [18].…”

Clinical Risk Factors for Osteoporotic Hip Fracture in Elderly Women – Implications for Fracture Prevention

“…In several case-control studies, customary physical inactivity was found to be an independent risk factor for hip fracture in elderly people [10,12,36,60,73]. In accordance with these cross-sectional reports, recent prospective data have confirmed that decreased levels of physical activity are associated with a substantially increased risk of hip fracture [18,72,90].…”

“…In line with these densitometric data, current smoking was found to be associated with an increased risk of hip fracture, both in case-control and most (but not all) prospective population-based studies [18,32,41,60,61,72,73,90,91]. The exact mechanism underlying this association has not been established but may be mediated through an effect of smoking on estrogen metabolism and calcium absorption [46,54].…”

“…By contrast, a recent population-based, prospective study did not show an increase in hip fracture risk in primary hyperparathyroidism [49]. Finally, cross-sectional data have suggested an increase in hip fracture risk with noninsulin-dependent diabetes mellitus, but these estimates were based on very small numbers [73]. Moreover, almost all studies indicate that bone mass is unaffected by diabetes, and diabetes was not associated with an increased risk of hip fracture in a recent prospective study among women aged 65 years or older [2,3,18].…”

A Combination of Low Doses of 17β-Estradiol and Norethisterone Acetate Prevents Bone Loss and Normalizes Bone Turnover in Postmenopausal Women

“…Through an antiresorptive mechanism, estrogen therapy has been shown to be effective in preserving cortical and trabecular bone in both the peripheral and axial skeleton at all stages of postmenopausal life [6]. Epidemiologic studies have consistently reported that estrogen therapy reduces the risk of vertebral, hip and forearm fractures in postmenopausal women [7][8][9][10][11][12][13], while only limited data are available from randomized clinical trials [14].…”