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Hormone Therapy Helps Combat Osteoporosis in Frail, Elderly Women

Hormone therapy (HT) has been established as an important component of osteoporosis prevention in menopausal women. However, the value of initiating HT in frail, elderly women -- those at the highest risk for osteoporotic fractures -- has not been studied. These authors conducted a randomized, double-blind, placebo-controlled trial of the effects of HT on bone mineral density (BMD) in frail women aged 75 and older from the Washington University Older Americans Independence Center.

The authors recruited women with mild-to-moderate physical frailty who met 2 of the following 3 criteria: low peak aerobic power; need for assistance with 2 instrumental activities of daily living (ADLs) or 1 basic ADL; and low modified physical performance test score. Women who had used HT within the past year and those with contraindications to HT were excluded. The subjects were randomized to receive either 0.625 mg of conjugated estrogens daily and 5 mg/day of medroxyprogesterone 13 days a month for 9 months (n=45) or placebo (n=22). Outcome measures were changes in BMD of the lumbar spine and hip measured by dual-energy X-ray absorptiometry and changes in biochemical markers of bone turnover at 9 months.

The groups were similar in weight, age, and dietary intake; however, the treatment subjects had been younger than the placebo subjects at menopause -- a statistically significant difference. Compared with the placebo group, the treatment group had significant increases in BMD of the lumbar spine and hip (P<0.001). As for the biochemical markers of bone turnover, the treatment group had significantly lower levels of urine N-telopeptide of type 1 collagen and serum bone-specific alkaline phosphatese than did the placebo group.

Comment: These findings are impressive in that there were quantifiable increases in BMD after only 9 months, suggesting that the bones of elderly women may be even more responsive to HT than those of women just beginning menopause. The preservation of BMD and reduction of fracture risk will continue to be an active area of research as our population ages. It is never too late to begin HT to prevent osteoporotic fractures.

— MA Shepard

Published in Journal Watch Women's Health October 3, 2001

Citation(s):

Villareal DT et al. Bone mineral density response to estrogen replacement in frail elderly women: A randomized controlled trial. JAMA 2001 Aug 15 286 815-820.

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