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Title Increase in Hip fracture after stopping HRT
Date 5 December 2011
Full Story Following widespread publicity in 2002 around the suggested risks of Hormone Replacement Therapy from the WHI trial, many women around the world stopped taking HRT, either after making their own decision, or by following advice from their doctor or nurse. Since then, concern has been expressed as to whether or not this discontinuation of HRT was the correct decision and whether serious consequences have occurred. A recent report has examined the effect on the incidence of hip fractures in a large group of women from the Southern California Kaiser Permanente health management organization.

In this longitudinal observational study, 80,955 postmenopausal women using HRT as of July 2002 were followed up through to December 2008. Data on HRT use after July 2002, antiosteoporotic medication use, and occurrence of hip fracture were collected from the electronic medical record system. Bone mineral density (BMD) was assessed in 54,209 women once during the study period using the dual-energy x-ray absorptiometry (DEXA) scan.

After 6.5 years of follow-up, results showed that women who discontinued HRT were at 55% greater risk of hip fracture compared with those who continued using. Hip fracture risk increased as early as 2 years after cessation of HRT, and the risk incrementally increased with longer duration of cessation. Longer duration of HRT cessation was correlated with lower BMD.

Conclusions made were that women who discontinued postmenopausal HRT had significantly increased risk of hip fracture and lower BMD compared with women who continued taking HRT. The protective association of HRT with hip fracture disappeared within 2 years of cessation of HRT.


With the initial results of WHI having been re-analysed extensively, it is now generally felt that for many women, especially those under the age of 60, the benefits of HRT outweigh the risks and it seems that stopping HRT does indeed have detrimental effects on bone health as demonstrated here. In line with the recent recommendation from the National Osteoporosis Society, HRT should be used for treatment and prevention of osteoporosis in women under the age of 60 and, if stopped, in women with risk factors for osteoporosis, or in those known to have osteoporosis, other bone protective measures should then be considered.

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