Prevalence and determinants of estrogen replacement therapy in elderly women

Article Abstract:

Estrogen (a female hormone) may be prescribed for older women, because it has been shown to have a beneficial effect against the development of osteoporosis (a disease associated with loss of bone mass, leading to fractures) and coronary heart disease. In 1986, 21 million prescriptions were written for estrogen; however, fears concerning an association between estrogen replacement therapy and cancer have caused estrogen replacement therapy to fluctuate from year to year. To learn more about current prevalence of estrogen use and the reasons the hormone is prescribed, a large group of nonblack women 65 years old or older (average age, 71; 9,704 subjects) was evaluated as part of The Study of Osteoporotic Fractures, a prospective, multicenter study. Subjects' estrogen and progestin (another female hormone) use was recorded, as were their histories of childbearing, disease, smoking, alcohol use, and physical activity. Results showed that slightly fewer than 14 percent of the women used oral estrogen, and 4 percent used estrogen via other routes (vaginal suppositories, injection). Most current users took only estrogen; three percent of the group took estrogen plus progestin. Older women tended less to take oral estrogen. Women who used estrogen were more likely to be married: they also had more education, and a history of hysterectomy (removal of the uterus), smoking, or pregnancy; and they reported more often than nonusers that they were physically active and drank alcohol. Women who had had a surgical menopause (after surgical removal of the ovaries) were almost five times more likely to be users than nonusers. For those with a natural menopause, current users were more likely than nonusers to have been diagnosed with osteoporosis. There was no relationship between such therapy and a history of hip fractures, suggesting that orthopedists may not prescribe such measures often. Overall, estrogen replacement therapy has a low prevalence; since it is known to improve risk factors for older women, the reasons for this should be addressed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Drug therapy, Dosage and administration, Drug use, Menopause, Estrogen, Estrogens

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Appendicular bone density and age predict hip fracture in women

Article Abstract:

Hip fracture is perhaps the most destructive of all bone fractures caused by osteoporosis, a disease characterized by reduced bone mass and strength. One out of five patients with a hip fracture dies from its complications, and in at least half the survivors ability to perform daily activities is curtailed during the first year after the fracture. Results from research to determine whether bone mass predicts risk for hip fracture have been contradictory, and the best site for determining bone mass has not been established. A group of 9,703 nonblack women age 65 and older had bone mineral density measured in the wrist and heel by single-photon absorptiometry, a procedure similar to an X-ray; the wrist and heel are part of the appendicular skeleton. Subjects were then contacted on a regular basis to determine whether they had suffered a hip fracture; during an average follow-up time of 1.6 years, 53 hip fractures were reported for the group. Hip fracture incidence was found to increase as bone density decreased; the different sites of bone density measurement were equivalent in predictive value. Analysis by age showed that independent of bone density, risk of hip fracture doubled with every 10-year increment in age. Since subjects tended to be healthy and not disabled, the results do not represent older women who are homebound or living in nursing homes. Some experts suggest it is important to screen women for bone density around age 50 to identify those at highest risk for osteoporosis and fractures. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diseases, Bone diseases, Hip joint, Hip fractures

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Which fractures are associated with low appendicular bone mass in elderly women?

Article Abstract:

Osteoporosis, the loss of bone mineral density that afflicts many older women, leads to an increased risk of bone fracture. In the past, there has been a tendency to attribute fractures to osteoporosis if they increase in incidence with age, especially among white women, or if they occur with a fall from only standing height. It is generally accepted that fractures of the hip, wrist, and vertebrae fall into this category; many physicians also include fractures of the humerus in the arm, the pelvis, and ribs. There is some disagreement whether fractures of other bones are likely to be the result of osteoporosis, even among older women. However, it is now possible to measure bone mass directly and accurately by measuring the absorption of high-energy photons passing through the bone. To determine which bone fractures are indeed directly related to decreased bone mass, a prospective study was conducted involving 9,704 women not of African ancestry. During the follow-up period, which averaged 2.2 years, 753 women had 841 fractures not including the spine. Seventy-four percent of the fractures appeared to be related to decreases in bone mass. These fractures involved bones of the wrist, foot, hip, toe, leg, pelvis, hand, the ribs, humerus, and clavicle. Fractures involving the ankle, fingers, elbow, or face were not found to be related to reductions in bone mineral density. These observations confirm that the majority of fractures in elderly white women are directly related to osteoporosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bones, Complications and side effects, Bone density

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