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HRT Builds Bone, But That's Not Benefit Enough

Yet another study finds hormone therapy's benefits outweighed by its risks

TUESDAY, Sept. 30, 2003 (HealthDayNews) -- Hormone replacement therapy does in fact help prevent broken bones, but this benefit doesn't outweigh the catalogue of risks that bedevil the troubled regimen, new research shows.

The work is the latest in a series of studies that have found hormone replacement therapy (HRT) simply isn't worth the trouble it can cause, at least for most women.

The latest results, reported in the Oct. 1 issue of the Journal of the American Medical Association, come from an arm of the Women's Health Initiative study looking at the effects of the combination of estrogen and progestin. Pairing the two guards against the small risk of uterine cancer associated with estrogen alone.

That trial was halted in July 2002, three years early, when researchers discovered a small but significant increase in the risk of breast cancer in women taking the two hormones. They concluded the benefits of the therapy, most notably its ability to prevent fractures, didn't outweigh the cancer risks, which also included more heart attacks, strokes and lung clots.

HRT is a proven bone-builder. As a result, it has been used for decades for the prevention and treatment of osteoporosis, a condition that puts 10 million Americans at high risk of fractures.

That history raised this question: Are there some women whose risk of broken bones -- and especially hip fractures -- is so high that taking HRT makes sense?

The new study suggests the answer is no.

"We did not see any evidence that there was a sub-group of women at high risk of fracture for whom the benefits" of HRT are substantial enough to ignore the perils, says study author Jane A. Cauley, a bone expert at the University of Pittsburgh. The 8,500 women taking the hormones gained much more bone mass, a plus for skeletal strength, than the 8,100 taking dummy pills in the WHI study. And their risk of fractures was about 25 percent lower than that of the other women.

But women at the highest risk of breaking a bone during the study didn't get more benefit from HRT than those at the lowest risk -- while enduring the same odds of suffering a heart attack, stroke, breast cancer or other serious adverse effect.

Because the women were healthy when they began the study, those risks don't seem worth taking, Cauley says, adding, "We're trying to keep people healthy and prevent chronic disease."

However, Cauley warns women taking HRT for their bones to consult their doctor before stopping the drugs abruptly. Doing so can accelerate bone loss -- by up to 5 percent a year -- she says.

A variety of alternative drugs for osteoporosis are also on the market.

A second paper, also in the journal, found a "worrisome" increase in ovarian cancers and death from ovarian cancer in women taking estrogen and progestin. However, the 58 percent increase compared with women not taking hormones wasn't statistically significant, suggesting it could have been due to chance or other factors the researchers couldn't account for.

While the percentage difference in risk of ovarian cancer seems quite high, the absolute difference in cases of the disease was small, says study author Garnet Anderson, a women's health expert at the Fred Hutchinson Cancer Research Center in Seattle. It works out to 44 cases per 100,000 women in the HRT group versus 27 per 100,000 among those taking dummy pills.

"This effect is a modest increase, if it's real," Anderson says. Complicating matters, she says, is that about a quarter of the women in group not receiving hormones had taken them in the past -- meaning that it's difficult to calculate a true background rate of ovarian cancer.

Some doctors believe HRT still has a role as a way for women to relieve symptoms of menopause, such as vaginal dryness and hot flashes. Taken this way, the therapy could be temporary.

Anderson agrees women with severe menopause problems shouldn't be dissuaded from considering HRT, even with her group's latest findings.

More information

For the latest on hormone replacement therapy, visit the Women's Health Initiative. For more on osteoporosis, try the National Osteoporosis Foundation.

SOURCES: Jane A. Cauley, Dr.P.H., professor, epidemiology, University of Pittsburgh; Garnet Anderson, Ph.D., member, Fred Hutchinson Cancer Research Center, Seattle; Oct. 1, 2003, Journal of the American Medical Association
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