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Study: Estrogen Use Should Begin at Menopause, Continue Indefinitely

January 4, 1995

PHILADELPHIA (AP) _ Women who begin taking estrogen within five years of menopause and continue for the rest of their lives substantially decrease their risk of almost all fractures, a new study concludes.

The report, in this week’s Annals of Internal Medicine, expands on other studies that have associated hormone replacement therapy with preventing the brittle and broken hips and wrists caused by osteoporosis.

The study extends the risk reduction to all nonspinal fractures. It also pinpoints the best starting time and duration for estrogen therapy.

``Our results suggest estrogen should be initiated early in menopause and continued indefinitely,″ said Jane A. Cauley, the study’s lead author and an associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health.

More than 9,700 women 65 years of age and older were recruited between September 1986 and October 1988 at centers in Baltimore County, Md.; Minneapolis, Minn.; Portland, Ore.; and in the Monongahela Valley in western Pennsylvania.

The participants included 1,331 women already taking estrogen; 2,621 previous users and 5,616 who had never used the hormone. Estrogen is often prescribed for relief from the unpleasant side-effects of menopause.

Researchers gathered details on extent of estrogen use, measured bone density and determined alcohol consumption, cigarette smoking, physical activity and health status.

The participants were contacted every four months for up to six years through April 1993 by postcard or telephone to determine whether they had sustained any fractures.

Women who began taking estrogen early and continued to take it showed a 50 percent reduction in the risk of all nonspinal fractures and a 71 percent decrease in the risk of broken hips and wrists. Those who started the hormone therapy later, but continued treatment, showed a 25 percent drop in the risk of all nonspinal fractures.

According to the study, women who stopped taking estrogen _ even those who took the hormone for more than 10 years _ showed no significant decrease in the risk of fractures.

``Their results are exciting, but I’d caution that more information is needed,″ said Marjorie Gass, an epidemiologist at University of Cincinnati Medical Center who has done her own research on estrogen.

``We don’t know the risks, such as breast cancer,″ Gass said.

Women with high risk of breast cancer or who are breast-cancer survivors are usually advised not to take estrogen. However, a study reported in the August 1994 issue of the Journal of the American Medical Association found no evidence that hormone therapy could reactivate dormant cancer cells.

Cauley noted the long-term effects of hormone therapy are unknown.

``If the average life span is 80 years, women would be taking estrogen for a long time after menopause. But we don’t know what effects 30 years of therapy will be,″ she said.

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