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Changes in Bone Density After Stopping HRT

Withdrawal of HRT after 2 years of treatment resulted in substantial loss of bone mass in these elderly women.

Since the publication of the Women's Health Initiative study (Journal Watch Jul 26 2002), many postmenopausal women have stopped using hormone replacement therapy (HRT). What happens to bone-mineral density (BMD) in such women?

Researchers randomized 489 women (age range, 65 to 77; mean, 72) to receive 3-year courses of HRT, calcitriol, both treatments, or placebo. A subset of 178 women were observed for 2 more years after treatment was withdrawn, with the following results in the groups that took HRT-containing regimens:

• Spine BMD increased by about 6% during 3 years on HRT; about two thirds of this gain was lost during 2 years off HRT.
  
• Femoral-neck BMD increased by about 4% during HRT; about two thirds of the gain was lost during 2 years off HRT.
  
• Total-body BMD showed a 2% gain during HRT, but all gain was lost during 2 years off HRT.
  

At each site, most of the decrease in BMD occurred during the first year of follow-up. However, mean BMD generally remained higher in the HRT groups than in the placebo group (which received no active treatment throughout the study).

Comment: Within 2 years of HRT withdrawal, elderly women lost a substantial portion of previously gained bone mass. In a recent similar study of substantially younger women (mean age, 56; Arch Intern Med 2002; 162:665), declines in bone mass after HRT withdrawal were less rapid than the declines noted in this study. Taken together, these data might be helpful for clinicians and patients who are deciding whether to replace HRT with other osteoporosis therapies.

— Allan S. Brett, MD

Published in Journal Watch General Medicine December 10, 2002

Citation(s):

Gallagher JC et al. Effect of discontinuation of estrogen, calcitriol, and the combination of both on bone density and bone markers. J Clin Endocrinol Metab 2002 Nov; 87:4914-23.

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