Benefits of HRT shown in frail elderly women
Frail elderly women benefit from the effects of hormone
replacement therapy on bone mineral density, a new study shows.
Dr Dennis Villareal of Washington University School
of Medicine, Missouri, and colleagues say that although oestrogen-based
hormone replacement therapy (HRT) is used for the prevention of osteoporosis,
it is rarely initiated in elderly women. They argue that bone mineral
density (BMD) continues to decline with age and that this is a strong
risk factor for osteoporosis. They add that most osteoporotic fractures
occur in women older than 75 years.
“Our findings of positive effects of HRT on hip
BMD have potentially important clinical implications for preserving the
independence of frail elderly women,” they say.
The researchers randomised 67 women aged 75 years
and over with mild-to-moderate physical frailty to receive either 0.625mg
of conjugated oestrogens daily plus 5mg of medroxyprogesterone acetate
daily for 13 consecutive days every third month, or matching placebo.
They found that increases in bone mineral content and BMD of the total
body, lumbar spine, total hip, and trochanter were significantly larger
in women who received HRT compared with those receiving placebo. For the
total hip, the mean change in BMD was 1.7 per cent in the HRT group compared
with –0.1 per cent in the placebo group. This gave a between-group difference
of 1.8 per cent (95 per cent confidence interval, 1.5 to 2.1 per cent).
They conclude: “Although our study suggests that
physically frail women are candidates for the osteogenic benefits of HRT,
their shorter life expectancy may limit the period over which the benefits
would accrue.” The study is published in JAMA (2001;286:815).
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