Variation in the Efficacy of Hormone Replacement Therapy in the Prevention of Hip Fracture |
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Authors: | K Michaëlsson J A Baron O Johnell I Persson S Ljunghall |
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Institution: | Department of Orthopaedics, University Hospital, Uppsala, Sweden, SE Departments of Medicine and Community & Family Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA, US Department of Orthopaedics, Malm? General Hospital, Malm?, Sweden, SE Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden, SE Department of Internal Medicine, University Hospital, Uppsala, Sweden, SE
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Abstract: | Use of postmenopausal hormone replacement therapy (HRT) has been associated with a reduced risk of osteoporotic fractures.
However, it is uncertain whether this risk reduction is modified by other risk factors for hip fracture. In a population-based
case–control study in Sweden, we investigated the association between HRT and hip fracture risk within categories of age,
body measures and lifestyle factors in postmenopausal women, 50–81 years of age. Mailed questionnaires and telephone interviews
were used to collect data. Of those eligible, 1328 incident cases with hip fracture (82.5%) and 3312 randomly selected controls
(81.6%) answered the questionnaire. Ever use of HRT in women less than 75 years old was associated with an odds ratio (OR)
of 0.66 (95% confidence interval: 95% CI 0.50–0.87) for hip fracture compared with OR 0.40 (95% CI 0.21–0.77) in women 75
years or older. We found a significant interaction between HRT and both weight and physical activity (p<0.05). The protective effect of HRT was particularly pronounced in lean women: compared with never HRT users, ever users
weighing under 60 kg had an OR of 0.44 (95% CI 0.30–0.66) whereas women weighing more than 70 kg had an OR of 0.91 (95% CI
0.53-1.-56). Women with low recent leisure physical activity (less than 1 h/week) similarly benefited more from HRT for hip
fracture prevention than women with a higher degree of recreational physical activity. The observed interactions with weight
and physical activity suggest that HRT has the best protective effect against hip fracture among high-risk women.
Received: 7 October 1997 / Revised: 21 January 1998 |
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Keywords: | :Estrogen – Hip fracture – Hormone replacement therapy – Interaction – Physical activity – Weight |
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