J Clin Endocrinol Metab. 2016 Nov 7:jc20163270. [Epub ahead of print]

 

Watts NB¹, Cauley JA², Jackson RD³, LaCroix AZ⁴, Lewis CE⁵, Manson JE⁶, Neuner J⁷, Phillips LS⁸, Stefanick ML⁹, Wactawski-Wende J¹⁰, Crandall C¹¹; Women’s Health Initiative Investigators.

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Abstract

CONTEXT:

The Women's Health Initiative (WHI) hormone therapy (HT) trials showed protection against hip and total fractures but a later observational report suggested loss of benefit and a rebound increased risk after stopping.

OBJECTIVE:

To examine fractures after discontinuation of HT Design and Setting: Two placebo-controlled randomized trials Patients: 15,187 WHI participants who continued active HT or placebo through the intervention period and did not take HT in the post-intervention period Interventions: Conjugated equine estrogen + medroxyprogesterone acetate (CEE+MPA) in naturally menopausal women and conjugated equine estrogen (CEE) alone in women with prior hysterectomy Main Outcome Measures: Total and hip fractures through 5 years after discontinuation Results: Hip fractures were infrequent (∼2.5 per 1,000 person years), similar between both trials and former HT and placebo groups. There was no difference in total fractures in the CEE+MPA trial for former HT vs former placebo (28.9 per 1,000 person years and 29.9 per 1,000 person years respectively) (hazard ratio [HR] 0.97; 95% CI 0.87, 1.09, p=0.63); however, in the CEE alone trial, total fractures were higher in former placebo users (36.9 per 1,000 person years) compared with former active group (31.1 per 1,000 person years), suggestive of a residual benefit of CEE against total fractures (HR 0.85, 95% CI 0.73, 0.98, p=0.03).

CONCLUSIONS:

We found no evidence for increased fracture risk, either sustained or transient, for former HT users compared with prior placebo women after stopping HT. There was residual benefit for total fractures in former HT users from the CEE-alone study.

PMID: 27820659 DOI: 10.1210/jc.2016-3270

資料來源：PubMed