For women who are former hormone therapy users, risk of fracture is not increased after discontinuing therapy, according to a study published in the The Journal of Clinical Endocrinology & Metabolism

Hormone therapy has shown to be protective against hip and total fractures in the Women’s Health Initiative (WHI) trials but an observational report has suggested a reduced benefit and a higher risk of fracture after discontinuing treatment. 

Researchers conducted two placebo-controlled randomized trials (n=15,187) to study the incidence of fractures after stopping hormone therapy. WHI participants who continued active hormone therapy or placebo through the intervention period and did not take hormone therapy in the post-intervention period were included. 

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Naturally menopausal women received conjugated equine estrogen + medroxyprogesterone acetate (CEE + MPA) and women with prior hysterectomy received CEE alone. The study’s main outcome measures were total fractures and hip fractures through five years post-discontinuation. 

The authors found that hip fractures were infrequent (~2.5 per 1,000 person years) with similar rates between the former hormone therapy groups and placebo groups. No difference was seen in total fractures in the CEE + MPA trial for former hormone therapy vs. placebo groups (28.9 per 1,000 person years vs. 29.9 per 1,000 person years, respectively) (hazard ratio [HR] 0.97, 95% CI: 0.87, 1.09; P=0.63). For the CEE alone trial, however, there were more total fractures in the former placebo users vs. the former active group (36.9 per 1,000 person years vs. 31.1 per 1,000 person years). This finding is “suggestive of a residual benefit of CEE against total fractures (HR 0.85, 95% CI: 0.73, 0.98; P=0.03). 

Neither a sustained nor transient increased risk for fractures was seen for former hormone therapy users vs. former placebo after stopping hormone therapy. A residual benefit for total fractures in former hormone therapy users from the CEE-alone study was noted.

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