Common Questions
What were the fracture outcomes in the WHI study?
The WHI study was the first large scale randomized trial to demonstrate fracture risk reduction with HT. Though overall health risks with HT exceeded benefits, fracture risk reduction was clearly demonstrated at all sites (see table below) for both combined HT and estrogen alone (1,2). This finding confirms the many observational studies suggesting fracture risk reduction with HT (3). Because the risks outweigh benefits for the HT-treated group overall, HT is no longer advised for long-term disease prevention including prevention of osteoporotic fractures (4). The best role for HT as prevention and therapy for osteoporosis is now uncertain (5).
| Outcome | ||
|---|---|---|
| WHI CEE + MPA* N = 16,608 Duration = 5.2 yrs |
WHI CEE N = 10,739 Duration = 6.8 yrs |
|
| Hazard Ratio (95% Confidence Interval) | ||
| Hip Fracture | 0.67 (0.47 - 0.96) | 0.61 (0.33 - 1.11) |
| Vertebral Fracture | 0.65 (0.46 - 0.92) | 0.62 (0.34-1.13) |
| Total Fractures | 0.76 (0.69 - 0.83) | 0.70 (0.59-0.83) |
*CEE=conjugated equine estrogen, MPA=medroxyprogesterone acetate
- Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative Randomized Controlled Tria. JAMA 2002; 288: 321-33.
- Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, Bonds D, Brunner R, Brzyski R, Caan B, Chlebowski R, Curb D, Gass M, Hays J, Heiss G, Hendrix S, Howard BV, Hsia J, Hubbell A, Jackson R, Johnson KC, Judd H, Kotchen JM, Kuller L, LaCro. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA 2004; 291: 1701-12.
- Cauley JA, Seeley DG, Ensrud K, Ettinger B, Black D, Cummings S, for the Study of Osteoporotic Fractures research group. Estrogen replacement therapy and fractures in older women. Ann Intern Med 1995; 122: 9-16.
- U.S. Preventive Services Task Force. Hormone therapy for the prevention of chronic conditions in postmenopausal women: recommendations from the U.S. Preventive Services Task Force. Ann Intern Med 2005; 142: 855-860.
- Cauley JA, Robbins J, Chen A, Cummings SR, Jackson RD, et al. Effects of Estrogen plus progestin on risk of fracture and bone mineral density. The Women’s Health Initiative Randomized Trial. JAMA 2003; 290: 1729-1738.