OsteoEd

Practice Cases

Estrogen Therapy

Eliza Sutton, MD Literature reviewed July 31, 2006. Updated May 22, 2009

A 55-year-old woman asks whether or not she should stop taking hormone therapy (HT). She began estrogen and progestin at age 50 for vasomotor symptoms. She had some mild to moderate hot flashes when she ran out of HT for a week recently while waiting for her medications to arrive by mail. She is healthy with no major medical problems and no history of fractures in adulthood. However, her mother has osteoporosis and had a hip fracture at age 70, and this woman would like to avoid that fate.

  • Medications:
    1. Conjugated equine estrogen 0.625 mg and medroxyprogesterone acetate 2.5 mg daily.
    2. Calcium carbonate 600 mg with vitamin D 400 IU, one tablet twice daily.
  • Habits:
    • Nonsmoker.
    • Weight-bearing exercise 5 days per week.
  • Physical exam:
    • Weight 150 lbs (BMI 24).
    • No kyphosis.
  • DXA results: T-score -1.8 at hip.

Click an answer under each question.

  1. What risk does combination HT pose for her?

    • Option A A 50% increase in breast cancer risk
    • Option B A 24% increase in cardiovascular event risk
    • Option C A 22% increase in endometrial cancer risk

  2. What did the Women's Health Initiative (WHI) reveal about fracture risk on HT compared with placebo?

    • Option A No statistically significant fracture risk reduction on HT
    • Option B Fracture risk reduction at spine but not hip on HT
    • Option C Fracture risk reduction at all sites on HT

  3. Are estrogen and HT FDA-approved for the prevention and/or treatment of osteoporosis

    • Option A Not approved for prevention or treatment of osteoporosis
    • Option B Approved for prevention of osteoporosis, in limited situations
    • Option C Approved for treatment of osteoporosis, in limited situations
    • Option D Approved for prevention and treatment of osteoporosis, in limited situations

  4. Which option below most closely reflects her 5-year risk of hip fracture?

  5. What will likely happen to her bone mineral density (BMD) after HT is discontinued?

    • Option A BMD will remain stable for one year, then begin to fall
    • Option B BMD will begin to decline by 3-5% per year
    • Option C BMD will begin to decline by 1-2% per year
    • Option D BMD will fall to baseline by one year

  6. What is the safest and most reasonable option now for this patient

    • Option A Discontinue HT and recheck BMD in 2 years
    • Option B Discontinue HT and start an oral bisphosphonate
    • Option C Discontinue HT and start nasal calcitonin
    • Option D Reduce HT dose by 50% and have her f/u in one month
Key Points
Last edited July 03, 2009