Hip fractures are associated with more death, morbidity and medical costs than all other osteoporotic fractures combined. The incidence begins to rise after age 50 but rises dramatically after age 70. Hip fracture rates are high in American and European whites, intermediate in oriental populations and low in American Blacks. This may be due to differences seen in peak bone mass achieved. However, much of the increased mortality may be accounted for by concomitant illness and interventions to prevent hip fracture may not decrease this high mortality.
Morbidity following hip fracture is high as well.
However, the important issue is whether this decrease in bone loss translates into decreased fracture rates. The optimal duration of use is not known. A recent study found that only women taking ERT for a minimum of 7 years had significantly higher bone mass compared with women who had never used estrogen. There is little information regarding when to discontinue therapy, if at all. The increased risk of endometrial cancer due to unopposed estrogen has been demonstrated in both case-control and cohort designs.