Should Prescription of Postmenopausal Hormone Therapy Be Based on the Results of Bone Densitometry?
Authors: Steven R. Cummings
Journal: Annals of Internal Medicine (1990)

Editorials15 October 1990Should Prescription of Postmenopausal Hormone Therapy Be Based on the Results of Bone Densitometry?Steven R. Cummings, MD, Warren S. Browner, MD, MPH, Deborah Grady, MD, MPH, Bruce Ettinger, MDSteven R. Cummings, MDSearch for more papers by this author, Warren S. Browner, MD, MPHSearch for more papers by this author, Deborah Grady, MD, MPHSearch for more papers by this author, Bruce Ettinger, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-113-8-565 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptA woman's decision about whether to take hormones after menopause can substantially change her risk for several diseases. A number of prospective studies (1) have found that women who use estrogen have about half the risk for coronary heart disease; because coronary heart disease is by far the leading cause of death among women, this is the most important potential benefit of estrogen therapy. Cancer, on the other hand, is less common than coronary heart disease but more frightening to many women. If used long-term without a progestin, estrogen substantially increases the risk for endometrial cancer (2). If used for...References1. Bush T. Noncontraceptive estrogen use and risk of cardiovascular disease: an overview and critique of the literature. In: Korenman SG, ed. The Menopause. Biological and Clinical Consequences of Ovarian Failure: Evolution and Management. Norwell, Massachusetts: Serono Symposia; 1990:211-3. Google Scholar2. Thomas D. Noncontraceptive estrogen use and risk of cardiovascular disease: an overview and critique of the literature. In: Korenman SG, ed. The Menopause. Biological and Clinical Consequences of Ovarian Failure: Evolution and Management. Norwell: Serono Symposia; 1990:211-3. Google Scholar3. BergkvistAdamiPerssonHooverSchairer LHIRC. The risk of breast cancer after estrogen and estrogen-progestin replacement. N Engl J Med. 1989;321:293-7. CrossrefMedlineGoogle Scholar4. WingoLaydeLeeRubinOry PPMGH. The risk of breast cancer in postmenopausal women who have used estrogen replacement therapy. JAMA. 1987;157:209-15. CrossrefGoogle Scholar5. KielFelsonAndersonWilsonMoskowitz DDJPM. Hip fracture and the use of estrogens in postmenopausal women. TV Engl J Med. 1987;317:1169-74. CrossrefMedlineGoogle Scholar6. WeissUreBallard NCJ. Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med. 1980;303:1195-8. CrossrefMedlineGoogle Scholar7. . Bone mineral densitometry. Ann Intern Med. 1987;107:932-6. LinkGoogle Scholar8. HuiSlemendaJohnston SCC. Baseline measurement of bone mass predicts fracture in white women. Ann Intern Med. 1989;111: 355-61. LinkGoogle Scholar9. GardsellJohnellNilsson POB. Predicting fractures in women by using forearm bone densitometry. Calcif Tissue Int. 1989;44:235-42. CrossrefMedlineGoogle Scholar10. CummingsBlackNevitt SDM. Appendicular bone density and age predict hip fracture in women. JAMA. 1990;263: 665-8. CrossrefMedlineGoogle Scholar11. TostesonRosenthalMeltonWeinstein ADLM. The cost-effectiveness of screening perimenopausal white women for osteoporosis: bone densitometry and hormone replacement therapy. Ann Intern Med. 1990;113:594-603. LinkGoogle Scholar12. SherwinGelfand BM. A prospective one year study of estrogen and progestin in postmenopausal women: effects on clinical symptoms and lipoprotein effects. Obstet Gynecol. 1989;73:759-6. MedlineGoogle Scholar13. WhiteheadHillardCrook MTD. The role and use of progestogens Obstet Gynecol. 1990;75(Suppl):59S-76S. MedlineGoogle Scholar14. Barrett-ConnorWingardCriqui EDM. Postmenopausal estrogen use and heart disease risk factors in the 1980s: Rancho Bernardo, Calif, revisited. JAMA. 1989;261:2095-100. CrossrefMedlineGoogle Scholar15. WhiteheadFraserSchenkelCrookStevenson MDLDJ. Transdermal administration of oestrogen/progestagen hormone replacement therapy. Lancet. 1990;1:310-2. CrossrefGoogle Scholar16. McGill H. Sex steroid hormone receptors in the cardiovascular system. Postrgrad Med. 1989;April:64-8. Google Scholar17. WilliamsAdamsKlopfenstein JMH. Estrogen modulates responses of atherosclerotic coronary arteries. Circulation. 1990;81: 1680-7. CrossrefMedlineGoogle Scholar18. MagazinerSimonsickKashnerHebelKenzora JETJJ. Survival experience of aged hip fracture patients. Am J Public Health. 1989;79:274-8. CrossrefMedlineGoogle Scholar19. MeltonWahnerRichelsonO'FallonRiggs LHLWB. Osteoporosis and the risk of hip fractures. Am J Epidemiol. 1986; 124:254-61. CrossrefMedlineGoogle Scholar20. Cummings S. Are patients with hip fractures more osteoporotic? Am J Med. 1985;78:487-94. CrossrefMedlineGoogle Scholar21. HuiSlemendaJohnston SCC. The contribution of bone loss to postmenopausal osteoporosis. Osteoporosis Internatal. 1990;l:[In press]. Google Scholar22. StormThamsborgSteinicheGenantSorenson TGTHO. Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med. 1990;322:1265-71. CrossrefMedlineGoogle Scholar23. WattsHarrisGenant NSH. Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. N Engl J Med. 1990;323:73-9. CrossrefMedlineGoogle Scholar24. HillnerHollenbergPauker BJS. Postmenopausal estrogens in the prevention of osteoporosis: a benefit that is virtually without risk if cardiovascular effects are considered. Am J Med. 1986;80: 1115-27. CrossrefMedlineGoogle Scholar25. MackRoss TR. A current perception of HRT risks and benefits. In: DeLuca HF, Mazess R, eds. Osteoporosis: Physiologic Basis, Assessment and Treatment. Proceedings of the Nineteenth Steenbock Symposium, June 5-8th, 1989, University of Wisconsin-Madison. New York: Elsevier; 1989:161-78. Google Scholar26. DetskyNaglie AI. A clinician's guide to cost-effectiveness analysis. Ann Intern Med. 1990;113:147-54. LinkGoogle Scholar27. CummingsBlackRubin SDS. Lifetime risks of hip, Colles' or vertebral fracture, and coronary heart disease among white post-menopausal women. Arch Intern Med. 1989;149:2445-8. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. 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Cummings, MDCompliance with hormone replacement therapy: Are women receiving the full impact of hormone replacement therapy preventive health benefits?Normal bone density in Irish women: is American normative data suitable for use in Ireland?Assessing hip fracture risk in a population-based health survey: The NHANES III osteoporosis componentAssessment of the risk of post-menopausal osteoporosis using clinical factorsEvaluating the benefits and risks of postmenopausal hormone therapyClinical Use of Bone DensitometryPostmenopausal oestrogen and cardioprotection 15 October 1990Volume 113, Issue 8Page: 565-567KeywordsBoneCoronary heart diseaseDensitometryEstrogensFellowshipsHormonal therapyHormonesMedical servicesMenopauseProspective studies Issue Published: 15 October 1990 PDF DownloadLoading ...