The WHI: the effect of hormone replacement therapy on fracture prevention

  title={The WHI: the effect of hormone replacement therapy on fracture prevention},
  author={Tobie J. de Villiers and John C Stevenson},
  pages={263 - 266}
ABSTRACT The Women's Health Initiative (WHI) randomized, controlled trial was the first study to prove that hormone replacement therapy (HRT) reduces the incidence of all osteoporosis-related fractures in postmenopausal women, even those at low risk of fracture. The study authors concluded that the bone-friendly aspect of HRT was limited in clinical practice as possible adverse effects outweighed possible benefit. On the strength of these publications, regulatory authorities downgraded the use… 

Estrogen therapy for osteoporosis in the modern era

Prior and current studies for various HT formulations used for the prevention and treatment of osteoporosis are focused on, exploring the safety profile of low-dose and transdermal HT that have been shown to be safer than oral standard-dose HT.

Long-term effect of hormone therapy on bone in early menopause: vertebral fractures after 20 years

The data suggest that HT used in the early years of menopause does not present a long-term protective effect on vertebral fracture after discontinuing treatment.

Risks and benefits of hormone therapy: has medical dogma now been overturned?

Over-interpretation and misrepresentation of the WHI findings have damaged the health and well-being of menopausal women by convincing them and their health professionals that the risks of HT outweigh the benefits.

Where are we 10 years after the Women's Health Initiative?

  • R. Lobo
  • Medicine
    The Journal of clinical endocrinology and metabolism
  • 2013
The question is posed as to whether the authors have now come full circle in their understanding of the use of HT in younger women, as it has been argued that in the 10 years since WHI, many women have been denied HT, including those with severe symptoms, and that this has significantly disadvantaged a generation of women.

The safety of osteoporosis medication.

The paper emphasises the fact that all osteoporosis medications have side-effects, some of which are potentially life-threatening, and expresses the National Osteoporotic Foundation of South Africa's view on the safety of these drugs.

The Impact of Hormone Therapy on the Clinical Symptoms of Menopause

An overview of the risks and benefits of estrogen, available hormone preparations, and an overview of menopausal therapies for women who choose not to or cannot take estrogen are discussed separately.

8th Pieter van Keep Memorial Lecture. Estrogen and bone: have we completed a full circle?

It is argued that this decision to relegate estrogen to second-line therapy for the prevention and treatment of postmenopausal osteoporosis is not a reasonable reflection of the available evidence, especially in comparison to other available drugs.

8th Pieter van Keep Memorial Lecture Estrogen and bone: have we completed a full circle?

  • T. D. de Villiers
  • Medicine
    Climacteric : the journal of the International Menopause Society
  • 2014
Evidence from a large, randomized clinical trial in 2002 proved the efficacy of estrogen in the prevention of all types of osteoporosis-related fractures, and estrogen was relegated to second-line therapy, based on perceived safety concerns.

The Benefit of Menopausal Hormone Therapy on Bone Density and Microarchitecture Persists After its Withdrawal.

MHT is associated with bone microarchitecture preservation, as assessed by trabecular bone score (TBS), and persists at least 2 years after withdrawal.

The role of estrogens in osteosarcopenia: from biology to potential dual therapeutic effects

Increased response to anabolic stimuli with estrogen therapy suggests similar beneficial effects on muscle as seen with bone, particularly when combined with resistance exercise.



Estrogens as first-choice therapy for osteoporosis prevention and treatment in women under 60

  • J. Studd
  • Medicine
    Climacteric : the journal of the International Menopause Society
  • 2009
The substantial but non-significant decrease in heart attacks, breast cancer and mortality in women under the age of 60 taking estrogens alone should persuade the advisory bodies to revise their judgment on the benefits and safety of hormone replacement therapy in this population.

Prevention of osteoporosis: one step forward, two steps back

It is concluded that HRT is as safe as the other treatment options, and its efficacy and low cost demand that it be restored as a first-line treatment for the prevention of postmenopausal osteoporosis.

Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial.

It is demonstrated that estrogen plus progestin increases BMD and reduces the risk of fracture in healthy postmenopausal women and there was no net benefit when considering the effects of hormone therapy on other important disease outcomes in a global model.

HRT, osteoporosis and regulatory authorities Quis custodiet ipsos custodes?

No new safety issues have been identified, and the regulatory authorities may have misinterpreted the data from these recent studies, so HRT should be recommended as first-line treatment for osteoporosis prevention.

Effects of Conjugated Equine Estrogen on Risk of Fractures and BMD in Postmenopausal Women With Hysterectomy: Results From the Women's Health Initiative Randomized Trial

Analysis of data from the Women's Health Initiative estrogen trial shows that CEE reduced fracture risk, but data do not support overall benefit over risk, even in women at highest risk for fracture.

Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial.

The use of conjugated equine estrogen (CEE) increases the risk of stroke, decreases therisk of hip fracture, and does not affect CHD incidence in postmenopausal women with prior hysterectomy over an average of 6.8 years, indicating no overall benefit.

Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial

Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD.

Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial.

In women with low BMD but without vertebral fractures, 4 years of alendronate safely increased BMD and decreased the risk of first vertebral deformity.

Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen.

It is argued that lowering of the risk of hip and forearm fractures must be weighed as a benefit of long-term estrogen use.