HRT is protective for
(A) Hip fracture # BONE DENSITY By reducing bone turnover and resorption rates, estrogen slows the aging-related bone loss experienced by most postmenopausal women. More than 50 randomized trials have demonstrated that postmenopausal estrogen therapy, with or without a progestin, rapidly increases bone mineral density at the spine by 4 to 6% and at the hip by 2 to 3%, and maintains those increases during treatment.> Fractures Data from observational studies indicate a 50 to 80% lower risk of vertebral fracture and a 25 to 30% lower risk of hip, wrist, and other peripheral fractures among current estrogen users; addition of a progestin does not appear to modify this benefit. Discontinuation of estrogen therapy leads to a diminution of protection.> In the WHI, 5 to 6 years of either combined estrogen-progestin or estrogen-only was associated with a 30 to 40% reduction in hip fracture and 20 to 30% fewer total fractures among a population unselected for osteoporosis.BENEFITS & RISKS OF POSTMENOPAUSAL HORMONE THERAPY (HT) IN PRIMARY PREVENTION SETTINGSOutcomeEffectDefinite Benefits Symptoms of menopauseDefinite improvementOsteoporosisDefinite increase in bone mineral density and decrease in fracture riskDefinite Risks Endometrial cancerDefinite increase in risk with estrogen alone; no increase in risk with estrogen- progestinVenous thromboembolismDefinite increase in riskBreast cancerIncrease in risk with long-term use (5 years) of estrogen-progestinGallbladder diseaseDefinite increase in riskProbable or Uncertain Risks and Benefits Coronary heart diseaseProbable increase in risk among older women and women many years past menopause; possible decrease in risk or no effect in younger or recent menopausal womenStrokeProbable increase in riskOvarian cancerProbable increase in risk with long-term use (5 years)Colorectal cancerProbable decrease in risk with estrogen-progestinDiabetes mellitusProbable decrease in riskCognitive dysfunctionUnproven decrease in risk (inconsistent data from observational studies and randomized trials)
Hip fracture
Breast cancer
DVT
MI
Miscellaneous