Estrogen Increases Bone Mass in Women Over 75
WebMD News Archive
Aug. 14, 2001 -- Use of estrogen to increase bone mass -- and thereby prevent bone loss and fractures associated with osteoporosis -- is an established approach in at-risk women in the period immediately after menopause.
But what about using the hormone in older women?
A small study in the Journal of the American Medical Association suggests that frail women over 75, like their younger postmenopausal counterparts, also experience an increase in bone mass, and therefore probably a lower risk of osteoporosis, when treated with estrogen.
Because that age group is at the highest risk for falls and fractures, estrogen replacement therapy may be a valuable treatment, says author Dennis T. Villareal, MD, an assistant professor of medicine in the division of geriatrics and gerontology at Washington University School of Medicine in St. Louis.
"Estrogen is beneficial to the skeletons of very frail elderly women, which corroborates what we know about younger postmenopausal women," Villareal tells WebMD.
But at least one osteoporosis expert argues vigorously against that recommendation, saying that increasing bone mass is of little value if it doesn't prevent fractures. And there is no evidence -- in the JAMA study or anywhere else -- that estrogen prevents fractures, says Felicia Cosman, MD.
The big question, according to Cosman, is not whether bones thicken, but "does it confer a clear protection against fractures? That's where we have a question in all populations, particular the older population."
She is clinical director of the National Osteoporosis Foundation, and an endocrinologist at Helen Hayes Hospital in West Haverstraw, N.Y.
In the study, 67 frail women 75 years or older received either estrogen or a placebo for nine months. Women were considered "frail" if they had low endurance, difficulty completing everyday activities, and poor physical functioning.
The women who took estrogen had significantly larger increases in bone mass in the spine and hip than did women who used the placebo. They also had decreased levels of indicators in the blood and urine associated with bone loss, according to the study.
Villareal says it is the first study of its kind to look at estrogen replacement therapy for women over 75. The prevailing wisdom has been that the rate of bone loss decreases in very old women, and that the ability of estrogen to increase bone mass diminishes with increasing age, he says.
Both of those assumptions may not be true. "We should not rule out estrogen as an option for these older frail women," he tells WebMD.
But Cosman says that other drugs, especially those classified as bisphosphonates, are safer than estrogen and have already been proven to do what really counts -- prevent fractures. One example is Fosamax, which can be taken in a single weekly tablet, she says. Another example is Actonel.
Cosman says that a very large study of estrogen replacement published last year found not only that estrogen did not prevent fractures, but that it increased the risk for blood clots in women with heart disease.
"Estrogen is still extremely controversial," Cosman says. "I believe that estrogen probably works reasonably well in younger women, but I am not convinced that it works in older women."