Bone density decreases when stopping, never using menopausal hormone therapy
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Key takeaways:
- Postmenopausal women who discontinued HT had bone loss of –0.021 gm/cm2 after 5 years.
- Compared with no bone loss among women who continued HT, never users had some bone loss of –0.012 gm/cm2.
Postmenopausal women who stopped or never used hormone therapy over a 5-year period experienced a loss in bone density, whereas bone density was maintained for those who continued treatment, researchers reported in Menopause.
“Discontinuation of hormone therapy use can result in bone loss similar to that which occurs at the time of menopause,” Alyssa N. Sheedy, BS, research assistant and third-year medical student at Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, and colleagues wrote. “Bone mineral density returns to pre-hormone therapy treatment levels after hormone therapy discontinuation.”
Sheedy and colleagues conducted a prospective, epidemiologic cohort study with data from 961 postmenopausal women (mean age, 65.9 years) who participated in the Buffalo OsteoPerio study. All participants had data on hip bone density, hormone therapy (HT) use and self-reported physical activity from 1997 to 2001 and 2002 to 2007. At baseline, 480 women were categorized as HT nonusers and 481 were categorized as current HT users.
Most participants (71.7%) who discontinued HT after baseline did so within 2 years of initiating therapy. From baseline to year 5, 336 women who were using HT discontinued treatment. Current HT users had the highest total hip bone density at baseline. Postmenopausal women who continued HT had no observed bone loss at year 5 compared with those who discontinued HT, who had the greatest bone loss of –0.021 gm/cm2. In addition, postmenopausal women who never used HT had some bone loss of –0.012 gm/cm2.
Researchers noted that physical activity did not significantly affect bone mineral density (BMD) for postmenopausal women whether or not they used, discontinued or never used HT.
“The potential effect that targeted physical activity regimens have on BMD loss in older postmenopausal women warrants further investigation,” the researchers wrote.
Perspective
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E. Michael Lewiecki, MD, FACE, FACP
This prospective observational study found that older women (mean age, 70 years) who discontinued estrogen experienced an accelerated rate of bone loss compared with age-related bone loss in non-users and stability of bone density in those who continued estrogen therapy. This is consistent with other studies showing that estrogen therapy started at the time of menopause can prevent bone loss as long as treatment is continued, while stopping estrogen essentially recapitulates the bone loss that would have occurred earlier if estrogen therapy had not been started.
The message is that women stopping estrogen therapy should expect to have a decrease in bone density and should be appropriately monitored to determine whether non-estrogen therapy to reduce fracture risk should be considered.
It was disappointing, but not entirely unexpected, that usual physical activity did not mitigate bone loss after stopping estrogen therapy. It seems that weight-bearing exercise and resistance training have the greatest skeletal benefits in younger patients with intense training under supervision. More study is needed to determine what sort of exercise program might be optimal for older women stopping estrogen therapy.
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