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Submitted by Greg Arnold, March 9, 2004, Abstracted from "Prevalence and
predictive factors for regional osteopenia in women with anorexia nervosa"
in the Annals of Internal Medicine 2000; 133(10): 790-4
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As women enter menopause, one of the largest concerns is the loss of estrogen and progesterone and the resulting bone loss. As a result, scientists have started experimenting with supplementing women with estrogen or estrogen plus progestin in an effort to prevent bone loss. In theory, it makes sense to replace a hormone in the body that, while they are young, provides women the benefit of maintaining bone health. But Mother Nature must do it for a reason.
A favorable outcome for estrogen supplementation came from a prospective cohort study in 1995 of 9,704 ambulatory, non-black women 65 years of age or older. Researchers found current estrogen use to be associated with a decrease in the risk for wrist fractures and for all non-spinal fractures when compared with no estrogen use. (1)
But the efficacy of a therapy must stand up to repeated trials, and a new study out of the same journal cites estrogen therapy and history of estrogen use to have no effect on bone density. A prospective cohort study was done on 130 women with anorexia nervosa. Researchers found bone mineral density did not differ by history of estrogen use at any site. In fact, the biggest predictor of bone mineral density was the patient's weight (2). A weak point in this study as compared to the 1995 study is the size of the study as well as the different ages of the subjects studied.
Bone health aside, estrogen therapy has been associated with numerous negative health side effects. Estrogen at daily doses of 0.625 mg or greater and in combination with progestin may increase risk for stroke (3) while estrogen by itself has been associated with increased risk of venous thromboembolism. (4)
Finally, the Women's Health Initiative sought to assess the risks vs. benefits for women taking estrogen plus progestin, a synthetic form of progesterone. A randomized, controlled primary prevention of 16, 608 postmenopausal women aged 50-79 years were recruited from 1993-1998. 8, 506 women received conjugated equine estrogen, 0.625 mg/d, plus medroxyprogesterone acetate, 2.5 mg/d, in 1 tablet while 8, 102 received placebo.
What the researchers found here was even more discouraging. Despite increasing bone mineral density and decreasing the risk of colorectal cancer, the subjects had increased risks for heart disease, stroke, and ovarian cancer. The risks were so much higher than the benefits that the study had to be stopped 3 years early. Slated to be an 8.5-year study, the researchers ended the study at 5.2 years (5). Finally, the combination therapy also increased the women's risk for dementia (6).
So, the effect of estrogen on bone health is still very debatable after looking at the research. But what isn't debatable are the other health risks women are exposed to, from heart disease to ovarian cancer to dementia, that severely discourage estrogen's use by itself or with progestin.
References:
1. Cauley JA. Estrogen Replacement Therapy and Fractures in Older Women
Annals of Internal Medicine 1995; 122: 9 – 16
2. Grinspoon S. Prevalence and Predictive Factors for Regional Osteopenia in Women with Anorexia Nervosa. Annals of Internal Medicine 2000; 133: 790 – 794
3. Grodstein F. A Prospective, Observational Study of Postmenopausal Hormone Therapy and Primary Prevention of Cardiovascular Disease. Annals of Internal Medicine 2000; 133: 933 - 941
4. Miller J. Postmenopausal Estrogen Replacement and Risk for Venous Thromboembolism: A Systematic Review and Meta-Analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine 2002; 136: 680 - 690.
5. Writing Group for the Women's Health Initiative Investigators. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled Trial. Journal of the American Medical Association 2002; 288: 321 – 333
6. Shumaker SA. Estrogen Plus Progestin and the Incidence of Dementia and Mild Cognitive Impairment in Postmenopausal Women: The Women's Health Initiative Memory Study: A Randomized Controlled Trial. Journal of the American Medical Association 2003; 289: 2651 - 2662
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