Search

Objective: To identify risk factors for hip fracture and to examine whether hormone replacement therapy (HRT) modifies the effect of these risk factors. Design: Prospective cohort study. Setting: The Danish Nurse Cohort Study. Participants: 14,015 female nurses aged 50 years and above who in 1993 completed a questionnaire on general health and lifestyle issues, reproductive history including information on HRT, and family history of osteoporosis and personal history of a wrist fracture. Outcome measures: End-point was the first-ever hip fracture registered in the Danish National Hospital Register during the period from 1993 to 1999. Results: During the follow-up period 245 hip fractures were identified. Ever users of HRT had a lower risk of hip fracture (hazard ratio 0.69; 0.50–0.94). Women reporting a poor health (hazard ratio 2.01; 1.30–3.11), restrictions in daily activities (hazard ratio 1.52; 1.05–2.21), low body mass index (hazard ratio 1.65; 0.98–2.77), and leisure time sedentary physical activity (hazard ratio 1.88; 1.30–2.70) were main identified risk factors for hip fracture. HRT did not modify the effect of risk factors on the risk of hip fracture. Conclusion: This study confirms that women with a frail health are at increased hip fracture risk and that ever use of HRT decreases the risk of hip fracture. HRT did not modify the effect of these risk factors, indicating that the preventive effect of this therapy is independent of risk factors. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of oestrogen alone and in combination with progestin on the risk of low-energy, hip, wrist, and upper arm fractures. Additionally, to examine to what extent previous use, duration of use as well as recency of discontinuation of hormone replacement therapy (HRT) influences the fracture risk. Design: Prospective cohort study. Setting: The Danish Nurse Cohort Study Participants: 7082 female nurses aged 50–69, who completed a questionnaire on lifestyle and use of HRT in 1993. Outcome measures: Self-reported low-energy, hip, wrist, and upper arm fractures between 1993–1999 obtained at a re-examination in 1999. Results: Compared to never users, current users of HRT, either oestrogen alone or combined with progestin, had a lower risk of low-energy, hip, wrist, and upper arm fractures (hazard ratio 0.60, 0.39–0.93 and hazard ratio 0.44, 0.30–0.66, respectively). The protective effect of HRT appeared to be significantly restricted to users who used the therapy for 10 years or more (hazard ratio 0.27, 0.14–0.51). Women who previously used hormones experienced no protective effect on fracture risk regardless of duration of therapy and recency of discontinuation. Conclusion: Only long-term HRT (10 years or more) offers a protective effect against low energy, hip, wrist, and upper arm fractures. In women with risk factors or established osteoporosis, benefits and risks of this therapy should be balanced when considering its use as a first line treatment for prevention of these fractures. [ABSTRACT FROM AUTHOR]