LETTER
Estrogen and Postmenopausal Osteoporosis
Gilbert S. Gordan
15 January 1993 | Volume 118 Issue 2 | Pages 155-156
TO THE EDITOR:
As one of Fuller Albright's students, I was gratified to read in the 1 July Annals [1, 2] that the value of estrogen replacement therapy for postmenopausal osteoporosis, first reported by him to the Association of American Physicians over half a century ago [3] has been finally recognized. In 1973, we reported that estrogen reduced fractures in women with advanced osteoporosis as shown by roentgenographic and height measurements [4]. Androgens and anabolic steroids were less effective. A number of other beliefs about osteoporosis and hormone replacement therapy need to be clarified, such as the belief that only some postmenopausal women become osteoporotic. In my experience, 66% of women 60 to 69 years of age are below the fracture threshold, and at 70 to 79 years of age, 99% are at risk. Evidently, the number one risk factor is being an untreated, postmenopausal woman. The increase in bone mass with estrogen therapy, although small (about 6 to 10 mg/cc in the first few years after menopause), may prevent further fractures. The increase is identical with or without medroxyprogesterone acetate and also before and after 65 years of age. Although the 19-nortestosterone derivatives adversely affect lipid metabolism, medroxyprogesterone acetate and progesterone itself do not.
Furthermore, why are thousands of postmenopausal women taking calcium under the erroneous belief that they are being protected? It is essential that physicians implement hormone replacement at or beyond menopause to reduce the incidence of osteoporotic fractures and possibly also of coronary artery disease [5].
1. Lufkin EG, et al. Treatment of postmenopausal osteoporosis with transdermal estrogen. Ann Intern Med. 1992; 117:1-9.
2. Ott SA. Estrogen therapy for osteoporosis—even in the elderly (Editorial). Ann Intern Med. 1992; 117:85-6.
3. Albright F, et al. Post-menopausal osteoporosis. Trans Assoc Am Physicians. 1940; 55:298-305.
4. Gordan GS, et al. Antifracture efficacy of long-term estrogens for osteoporosis. Trans Assoc Am Physicians. 1973; 86:326-32.
5. Stampfer MJ, et al. Postmenopausal estrogen therapy and cardiovascular disease: ten year follow-up from the Nurses' Health Study. N Engl J Med. 1991; 325:756-62.
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