The recently published JAMA article "Hormone Replacement Therapy and Prevention of Nonvertebral Fractures: A Meta-analysis of Randomized Trials," by David J. Torgerson, PhD. and Sally E. M. Bell-Syer, MSc., reaffirms that hormone replacement therapy (HRT) helps prevent nonvertebral fractures when therapy is started early in menopause. The most common nonvertebral fractures are those of the hip and wrist. "We found that HRT prevents nonvertebral fractures, especially in younger postmenopausal women. For women to obtain the most protective benefit, therapy should be started soon after the menopause," said Torgerson, the study author.

This meta-analysis evaluated published and unpublished data from 22 randomized trials that reported or collected nonvertebral fracture data for more than 8,800 women. Overall, HRT was found to reduce the risk of nonvertebral fractures by 27 percent, a statistically significant result. For hip and wrist fractures alone, the reduction in risk was more marked (40 percent), particularly for women less than 60 years of age (55 percent).

The study demonstrates that the greatest protection from fracture occurs when therapy is started early in menopause. This is especially important considering that up to 20 percent of a woman's expected lifetime bone loss may occur in the first 5 to 7 years after menopause. The study indicates that there was a 33% reduction in nonvertebral fracture risk among women less than 60 years of age, and a risk reduction of 12% in women age 60 and older. Torgerson further states "our review suggests that the effect of HRT on fracture for women starting therapy when older than age 60 years may be reduced," but acknowledges this finding was heavily influenced by one study in women at low risk of developing osteoporosis.

Osteoporotic fractures create a heavy economic burden, costing the American health care system over $14 billion annually. According to the National Osteoporosis Foundation, "Based on its effectiveness in preventing ... osteoporosis, along with other potential benefits for postmenopausal health, HRT provides the greatest benefit relative to its cost." The cost of HRT is generally less than half the daily cost of other brand name products prescribed for the prevention of osteoporosis. However, these other brand name products do not treat menopausal symptoms.

There can be side effects with ERT and HRT.

Estrogen can increase the risk of cancer of the uterus. Your doctor may prescribe a progestin along with ERT, or a progestin combined with estrogen, as in HRT, to reduce this risk. Women who have had a hysterectomy do not have this risk. HRT contains progestin, which may have unfavorable effects on blood sugars and may worsen a diabetic condition. Side effects of ERT and HRT include blood clots, nausea, abdominal pain, breast tenderness, irregular bleeding, headache, and hair loss.

ERT and HRT are not for every woman.

Patients should not take ERT or HRT if they have had any breast or uterine cancer, abnormal vaginal bleeding, abnormal blood clotting, or if they may are pregnant. Pregnant women should not take ERT or HRT because of possible risk to the fetus. HRT is contraindicated in liver and stroke. Women with heart disease are advised to consult their practitioner if they have heart disease.