Yorkshire Menopause Group

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HRT should be started before 60 to prevent fractures in older women
19 September 2001

A meta-analysis of 22 studies suggests that the relative risk of vertebral fractures is reduced by about 35% when HRT is started before the age of 60. For fractures of the wrist and hip, the relative risk reduction was of the order of 50%. Four studies, in which age of commencement of HRT was identified, suggested that there was no significant reduction in risk when HRT was started over the age of 60.

The authors of this paper recommend oestrogen replacement as a suitable first line option for osteoporosis prevention, in younger postmenopausal women, at higher risk. An accompanying editorial, however, suggests that until more direct evidence of fracture prevention is available, especially in light of the potential side effects and risks associated with HRT, other forms of bone-sparing treatment should be considered as first choice treatments.

? JAMA 2001; 285: 2891-2897

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