Once started, you never outgrow your need for estrogen treatment

ON CALL

November 02, 1993|By Dr. Simeon Margolis | Dr. Simeon Margolis,Contributing Writer

Q: My doctor has kept me on estrogen hormone replacement ever since my periods stopped four years ago.

The estrogen was originally prescribed to control hot flashes, and I am pretty sure they will not return or will be tolerable if the estrogen is stopped.

But I am concerned abut osteoporosis because I am thin and my mother fractured her hip in her late 70s.

How long must estrogen be taken to protect me against osteoporosis?

A: A recent article in the New England Journal of Medicine cited somewhat disappointing results of a study carried out on 212 women from Framingham, Mass., who had taken estrogen after menopause.

They found that estrogen replacement treatment had to be continued for at least seven years before the women's bone density (a measurement that correlates well with this risk of bone fracture) was higher than in those who had never taken estrogen.

In the women less than 75 years of age, bone density was 11 percent greater in those who had taken es

trogen for seven or more years than in those who never took estrogen.

However, the beneficial effect of estrogen on bone density does not persist for long after the estrogen is stopped.

Even in those using estrogen for more than seven years before stopping, bone densities after 75 -- when the number of fractures is highest -- were not significantly different from in those who never took any estrogen at all.

These results are consistent with other studies that have shown that estrogen must begin at the time of the menopause, and continue to avoid rapid bone loss.

The new findings suggest that you can never stop taking estrogen if you want to achieve maximal protection from osteoporosis and its associated fractures.

Such lifelong estrogen treatment may not appeal to you, but there is ample evidence that it may lessen your risk of coronary disease as well as osteoporosis.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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