Bone loss and wrist fractures after withdrawal of hormone therapy: The 15-year follow-up of the OSTPRE cohort

• Long-term HT-use protects from bone loss and wrist fracture, reducing, thus, the incidence of osteopenia and osteoporosis.
• HT-use of less than 5 years does not have long-term bone protection.
• The three main reasons for discontinuation of HT were resolution of menopausal symptoms, disease and fear of adverse effects or cancer.

ContextLong-term bone mineral density (BMD) or fracture incidence changes after withdrawal of postmenopausal hormone therapy (HT) are not well known.ObjectiveTo study long-term postmenopausal bone loss and incidence of wrist fracture in respect to duration and withdrawal of self-reported HT.Design/settingA 15-year follow-up of the population-based prospective OSTPRE cohort in Kuopio, Finland.ParticipantsWomen (mean baseline age 53.4 years, range 48.1–59.6) were divided into four groups based on duration of HT: (1) never users (non-HT); (2) those who had used HT only throughout the 1st 5-year period (HT5); (3) throughout the first 10-years (HT10); (4) those who used HT throughout the entire 15-year follow-up (HT15).Outcome measuresFemoral (n = 857) and spinal (n = 599) BMD measurements with dual X-ray absorptiometry (DXA) were carried out at 5-year intervals in 1989–2004. Wrist fracture incidence in 1989–2004 was studied in a population of 5119 women.ResultsThe adjusted spinal BMD (L2–L4) changes by HT use during the entire 15-year follow-up were −4.8% for non-HT (p < 0.0001), −4.2% for HT5 (p = 0.003), +0.02% for HT10 (p > 0.05) and +3.2% for HT15 (p < 0.0001) groups. The respective femoral bone losses were -8.6% for non-HT (p < 0.0001), −7.9% for HT5 (p < 0.0001), −2.5% for HT10 (p = 0.010) and −0.2% for HT15 (p > 0.05) groups. Comparing to non-HT group the risk of wrist fracture was reduced by 33% (p = 0.045) in HT10 group and by 63% (p < 0.0001) in HT15 group during the 15-year follow-up.ConclusionLong-term HT-use protects from bone loss. Thus, it reduces the incidence of osteopenia, osteoporosis and wrist fractures. Still, HT-use of less than 5 years did not have long-term bone protective effects, but a larger sample size is needed to confirm this result.