Relationship between menopausal hormone therapy and incidence of fractures in postmenopausal women

Abstract

Objective

Long-term protective effects of menopausal hormone therapy (MHT) at fractures with different doses and components are controversial. We analyzed the effect of MHT on the incidence of spine and femur fractures according to MHT type, age at commencement, duration and dose of hormones in Korean women.

Method

This retrospective study evaluated propensity score-matched patients with MHT from the Korean National Health Insurance Service database. Among women aged ≥50 years with menopause between 2004 and 2007, spine and femur fracture incidence until 2017 was analyzed in 36,446 women who had received MHT for >1 year. Estrogen–progesterone therapy (EPT), estrogen-only therapy (ET) or tibolone therapy was conducted.

Results

EPT significantly lowered the incidence of spine and femur fractures with a conventional dose, but not with a low dose. Tibolone significantly decreased the incidence of spine fractures in women aged 50–59 years when used for >5 years, and the incidence of femur fractures in women older than 60 years when used for >3 years. ET significantly lowered the risk of femur fractures when estradiol was used for >5 years.

Conclusion

In menopausal women, all MHT including conventional-dose EPT, ET and tibolone tended to lower the incidence of fractures. The effects, however, varied with the type of fracture and type of MHT.

摘要

目的: 不同剂量和成分的绝经后激素治疗(MHT)对骨折的长期保护作用存在争议, 我们根据韩国女性的MHT类型、开始年龄、持续时间和激素剂量分析了MHT对脊柱和股骨骨折发生率的影响。

方法: 这项回顾性研究评估了来自韩国国民健康保险服务数据库的倾向评分匹配的MHT患者。在2004年至2007年年龄≥50岁且绝经的女性中, 分析了36446名接受MHT> 1年的女性中截至2017年的脊柱和股骨骨折发生率。她们接受了雌激素-孕激素治疗(EPT)、单纯雌激素治疗(ET)或替勃龙治疗。

结果: EPT在常规剂量下显著降低了脊柱和股骨骨折的发生率, 但低剂量下无显著差异。当替勃龙使用>5年时, 显著降低了50-59岁女性脊柱骨折的发生率, 当使用>3年时, 显著降低了60岁以上女性的股骨骨折发生率。当雌二醇使用>5年时, ET显著降低了股骨骨折的风险。

结论: 在绝经后女性中, 所有MHT, 包括常规剂量的EPT、ET和替勃龙, 都有降低骨折发生率的趋势, 但其效果因骨折类型和MHT类型而异。

Keywords:

• Menopausal hormone therapy
• hormone replacement therapy
• fracture
• bone
• tibolone

Potential conflict of interest

No potential conflict of interest was reported by the authors.

Source of funding

Nil.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.