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Estrogen and Postmenopausal Osteoporosis
- Olga Petrovic, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
Although the recent study by Lufkin and colleagues [1] was most interesting, the conclusions of the article and of the accompanying editorial [2] may be overdrawn.
Nearly one third of patients had taken estrogen as recently as 4 years earlier, and a few had received estrogen 6 months before the study began. How many of the previous estrogen users had not taken it for more than 15 to 20 years before entering the study? What was the average duration of use, especially in patients 65 to 75 years old? How many took it continuously or nearly continuously after menopause? If previous users of estrogen are eliminated from the study analysis, how are the results affected?
The Framingham study [3] suggested that estrogen use in women 65 to 74 years old decreased hip fracture, but almost half initiated it before 60 years of age. Quigley and colleagues [4] showed estrogen's efficacy in maintaining bone mass in elderly women (71 to 80 years of age); however, in previous nonusers of estrogen, baseline bone loss was so low that benefit from initiation of estrogen at that age was unclear.
Women who initiate estrogen at menopause still undergo rapid bone loss when it is discontinued, even years later. Therefore, it should not be surprising that a 75-year-old (or 55-, or 65-, or 85-year-old) woman who took estrogen continuously after menopause, stopped it for 4 years, and subsequently resumed it, might respond favorably compared with a women who did not resume estrogen. Furthermore, a 75-year-old woman who has never taken estrogen after menopause usually has low bone turnover and might not respond further to estrogen.
Olga Petrovic
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
