Postmenopausal hormone use and skeletal fracture: does the size of the benefit decrease with increasing age?

Results of a recent meta-analysis of randomized trials suggest that, among postmenopausal women, the relative impact of hormone use in reducing the incidence of skeletal fracture declines with increasing age. We contend that: 1) the duration of the randomized trials in which older postmenopausal women were included was too short to adequately evaluate the impact of long-term hormone use on fracture risk; 2) randomized trials of hormone use in relation to a surrogate end point, bone mineral density, as well as nonrandomized studies of hormones and fracture risk, have documented a skeletal benefit associated with long-term hormone use among postmenopausal women irrespective of age; and 3) even if with increasing age there were a true decline in the relative benefit associated with the use of hormones, the size of the absolute reduction in fracture risk produced by hormone use among older postmenopausal women could be similar to or greater than that among younger postmenopausal women. For these reasons, we believe that when weighing the risks and benefits of the initiation or continuation of hormone therapy, a postmenopausal woman and her provider of health care need not consider her age when estimating the skeletal benefit such therapy can offer.