Call for hormone replacement therapy re-think after hip fracture study

Monday, 25 June 2018

Newcastle endocrinologist, Laureate Professor Roger Smith, has urged a re-think on the use of hormone replacement therapy (HRT) after studying the risk of hip fracture in both elderly women and men.

Laureate Professor Roger Smith

His research team at the Hunter Medical Research Institute evaluated patients who were treated at John Hunter Hospital in 1998 and 2015 respectively after fracturing their “neck of femur” – the angled joint where the thigh bone meets the hip.

While there was an increase in fractures from 233 to 308, it was the average age that most intrigued Laureate Professor Smith, a University of Newcastle and Hunter New England Health researcher.

“The mean age for women in 2015 was 83.8 and in 1998 it was 84, so there was negligible change in those 17 years. Men, however, improved from a mean of 80 years to almost 85 in the same period,” he says.

“So men seem to be ageing more slowly, at least in bone health, whereas it hasn’t improved for women. That’s despite only 1 in 12 Australian men getting treatment for osteoporosis compared to 1 in 4 women.

“We’re spending a lot of money without a significant effect.”

To explain the paradox, Laureate Professor Smith believes that declining smoking rates have helped men to maintain better health. In 2000, 23 per cent of males were smokers, dropping to 13 per cent by 2015.

“Men’s bones are fortified by testosterone, which only drops when they’re ill,” he explains. “On the other hand, far fewer women are being administered HRT today. Rates in Australia dropped by 40 per cent between 2001 and 2005 and are currently only 12-15 per cent of women.

“This is because a US study linked HRT with increased breast cancer risk, but people later realised it was progesterone, not estrogen, causing the risk. And it’s estrogens that are very protective of bones.

“Calcium and vitamin D supplementation aren’t going to solve this problem, and anti-osteoporosis therapies are simply keeping the rates static.”

Once bone density becomes too thin and brittle, the neck of femur can break just by stepping awkwardly or turning suddenly. Patients also remain vulnerable to other fragility injuries.

Laureate Professor Smith previously studied the effects of estrogen during pregnancy before researching the post-menopause phase. John Hunter Hospital, as the main orthopedic centre in the Hunter New England region dealing with hip fractures, provided his team with records including individual x-rays.

“We need more data, as this study was relatively small, but to me it’s a very important early finding because women can live 50 years or more without estrogen, which may have a major impact on their bones and possibly other tissues,” he adds.

“I think it’s time we again consider a wider use of HRT following menopause. We also need to continue reducing cigarette smoking in the community.”

Study results were published in Clinical Endocrinology, a leading international journal published by the Society of Endocrinology. Kaushalya Perera from the University of Newcastle and Daniela Chan from the Department of Endocrinology at John Hunter Hospital assisted with the project.

Professor Smith is Co-Director of Priority Research Centre for Reproductive Science, Director of the Department of Endocrinology at the John Hunter Hospital and Leader of the HMRI Pregnancy and Reproduction Program. HMRI is a partnership between the University of Newcastle, Hunter New England Health and the community.

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