Call for Hormone Therapy Re-Think

A study of hip fracture risk at the Hunter Medical Research Institute could reignite the Hormone Replacement Therapy debate. Laureate Professor Roger Smith and his research team 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.”

Study results were published in Clinical Endocrinology, a leading international journal published by the Society of Endocrinology.