Naessén T, Persson I, Adami H O, Bergström R, Bergkvist L
University Hospital, Uppsala, Sweden.
Ann Intern Med. 1990 Jul 15;113(2):95-103. doi: 10.7326/0003-4819-113-2-95.
To determine the relative risk for sustaining a first hip fracture after hormone replacement therapy.
Prospective population-based cohort study with an average observation period of 5.7 years.
A prescription-based cohort in the Uppsala health care region in Sweden.
The cohort (23 246 women) comprised virtually all women of 35 years of age and older who received noncontraceptive estrogens from April 1977 through March 1980. Comparisons were made with women in the background population.
Follow-up through 1983 was done with regard to hospital admissions for a first cervical or trochanteric hip fracture. The observed number of cases was compared with that expected on the basis of person-years of observation in the cohort and incidence rates in the background population. Analyses were made in exposure categories, based solely on prescription data.
During 133 022 person-years of observation, 163 cases of first hip fracture occurred, compared with the 205.5 expected, yielding an overall relative risk of 0.79 (95% CI, 0.68 to 0.93). The greatest protective effect (relative risk, 0.37; CI, 0.13 to 0.79) was found against trochanteric fracture among women receiving potent estrogens who were under 60 years of age at cohort entry. This group also had the highest proportion of treatments with combinations of estrogens and progestogen (41%). Treatment with less potent estrogens, mainly estriols, had no protective effect. Data indicated that the baseline risk for hip fracture was not lower in the cohort women than in the background population.
Treatment with potent estrogens, both alone and possibly when combined with progestogens, reduces the risk for both cervical and trochanteric hip fractures within the first decade after menopause.
确定激素替代疗法后首次发生髋部骨折的相对风险。
基于人群的前瞻性队列研究，平均观察期为5.7年。
瑞典乌普萨拉医疗保健地区一个基于处方的队列。
该队列（23246名女性）几乎包括了1977年4月至1980年3月期间接受非避孕雌激素治疗的所有35岁及以上女性。与背景人群中的女性进行比较。
对首次发生颈椎或转子间髋部骨折的住院情况进行随访至1983年。将观察到的病例数与根据队列中的观察人年数和背景人群中的发病率预期的病例数进行比较。仅根据处方数据对暴露类别进行分析。
在133022人年的观察期内，发生了163例首次髋部骨折，而预期为205.5例，总体相对风险为0.79（95%可信区间，0.68至0.93）。在队列入组时年龄小于60岁且接受强效雌激素治疗的女性中，对转子间骨折的保护作用最大（相对风险，0.37；可信区间，0.13至0.79）。该组中雌激素与孕激素联合治疗的比例也最高（41%）。使用效力较弱的雌激素（主要是雌三醇）治疗没有保护作用。数据表明，队列中的女性髋部骨折的基线风险并不低于背景人群。
单独使用强效雌激素治疗，可能与孕激素联合使用时，可降低绝经后第一个十年内颈椎和转子间髋部骨折的风险。
