Women's Health

Bone protection therapy shifted from estrogen to nonestrogen anti-osteoporosis medicine after publication of the Women's Health Initiative study

The Women's Health Initiative (WHI) study established that hormone therapy (HT) containing estrogen plus progestin increased post-menopausal women's risk of breast cancer, stroke, and heart attack. The study also found a decreased risk of hip fractures among HT users. Nevertheless, researchers concluded that HT should be considered only for women at significant risk of osteoporosis (loss of bone density that can lead to fractures), who cannot take nonestrogen medications. Physicians prescribed less estrogen and more nonestrogen anti-osteoporosis medicine (AOM) after publication of the WHI study findings, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11673).

Researchers analyzed Medicaid claims data for women 50 years of age and older, who were enrolled in the Pennsylvania Medicaid program from December 1, 2001, through December 31, 2002. The researchers compared use of the following AOMs: estrogens, biphosphonates, selective estrogen receptor modulators (SERMS), and calcitonin in the pre-WHI (December 1, 2001, to July 30, 2002) and post-WHI (August 1, 2001, to December 31, 2002) study periods.

Estrogen use decreased significantly for women from all age and racial groups, but mostly among women 80 years and older (30 percent decrease) and racial groups other than white or black (38 percent decrease). In contrast, use of biphosphonates increased in all age and racial groups. Use of SERMs significantly increased among white and black women, and all age groups except for women in their 70s. Yet, after the WHI study findings were published, only 15 percent of women were prescribed an AOM of any kind, similar to the pre-WHI period.

See "Osteoporosis management in a Medicaid population after the Women's Health Initiative study," by Euni Lee, Pharm.D., Ph.D., Anthony K. Wutoh, Ph.D., Zhenyi Xue, M.D., and others, in the March 2006 Journal of Women's Health 15(2), pp. 155-161.

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