Correspondence (letter to the editor): Do Not Forget Estrogen Therapy

The absolute numbers for the prevalence rates for osteoporosis and other sequelae of estrogen deficiency were not reported in the article. Osteoporosis affects one in every three women. More than 100 000 women contract fractures of the neck of femur every year, and 10–20% die as a result in the aftermath. In 55 000 incident cases of breast cancer, cure is possible in 85%, and a higher incidence of breast cancer owing to hormone replacement has been disproved or, in the worst-case scenario, is about one in 1000. The WHI (Women’s Health Initiative) Study, the largest on the subject, showed that the risk of breast cancer was significantly reduced in women taking estrogen replacement therapy—namely, by 20%. German data show that women who take HRT have a 30% lower risk of being admitted as inpatients to be treated for breast cancer. A US study showed that the risk of stroke was 0.1/10 000 women aged 50–60 (1). In Germany, osteoporosis related fractures cost some 3 billion euro every year. The total costs for osteoporosis amount to 6 billion euro. Women aged 47 or younger at menopause have double the risk of osteoporosis as do women with a later menopause: after 34 years of observation, 56–30% (fractures within the respective groups: 44% to 31%) (2) Furthermore, mortality in women with an earlier menopause was 52–35% higher. This was confirmed by large meta-analyses (n=26 000) (4): more than 40% reduction in mortality in women taking hormone therapy than in women with a later menopause. A study in Californian teachers showed a 50% reduced risk for coronary cardiovascular diseases and 50% reduction in overall mortality for HR (n=71 000). By contrast, the risks associated with hormone replacement are 0.6–0.2/1000. Twice as many women die from the consequences of osteoporotic fractures than from breast cancer.