Hormone Therapy and Fractures in Postmenopausal Women

• Type of Material: Article
• Authors: Michael T Yin, Columbia University; Donald R Hoover, Rutgers University; Qiuhu Shi, New York Medical College; Phyllis C Tien, University of California San Francisco, San Francisco, California; Mardge H Cohen, Stroger Hospital; Seble Kassaye, Georgetown University; Deborah Gustafson, State University of New York, Brooklyn, New York; Adaora Adimora, University of North Carolina School of Medicine, Chapel Hill, North Carolina; M Neale Weitzmann, Emory University; Hector Bolivar, University of Miami; Amy Warriner, University of Alabama; Sara H Bares, University of Nebraska; Anjali Sharma, Albert Einstein College of Medicine
• Language: English
• Date: 2022-06-22
• Publisher: Wolters Kluwer Health, Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Wolters Kluwer Health, Inc. All rights reserved. Welcome to RightsLink
• Final Published Version (URL): https://doi.org/10.1097%2FQAD.0000000000003292
• Title of Journal or Parent Work: AIDS
• Volume: 36
• Issue: 12
• Start Page: 1683
• End Page: 1688
• Grant/Funding Information: The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD), and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research (OAR). MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR003098 (JHU ICTR), UL1-TR001881 (UCLA CTSI), P30-AI-050409 (Atlanta CFAR), P30-AI-073961 (Miami CFAR), P30-AI-050410 (UNC CFAR), P30-AI-027767 (UAB CFAR), and P30-MH-116867 (Miami CHARM). The authors gratefully acknowledge the contributions of the study participants and dedication of the staff at the MWCCS sites. This research was also supported by R01-AI095089 and K24- AI155230 (MTY) and K23-AR06199301 (AS).
• Keywords: women living with HIV; orthopaedics; estrogen; hormone therapy; menopause
• Research Categories: Health Sciences, General; Health Sciences, Obstetrics and Gynecology; Health Sciences, Rehabilitation and Therapy

Abstract

Background: Fracture rates have been reported to be higher among older women living with HIV (WLWH) than HIV- women. Hormone therapy (HT) with estrogen can reduce vasomotor symptoms (VMS) associated with menopause and prevent fractures. Since data are limited on the benefits of HT use in WLWH, we examined associations of HT use and fractures. Methods: A prospective study of 1765 (1350 WLWH and 415 HIV-) postmenopausal Women’s Interagency HIV Study (WIHS) participants was performed, including self-reported HT use and fracture data from 2003-2017. Proportional hazards models determined predictors of new fractures at any site or at typical fragility fracture sites (hip, spine, wrist). Results: At the first postmenopausal visit, the median (IQR) age of WLWH was slightly younger than HIV- women [49.8 (46.4., 53.0) vs 50.7 (47.5, 54.0), p=0.0002] and a smaller proportion of WLWH reported presence of VMS (17% vs 26%, P<0.0001). A greater proportion of WLWH than HIV- women reported HT use (8% vs 4%, p=0.007) at the first postmenopausal visit. In multivariate analyses, white race and smoking were significant predictors of incident fracture at any site, but HT (p=0.69) and HIV status (p=0.53) were not. Conclusion: Our study did not find evidence of benefit or harm with regards to fracture outcomes in postmenopausal WLWH receiving HT. Further research is needed to determine whether HT has benefits beyond treatment of VMS such as prevention of adverse aging-associated outcomes.