Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: Dr Villareal and colleagues1 found that frail elderly women who received 9 months
of hormone replacement therapy (HRT) had significantly increased bone mineral
density. Although the authors excluded women with active serious illness,
they did not indicate whether they excluded women with a history of coronary
artery disease (CAD). The Heart and Estrogen/Progestin Replacement Study (HERS)2 reported that women with coronary artery disease
are at increased risk for cardiovascular events in the first year of HRT.
However, Villareal et al followed up their patients for only 9 months. Given
the high prevalence of CAD in older women (33% in women older than 65 years),3 alternatives to estrogen for bone health, such
as bisphosphonates, are appropriate for many patients.
Reed SB, Bellantoni MF. Estrogen for Bone Health in Frail Elderly Women. JAMA. 2001;286(20):2544. doi:10.1001/jama.286.20.2542