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July 15, 1992


Author Affiliations

Oregon Health Sciences University, Portland

JAMA. 1992;268(3):352-354. doi:10.1001/jama.1992.03490030064029

Fuller Albright was the first to suggest, in 1940, that osteoporosis in menopause was, in part, due to estrogen deprivation. Across the intervening years, the response to this intelligence has been a desultory and inconsistent recommendation for estrogen replacement therapy. However, recent research findings provide evidence for a new and compelling role for hormonal replacement therapy (HRT) in menopausal women.

Most dramatic is the somewhat unexpected effect of HRT on the incidence of cardiovascular deaths in menopausal women. Cardiovascular events are the most common cause of death in this group of women. In the United States this amounts to about 250 000 deaths per year. Recent evidence suggests that this cause of death can be reduced by half with HRT, an immense impact on the public health.1 The mechanism of this effect is not yet clear. Although there is a measurable effect on the plasma lipid profile, the magnitude