—We thank Dr Atkins for his clarification of our report of bone mineral density (BMD) and breast cancer. Dr Atkins is correct in his interpretation. We believe that the risk/benefit ratio for estrogen replacement therapy (ERT) needs to be reevaluated with respect to BMD, osteoporosis, breast cancer, and coronary heart disease. In our previous analysis of the determinants of ERT, we found that a history of osteoporosis or spine fracture was a primary determinant of ERT—in particular, continued long-term ERT.1 Hence, women who are long-term users of ERT are more likely to have osteoporosis and, by inference, lower BMD and lower risk of breast cancer.
Cauley JA, Kuller LH. Estrogen Replacement Therapy: New Options, Continuing Concerns-Reply. JAMA. 1997;277(19):1516. doi:10.1001/jama.1997.03540430028019