28124
document
Effect of hormone therapy on risk of hip and knee joint replacement in the Women 's Health Initiative . OBJECTIVE To determine the effect of hormone therapy on arthroplasty rates . METHODS We examined data from the Women 's Health Initiative placebo-controlled , double-blind , randomized trials . Community-dwelling women ages 50-79 years were enrolled at 40 US clinics . Women with prior arthroplasty were excluded , yielding a sample size of 26,321 subjects . Women who had had hysterectomies ( n = 10,272 ) were randomly assigned to receive 0.625 mg/day conjugated equine estrogens ( n = 5,076 ) , or placebo ( n = 5,196 ) , with a mean followup of 7.1 years . Those who had not had hysterectomies ( n = 16,049 ) were randomly assigned to receive estrogen plus progestin ( n = 8,240 ) , given as 0.625 mg/day conjugated equine estrogens plus 2.5 mg/day medroxyprogesterone acetate , or placebo ( n = 7,809 ) , with a mean followup of 5.6 years . Participants reported hospitalizations , and arthroplasties were identified by procedure codes . Arthroplasties due to hip fracture were censored . Cox proportional hazards regression was used to assess hazard ratios ( HRs ) and 95 % confidence intervals ( 95 % CIs ) using intent-to-treat methods and outcome of time to first procedure . RESULTS In the estrogen-alone trial , women receiving hormone therapy had significantly lower rates of any arthroplasty ( HR 0.84 [ 95 % CI 0.70-1.00 ] , P = 0.05 ) . However , this effect was borderline statistically significant for hip arthroplasty ( HR 0.73 [ 95 % CI 0.52-1.03 ] , P = 0.07 ) , and not significant for knee arthroplasty ( HR 0.87 [ 95 % CI 0.71-1.07 ] , P = 0.19 ) . In the estrogen-plus-progestin trial , there was no association for total arthroplasty ( HR 0.99 [ 95 % CI 0.82-1.20 ] , P = 0.92 ) or for individual hip ( HR 1.14 [ 95 % CI 0.83-1.57 ] , P = 0.41 ) or knee ( HR 0.91 [ 95 % CI 0.72-1.15 ] , P = 0.41 ) arthroplasties . CONCLUSION These data suggest that hormone therapy may influence joint health , but this observed decrease in risk may be limited to unopposed estrogen and may possibly be more important in hip than in knee osteoarthritis .
28125
Intervention_Pharmacological
conjugated equine estrogens
28126
Intervention_Pharmacological
estrogen plus progestin
28127
Intervention_Pharmacological
conjugated equine estrogens
28128
Intervention_Control
placebo
28129
Outcome_Physical
arthroplasty rates .
28130
Outcome_Physical
hospitalizations
28131
Outcome_Physical
arthroplasties
28132
Outcome_Physical
procedure codes
28133
Outcome_Physical
Arthroplasties
28134
Outcome_Physical
rates of any arthroplasty
28135
Outcome_Physical
total arthroplasty
28136
Outcome_Physical
individual hip
28137
Outcome_Physical
knee
28138
Outcome_Physical
arthroplasties
28139
Participant_Condition
hip and knee joint replacement
28140
Participant_Sex
Women 's
28141
Participant_Sex
Women 's
28142
Participant_Condition
Community-dwelling
28143
Participant_Sex
women
28144
Participant_Age
50-79 years
28145
Participant_Sex
Women
28146
Participant_Sample-size
26,321
28147
Participant_Condition
who had had hysterectomies
28148
Participant_Condition
Those who had not had hysterectomies
28149
Participant_Sex
women