Objective: To determine the trend in incidence of fractures among perimenopausal and postmenopausal women during the periods immediately before and after publication of the Women's Health Initiative and Heart and Estrogen/Progestin Replacement Study (HERS) II data.
Design: This was an ecological study using a claims database for multiple healthcare plans. The cohort of women aged 40 to 69 years was included. Diagnostic codes for fractures likely to be osteoporosis related and prescriptions for hormone therapy and other bone-modifying medications were identified. Annual incidence rates and trends in incidence over time for fractures and prescriptions were determined for the period 2000 through 2005.
Results: Enrollment among women aged 40 to 69 years increased from 919,389 in 2000 to 2,872,372 in 2005. A total of 43,017 new fractures were identified. There was a significant increasing trend in age-adjusted rates of radius and ulna, vertebra, ribs, hip, pelvis, multiple, and pathologic fractures during the period from 2003 through 2005 (P < 0.03). The incidence of each fracture type was significantly greater during 2004 to 2005 than 2000 to 2001 (P < 0.04). The use of estrogen, estrogen plus progestin, and other hormones declined over the period from 2000 to 2003, whereas the use of other bone-modifying drugs increased from 2003 through 2005.
Conclusions: The incidence of fractures among perimenopausal and postmenopausal women increased significantly in the 3 years after publication of Women's Health Initiative and Heart and Estrogen/Progestin Replacement Study II results. This trend followed a decline in the use of hormone therapy, concurrent with an increase in the use of other bone-modifying agents.