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The objective of the study was to determine the incidence rate of osteoporotic fractures among elderly women who had long-term postmenopausal estrogen replacement therapy (ERT) and to compare this with the incidence rate in women who had not used estrogen. In a previous retrospective cohort study based on medical record review in 1982, we showed that long-term ERT was associated with lower incidence of wrist and vertebral fractures. We have extended our follow-up of 490 women by adding a mean 8 years to the observation period, which more than triples the number of osteoporotic fractures. At the Kaiser Permanente Medical Center, San Francisco, a large health maintenance organization, a review of computer pharmacy records from 1968 through 1971 identified 245 postmenopausal women; all had begun estrogen within 3 years of menopause and had used estrogen for at least 5 years. From the same pharmacy records, 245 age-matched postmenopausal non-users were identified. Among estrogen users, mean length of use was 17.0 years, mean follow-up after treatment was 7.3 years and mean dose of conjugated oral estrogen was 0.9 mg daily. We found statistically significant reduction in the incidence of wrist and vertebral fractures in users compared with non-users. The age-adjusted incidence ratios (95% confidence intervals for wrist fractures were 0.55 (0.32-0.92) and for vertebral fractures were 0.57 (0.41-0.80). These results were not statistically significantly altered after adjustment for age of menopause, body mass index and smoking. It is concluded that long-term ERT confers statistically significant protection against wrist and vertebral fractures.

BACKGROUND The current study was conducted to assess posttreatment changes in the mental components of health related quality of life in prostate carcinoma patients during the two years following diagnosis and management with radical prostatectomy, pelvic irradiation, or watchful waiting. METHODS The authors studied the mental domains of general health related quality of life in 452 men recently diagnosed with early stage prostate carcinoma and treated with radical prostatectomy, pelvic radiation, or watchful waiting. Outcomes were assessed with the RAND 36‐Item Health Survey, a validated health‐related quality of life instrument that includes four mental domains. To minimize the influence of potentially confounding factors, the authors adjusted for age, comorbidity, prostate specific antigen (PSA) at diagnosis, and biopsy Gleason score. All subjects were drawn from CaPSURE™, a national, longitudinal cohort. RESULTS By 6–12 months after treatment, the active treatment groups began to show differences in mental health and vitality. By 15 months, surgery and radiation patients scored differently in all four mental domains. Over time, the gaps between mental domain scores grew wider among the treatment groups, with surgery patients performing the best, radiation patients performing the worst, and watchful waiting patients falling in between. CONCLUSIONS The mental health profiles differ for patients undergoing surgery, radiation, or watchful waiting for early stage prostate carcinoma. Men with more serious disease, as evidenced by higher PSA levels or more aggressive histology, tended to worry more about it. Older men performed better, while sicker men performed worse, even though the older men tended to be sicker. Cancer 2002;95:54–60. © 2002 American Cancer Society. DOI 10.1002/cncr.10651