HE WOMEN'S HEALTH INITIAtive (WHI) trial of estrogen plus progestin was a randomized, controlled, double-blind trial designed to determine the effects of estrogen plus progestin compared with placebo on a number of important chronic diseases of older women. 1 After an average follow-up of 5.2 years, the trial was stopped early because of safety concerns. Hip and clinical vertebral fractures were significantly reduced by 34% and total osteoporotic fractures by 24%. However, the overall risk-benefit profile of estrogen plus progestin, summarized in a global index, was not consis-tent with a viable intervention for primary prevention of chronic diseases in postmenopausal women.This article provides an updated final analysis of fracture end points Author Affiliations, Financial Disclosures, and Women's Health Initiative investigators are listed at the end of this article.

Calcium and vitamin D supplementation did not reduce invasive breast cancer incidence in postmenopausal women. In addition, 25-hydroxyvitamin D levels were not associated with subsequent breast cancer risk. These findings do not support a relationship between total vitamin D intake and 25-hydroxyvitamin D levels with breast cancer risk.