HORMONE REPLACEMENT THERAPY AND COBALAMIN STATUS IN ELDERLY WOMEN

Serum cobalamin concentrations are frequently low in the elderly but t he cause is often not apparent. Because oral contraceptives have been associated with low cobalamin concentrations in young women, we compar ed hormone use with cobalamin status in elderly women to determine whe ther it could account for their unexplained low cobalamin concentratio ns. Thirty-eight of the 111 women had abnormal cobalamin status (defin ed by low cobalamin, elevated methylmalonic acid, and/or elevated homo cysteine concentrations) and 73 had normal status. There was no differ ence in hormone use between the two groups: 7 (18.4%) of the 38 cobala min-deficient subjects used estrogens compared with 20 (27.4%) of the 73 control subjects. No differences in hormone use were apparent eithe r when analysis was confined to abnormal serum cobalamin concentration s alone. Similarly, the 27 women taking hormones and the 84 women not taking hormones did not have significantly different serum cobalamin o r serum total homocysteine concentrations. Indeed, hormone users had s lightly, though not significantly, higher cobalamin concentrations and lower homocysteine concentrations than nonusers; furthermore, hormone users also had significantly lower serum methylmalonic acid concentra tions. Thus, neither cobalamin concentrations nor cobalamin metabolic status were significantly worse in elderly women taking estrogen than in those not taking it (and, if anything, may have been slightly bette r). Hormone use does not appear to be a significant contributor to the low cobalamin concentrations or the mild metabolic evidence of cobala min deficiency so often seen in the elderly.