Effect of hormone replacement therapy on the bone mass and urinary excretion of pyridinium cross-links
Keywords:
Pyridinium cross-links, Hormone replacement therapy, Bone remodelingAbstract
CONTEXT: The menopause accelerates bone loss and is associated with an increased bone turnover. Bone formation may be evaluated by several biochemical markers. However, the establishment of an accurate marker for bone resorption has been more difficult to achieve. OBJECTIVE: To study the effect of hormone replacement therapy (HRT) on bone mass and on the markers of bone resorption: urinary excretion of pyridinoline and deoxypyridinoline. DESIGN: Cohort correlational study. SETTING: Academic referral center. SAMPLE: 53 post-menopausal women, aged 48-58 years. MAIN MEASUREMENTS: Urinary pyr and d-pyr were measured in fasting urine samples by spectrofluorometry after high performance liquid chromatography and corrected for creatinine excretion measured before treatment and after 1, 2, 4 and 12 months. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DEXA) before treatment and after 12 months of HRT. RESULTS: The BMD after HRT was about 4.7% (P < 0.0004); 2% (P < 0.002); and 3% (P < 0.01) higher than the basal values in lumbar spine, neck and trochanter respectively. There were no significant correlations between pyridinium cross-links and age, weight, menopause duration and BMD. The decrease in pyr and d-pyr was progressive after HRT, reaching 28.9% (P < 0.0002), and 42% (P < 0.0002) respectively after 1 year. CONCLUSIONS: Urinary pyridinoline and deoxypyridinoline excretion decreases early in hormone replacement therapy, reflecting a decrease in the bone resorption rate, and no correlation was observed with the bone mass evaluated by densitometry.
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References
Hassager C, Colwell A, Assiri AMA, Eastel R, Russel RGG, Christiansen C. Effect of menopause and hormone replacement therapy on urinary excretion of pyridinium cross-sectional study. Clinical Endocrinology 1992;37:45-50.
Belchetz PE. Hormonal treatment of postmenopausal women. N Engl J Med 1994;330(15):1062-71.
Nilas L, Christiansen C. The pathophysiology of peri and postmenopausal bone loss. Br J Obstet Gynaecol 1989;96:580-7.
Nordin BEC, Polley KJ. Metabolic consequences of the menopause: a cross-sectional, longitudinal, and intervention study on 557 normal postmenopausal women. Calcif Tissue Int 1987;41(Suppl 1):1-58.
Prestwood KM, Pilbeam CC, Burleson JA, et al. The short term effects of conjugated estrogen on bone turnover in older women. J Clin Endocrinol Metab 1994;79:366-71.
Brincat M, Moniz CF, Kabalan S, et al. Decline in skin collagen content and metacarpal index after the menopause and its prevention with sex hormone replacement. Br J Obstet Gynaecol 1987;94:126-9.
Delmas PD, Schlemmer A, Gineyts E, Riis BJ, Christiansen C. Urinary excretion of pyridinoline cross-links correlates with bone turnover measured in iliac crest biopsy in patients with vertebral osteoporosis. J Bone Min Res 1991;6:639-44.
Eyre DR. Collagen cross-linking aminoacids. Meth Enzymol 1987;144:115-39.
Black D, Duncan A, Robins SP. Quantitative analysis of the pyridinium cross-links of collagen in urine using ion-paired reversed phase high-performance liquid chromatography. Analytical Biochem 1988;169:197-203.
Parfitt AM. The contribution of bone histology to understanding the pathogenesis and improving the management of osteoporosis. Clin Invest 1982;5:163-7.
Uebelhart D, Gineyts E, Chapuy MC, Delmas PD. 1990. Urinary excretion of pyridinium cross-links: a new marker of bone resorption in metabolic bone disease. Bone Mineral 1982;8:87-96.
Riggs BL, Jowsey J, Goldschmit RS, Kelly PJ, Hoffman DL, Arnaud CD. Short and long term effects of estrogen and synthetic anabolic hormone in postmenopausal osteoporosis. J Clin Invest 1972;51:1659-63.
Parfitt AM. Treatment of osteoporosis: theoretical possibilities. Clin Invest Med 1982;5:181-3.
Uebelhart D, Schlemmer A, Johansen JS, Gineyts E, Christiansen C, Delmas PD. Effect of menopause and hormone replacement therapy on the urinary excretion of pyridinium cross-links. J Clin Endocrinol Metab 1991;72:367-73.
Schlemmer A, Hassager C, Delmas PD, Christiansen C. Urinary excretion of pyridinium cross-links in healthy women: the long term effects of menopause and estrogen/progesterone therapy. Clin Endocrinol 1994;40:777-82.
Parfitt AM. Bone remodeling: relationship to the amount and structure of bone, and the pathogenesis and prevention of fractures. In: Riggs BL, Melton LJ, editors. Osteoporosis. New York: Raven Press;1988:45-94.
Marabini R, Sirtori P, Chionna R, Barzizza L, Rubinacci A. Galactosylhydroxylysine and pyridinium cross links in monitoring the bone response to hormone replacement therapy. J Endocrinol Invest 1996;19:154-8.
