Do Estrogens improve bone mass in osteoporotic women over ten years of menopause
Keywords:
established osteoporosis, hormonal replacement therapy, women with ten or more years of menopauseAbstract
A retrospective analysis of 24 patients with established osteoporosis and with ten or more years of menopause treated with conjugated estrogen, progesterone and calcium followed for one year has been performed. Treated women received 0.625 mg/day of conjugated estrogen from day 1 to 25, 5 mg/day of medroxiprogesterone from day 13 to 25, of each cycle, plus calcium (500 - 1000 mg/day), during one year (12 cycles). As control group was used 18 age-matched that received only calcium (500 a 1000 mg/day). All patients had at least two dual-photon spine and proximal femur (neck, Ward's triangle and trocanter) densities measurements performed 12 months apart. Estrogen treatment was associated with increased bone mineral density at spine and trocanter. Control group did not present any statistically change after one year in any site studied. We concluded that women with ten or more years of menopause and established osteoporosis treated with replacement hormonal therapy and calcium results in improvement of bone mineral density. These data support that women with ten or more years of menopause respond to estrogen replacement therapy with absolute increments in bone density similar to those seen in younger women, in the early menopause.
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AL-AllAWI, F.; HART, D. M. & LINDSAY, R. - Long term effect of oestrogen replacement therapy on bone mass as measured by dual-photon absorptiometry. Br Med J, 294: 1261-1262, 1987.
BARZEL, U. S. - Estrogens in the prevention and treatment of postmenopausal osteoporosis: a review. Am J Med, 85: 847-850, 1988.
CHRISTIANSEN, C.; CHRISTIENSEN, M. S.; McNAIR, P.; HAGEN, C.; KNUDERICK, S. & TRANSBOL,I. - Prevention of early postmenopausal bone loss: control led 2-year study in 315 normal females. Eur J Clin Invest, 10: 273-279, 1980.
CHRISTIANSEN, C. & RIIS, B. J. - 17 beta-estradiol and continuous norethisterone: a unique treatment for established osteoporosis in elderly women. J Clin Endocrinol Metab, 71: 836-841, 1990.
CIVITELLI, R.; AGNUSDEI, D.; NARDI, P.; ZACCHEI, F.; AVIOLI, L. V. & GENNARI, C. - Effects of one-year treatment with estrogens on bone mass, intestinal calcium absorption, and 25-hydroxyvitamin D-1-alpha-hydroxylase reverse in postmenopausal osteoporosis. Calcif Tissue, Int, 42: 77-86, 1988.
ETTINGER, B.; GENANT, H. K.& CANN, C. E. - Long term estrogen therapy prevents bone loss and fracture. Ann Intern Med, 102: 319-24, 1985.
GENANT, H. K.; CANN, C. E.; ETTINGER, B. & GORDAN, G. S. - Quantitative computed tomography of vertebral spongiosa: a sensitive method for detecting early bone loss after oophorectomy. Ann Intern Med, 97: 699-705, 1982.
HORSMAN, A.; GALLAGHER, J. C.; SIMPSON, M. & NORDIN, B. E. C. -Prospective trial of oestrogen and calcium in postmenopausal women. Br Med J, 2: 789-92, 1977.
HORSMAN, A.; JONES, M.; FRANCIS, R. & NORDIN, B. E. C. - The effect of estrogen dose on postmenopausal bone loss. N Engl J Med, 309: 1405-1407, 1983.
HUTCHINSON, T. A.; POLANSKY, S. M. & FEINSTEIN, A. R. - Post-menopausal oestrogens protect against fractures of hip and distal radius: a case-control study. Lancet, 2: 705-709, 1979.
JENSEN, G. F.; CHRISTIANSEN, C. & TRANSBOL, I. - Fracture frequency and bone preservation in postmenopausal women treated with estrogen. Obstet Gynecol, 60: 493-496, 1982.
KREIGER, N.; KELSEY, J. L.; HOLFORD, T. R. & O'CONNOR, T. - An epidemiologic study of hip fracture in postmenopausal women. Am J Epidemiol, 116: 141-148, 1982.
LINDSAY, R.; COUTTS, J. R. T. & HART, D. M.-The effect of endogenous oestrogen on plasma and mineral calcium and phosphate in oophorectomized women. Clin Endocrinol, 6: 87-93, 1977.
LINDSAY, R.; HART, D. M.; AITKEN, J. M.; MacDONALD, E. B.; ANDERSON, J. & CLARKE, A. C. - Long-term prevention of postmenopausal osteoporosis by oestrogen: evidence for an increased bone mass after delayed onset of oestrogen treatment. Lancet, 1: 1038-1041, 1976.
LINDSAY, R. & TOHME, J. F. - Estrogen treatment of patients with established postmenopausal osteoporosis. Obstet Gynecol, 76(2): 290-294, 1990.
MOORE, M.; BRACKER, M.; SARTORIS, D.; SALTMAN, P. & STRAUSE, L. - Long-term estrogen replacement therapy in postmenopausal women sustains vertebral bone mineral density. J Bone Miner Res, 5(6): 659-664, 1990.
MUNK-JENSEN, N.; NIELSEN, S. P.; OBIEL, E. B.& ERIKSEN, P. B. - Reversal of postmenopausal vertebral bone loss by oestrogen and progesterone: A double-bind placebo controlled study. Br Med J, 296: 1150-1152, 1988.
NACHTIGALL, L. E.; NACHTIGALL, R. H.; NACHTIGALL, R. D. & BECKMAN, E. M. - Estrogen replacement therapy I: a 10-year prospective study in the relationship to osteoporosis. Obstet Gynecol, 53: 277-281, 1979.
PRIOR, J. C. - Progesterone as a bone-trophic hormone. Endrocrine Reviews, 11(2): 386-398, 1990.
QUIGLEY, M. E. T.; MARTIN, P. L.; BURNIER, A. M.& BROOKS, P. - Estrogen arrests bone loss in elderly women. Am J Obstet Gynecol, 156: 1516-1523, 1987.
RECKER, R. R.; SAVILLE, P. D. & HEANEY, R. P. - Effect of estrogens and calcium carbonate on bone loss in postmenopausal women. Ann Intern Med, 87: 649-655, 1977.
STEINICHE, T.; HASLING, C.; CHARLES, P.; ERIKSEN, E. F.; MOSEKILDE, L. & MELSEN, F. - A randomized study on the effects of estrogen/gestagen or high dose oral calcium on trabecular bone remodeling in postmenopausal osteoporosis. Bone, 10: 313-320, 1989.
WAHNER, W. H. - Single and duual-photon absorptiometry in osteoporosis and osteomalacia. Seminars in Nuclear Medicine, 17(4): 305-315, 1987.
WEISS. N. S.; URE, C. L. & BALLARD, J. H.-Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med, 303: 1195-8, 1981.