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The effect of various hormonal preparations and calcium supplementation on bone mass in early menopause. Is there a predictive value for the initial bone density and body weight?
Author(s) -
Pines A.,
Katchman H.,
Villa Y.,
Mijatovic V.,
Dotan I.,
Levo Y.,
Ayalon D.
Publication year - 1999
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1046/j.1365-2796.1999.00578.x
Subject(s) - medicine , menopause , medroxyprogesterone acetate , bone mineral , bone density , osteoporosis , hormone replacement therapy (female to male) , hormone , norethisterone acetate , medroxyprogesterone , endocrinology , densitometry , calcium , testosterone (patch)
. Pines A, Katchman H, Villa Y, Mijatovic V, Dotan I, Levo Y,. Ayalon D (Ichilov Hospital, Tel‐Aviv; Ramat Marpe Hospital, Ramat‐Gan, Tel‐Aviv, Israel. VU Ziekenhuis, Amsterdam, The Netherlands). The effect of various hormonal preparations and calcium supplementation on bone mass in early menopause. Is there a predictive value for the initial bone density and body weight? J Intern Med 1999; 246 : 357–361. Objectives. To compare the effect of various oestrogen and oestrogen/progestin preparations on bone density over a 2‐year follow‐up period in early postmenopausal women. Setting. A retrospective study on 315 women followed in a menopause clinic. Design. Antero‐posterior lumbar spine bone densitometry was performed at baseline and between 18 and 24 months (mean 22 months) after initiation of hormone therapy. Participants were divided into six groups: women taking conjugated equine oestrogen (CEE) ( n = 30); CEE plus sequential monthly medroxyprogesterone acetate (MPA) ( n = 52); CEE plus sequential bimonthly MPA ( n = 51); oral estradiol plus sequential monthly norethisterone acetate ( n = 52); transdermal estradiol plus sequential monthly MPA ( n = 30). A control group ( n = 100) was composed of nonusers of hormones. Results. Hormone users, as a whole ( n = 215), increased their bone mineral density (BMD) by 2.9% (4.8) as compared to the controls who lost 3.5% (3.4; P < 0.001). There were similar gains in BMD amongst the five study groups. Calcium supplementation was associated with better results in all women: users of hormones and calcium had a gain in BMD of 4.5% (4.8) compared to only 1.5% (4.5) in those on hormones but without calcium ( P < 0.001); amongst the controls, women using calcium lost 1.4% (2.4), whilst nonusers of calcium lost 3.7% (2.4; P < 0.001). A dose–response curve was found between basal BMD and the effect of hormone therapy: women with osteoporosis (T‐score <75%) demonstrated the largest increase in BMD – 6.3% (4.6), osteopenia (T‐score 75–85%) was associated with a gain of 3.2% (5.6), low‐borderline values (T‐score 86–100%) gave a modest increase of 1.3% (4.3), and those with more than average BMD values (T‐score >100%) actually lost bone despite hormone treatment [–2.1% (4.1)]. Conclusions. All hormone regimens had a similar bone conserving effect. Basal BMD value may serve as a predictor for the success of treatment. Calcium supplementation should be recommended in all postmenopausal women.