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Prevention of Postmenopausal Bone Loss Using Tibolone or Conventional Peroral or Transdermal Hormone Replacement Therapy with 17β‐Estradiol and Dydrogesterone
Author(s) -
Lippuner Kurt,
Haenggi Willy,
Birkhaeuser Martin H.,
Casez JeanPaul,
Jaeger Philippe
Publication year - 1997
Publication title -
journal of bone and mineral research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.882
H-Index - 241
eISSN - 1523-4681
pISSN - 0884-0431
DOI - 10.1359/jbmr.1997.12.5.806
Subject(s) - tibolone , medicine , dydrogesterone , hormone replacement therapy (female to male) , progestogen , osteoporosis , transdermal , menopause , estrogen , progestin , urology , endocrinology , testosterone (patch) , pharmacology
Postmenopausal bone loss can be prevented by continuous or intermittent estradiol (E 2 ) administration. Concomitant progestogen therapy is mandatory in nonhysterectomized women to curtail the risk of endometrial hyperplasia or cancer. However, the recurrence of vaginal bleeding induced by sequential progestogen therapy in addition to continuous estrogen administration is one of the reasons for noncompliance to hormone replacement therapy (HRT). Tibolone, a synthetic steroid with simultaneous weak estrogenic, androgenic, and progestational activity, which does not stimulate endometrial proliferation, has recently been proposed for the treatment of climacteric symptoms. To compare the efficacy of conventional oral and transdermal HRT with that of tibolone in the prevention of postmenopausal bone loss, 140 postmenopausal women (age, 52 ± 0.6 years; median duration of menopause, 3 years) were enrolled in an open 2‐year study. Volunteers had been offered a choice between HRT and no therapy (control group, CO). Patients selecting HRT were randomly allocated to one of the following three treatment groups: TIB, tibolone, 2.5 mg/day continuously, orally; PO, peroral E 2 , 2 mg/day continuously, plus sequential oral dydrogesterone (DYD), 10 mg/day, for 14 days of a 28‐day cycle; TTS, transdermal E 2 by patch releasing 50 μg/day, plus DYD as above. Bone densitometry of the lumbar spine, upper femur, and whole body was performed using dual‐energy X‐ray absorptiometry at baseline, and then 6, 12, 18, and 24 months after initiation of therapy. One hundred and fifteen women (82%) completed the 2 years of the study. The dropout rate was similar in each group. Over 2 years, bone preservation was observed in all three treatment groups as compared with controls, without significant differences among treatment regimens. In conclusion, tibolone can be regarded as an alternative to conventional HRT to prevent postmenopausal bone loss.