title: Treatment of postmenopausal osteoporosis with transdermal estrogen.
abstract: OBJECTIVE
  To evaluate the tolerance and effectiveness of transdermal estrogen for women with established postmenopausal osteoporosis and vertebral fractures.
  
  
  METHODS
  Double-blind, randomized, placebo-controlled clinical trial lasting 1 year.
  
  
  METHODS
  Referral-based outpatient clinic.
  
  
  METHODS
  Seventy-five postmenopausal women, 47 to 75 years of age, with one or more vertebral fractures due to osteoporosis.
  
  
  METHODS
  Thirty-nine women received dermal patches delivering 0.1 mg of 17 beta-estradiol for days 1 to 21 and oral medroxyprogesterone acetate for days 11 to 21 of a 28-day cycle. Another 39 women received placebo.
  
  
  METHODS
  Bone turnover assessed by biochemical markers and iliac bone histomorphometry; bone loss assessed by serial measurement of bone density; and vertebral fracture rate.
  
  
  RESULTS
  Compared with the placebo group, the median annual percentage change in bone mineral density in the estrogen group reflected increased or steady-state bone mineral density at the lumbar spine (5.3 compared with 0.2; P = 0.007), femoral trochanter (7.6 compared with 2.1; P = 0.03), and midradius (1.0 compared with -2.6, P less than 0.001) but showed no significant difference at the femoral neck (2.6 compared with 1.4; P = 0.17). Estrogen treatment uniformly decreased bone turnover as assessed by several methods including serum osteocalcin concentration (median change, -0.35 compared with 0.02 nmol/L; P less than 0.001). Histomorphometric evaluation of iliac biopsy samples confirmed the effect of estrogen on bone formation rate per bone volume (median change, -12.9 compared with -6.2% per year; P = 0.004). Also, 8 new fractures occurred in 7 women in the estrogen group, whereas 20 occurred in 12 women in the placebo group, yielding a lower vertebral fracture rate in the estrogen group (relative risk, 0.39; 95% CI, 0.16 to 0.95).
  
  
  CONCLUSIONS
  Transdermal estradiol treatment is effective in postmenopausal women with established osteoporosis.
authors.affiliation: Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN 55905.
authors.forename: E G
authors.initials: EG
authors.lastname: Lufkin
authors.forename: H W
authors.initials: HW
authors.lastname: Wahner
authors.forename: W M
authors.initials: WM
authors.lastname: O'Fallon
authors.forename: S F
authors.initials: SF
authors.lastname: Hodgson
authors.forename: M A
authors.initials: MA
authors.lastname: Kotowicz
authors.forename: A W
authors.initials: AW
authors.lastname: Lane
authors.forename: H L
authors.initials: HL
authors.lastname: Judd
authors.forename: R H
authors.initials: RH
authors.lastname: Caplan
authors.forename: B L
authors.initials: BL
authors.lastname: Riggs
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000368:Aged; D015519:Bone Density / Q000187:drug effects; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D004970:Estrone / Q000097:blood; D005260:Female; D006801:Humans; D008525:Medroxyprogesterone / Q000008:administration & dosage / Q000031:analogs & derivatives; D017258:Medroxyprogesterone Acetate; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy*; D011446:Prospective Studies; D016103:Spinal Fractures / Q000209:etiology / Q000517:prevention & control
chemical_list: D004970:Estrone; D004958:Estradiol; D017258:Medroxyprogesterone Acetate; D008525:Medroxyprogesterone