Skeletal effects of oral oestrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women.
OBJECTIVE
To compare oral and implanted oestrogens for their effects in preventing postmenopausal osteoporosis.


METHODS
Non-randomised cohort study of postmenopausal women treated with oral or depot oestrogens and postmenopausal controls.


METHODS
Gynaecological endocrine clinic in tertiary referral centre.


METHODS
Oral treatment group of 37 postmenopausal women (mean age 57.5 years, median 8.75 years from last menstrual period), compared with 41 women given oestrogen implants (mean age 56.2 years, median 9.5 years from last menstrual period) and 36 controls (mean age 51.8 years, median 2.0 years from last menstrual period). Weight was not significantly different among the groups.


METHODS
Oral treatment group was given continuous treatment with cyclic oestrogen and progesterone preparations (Prempak C or Cycloprogynova) for a median of 8.0 years. Implant group was given subcutaneous implants of oestradiol 50 mg combined with testosterone 100 mg, on average six monthly for a median of 8.5 years. Controls were not treated.


METHODS
Significant increase in bone density.


RESULTS
Bone density measured by dual beam photon absorptiometry was 1.02 (SD 0.13) g hydroxyapatite/cm2 in implant group versus 0.89 (0.11) in oral group (p less than 0.01) and 0.87 (0.14) in controls (p less than 0.01). Serum oestradiol concentration in implant group was (median) 725 pmol/l versus 170 pmol/l in oral group (p less than 0.01) and 99 pmol/l in controls (p less than 0.01). Serum follicular stimulating hormone was median 1 IU/l (range 1-11) in implant group (equivalent to premenopausal values) versus 43 (4-94) IU/l in oral group (p less than 0.01) and 72 (28-99) IU/l in controls (p less than 0.01).


CONCLUSIONS
Subcutaneous oestrogen is more effective than oral oestrogen in preventing osteoporosis, probably owing to the more physiological (premenopausal) serum oestradiol concentrations achieved. It also avoids problems of compliance that occur with oral treatment.
D000284:Administration, Oral; D001842:Bone and Bones / Q000378:metabolism*; D003430:Cross-Sectional Studies; D004958:Estradiol / Q000097:blood; D004967:Estrogens / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006882:Hydroxyapatites / Q000378:metabolism*; D007279:Injections, Subcutaneous; D016912:Levonorgestrel; D008593:Menopause; D008875:Middle Aged; D009644:Norgestrel / Q000008:administration & dosage; D010024:Osteoporosis / Q000517:prevention & control*; D013739:Testosterone / Q000008:administration & dosage* / Q000097:blood
D004967:Estrogens; D006882:Hydroxyapatites; D009644:Norgestrel; D013739:Testosterone; D004958:Estradiol; D016912:Levonorgestrel