Effect of hormone replacement therapy on bone mass in rheumatoid arthritis patients treated with and without steroids.
OBJECTIVE
To assess the effect of hormone replacement therapy (HRT) on bone mass in rheumatoid arthritis (RA) patients treated with and those not treated with steroids.


METHODS
Two hundred postmenopausal women with RA (ages 45-65 years) were randomly allocated to receive transdermal estradiol (hormone replacement therapy; HRT) (50 micrograms daily) or calcium supplementation (400 mg daily) for 2 years. Forty-two of the patients (21%) were taking corticosteroids. Bone mineral density of the lumbar spine (BMDLS) and of the proximal femur (BMDF) was measured at study entry and at 12 months and 24 months.


RESULTS
In the HRT group overall, mean BMDLS had changed by +2.22% (95% confidence interval [95% CI] +0.72, +3.72) and mean BMDF by -0.41% (95% CI -1.89, +1.07) after 24 months. In the calcium group, mean BMDLS changed by -1.19% (95% CI -2.29, -0.09) and mean BMDF by -0.56% (95% CI -2.60, +1.48). Differences between treatment groups were significant for the spine only (P < 0.001). In the 21 HRT-treated patients taking steroids, BMDLS increased by 3.75% (95% CI +0.72, +6.78) and BMDF by 1.62% (95% CI -1.27, +4.51).


CONCLUSIONS
This study shows that HRT increases spinal BMD and maintains femoral BMD in postmenopausal RA. HRT is also an effective agent in preserving bone mass in patients taking low-dose corticosteroids.
Hall
G M
GM
St. Bartholomew's Hospital, London, UK.
Daniels
M
M
Doyle
D V
DV
Spector
T D
TD
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000367:Age Factors; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000503:physiopathology*; D015519:Bone Density / Q000187:drug effects*; D002118:Calcium / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005260:Female; D005269:Femur / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000503:physiopathology; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies
D000305:Adrenal Cortex Hormones; D002118:Calcium