Alveolar and postcranial bone density in postmenopausal women receiving hormone/estrogen replacement therapy: a randomized, double-blind, placebo-controlled trial.
BACKGROUND
We conducted a 3-year, double-blind, randomized, placebo-controlled study to determine whether the positive effects of hormone/estrogen replacement therapy (H/ERT) on postcranial bone density are accompanied by similar positive effects on oral bone mass.


METHODS
A total of 135 postmenopausal women (aged 41-70 years) with no evidence of moderate or severe periodontal disease were randomized to receive daily oral conjugated estrogen (Premarin; 0.625 mg) alone or in combination with medroxyprogesterone acetate (Prempro; 0.625 and 2.5 mg, respectively) or placebo. All subjects received calcium carbonate (1000 mg/d) and cholecalciferol (400 [corrected] IU/d) supplements. The primary efficacy end points were the changes in alveolar crest height and alveolar bone density. Alveolar crest height was measured on bite-wing radiographs, and changes in alveolar bone mass were assessed by means of digital-subtraction radiography. Postcranial bone density was measured in the lumbar spine and left proximal femur by means of dual-energy x-ray absorptiometry.


RESULTS
Hormone/estrogen replacement therapy significantly increased alveolar bone mass compared with placebo (+1.84% vs +0.95% [P =.04]), and tended to improve alveolar crest height (+4.83% vs +3.46% [P =.34]). Bone mineral density of the proximal femur significantly increased in the H/ERT compared with the placebo group (total proximal femur, +3.59% vs +0.22% [P =.001]; neck, +2.05% vs -0.34% [P =.02]; trochanter, +3.49% vs +0.08% [P<.001]), but not the lumbar spine (+1.01% vs +0.17% [P =.39]). Changes in alveolar bone mass correlated with bone density changes in the total femur (r = 0.28 [P =.02]) and femoral trochanter (r = 0.25 [P =.04]) in the H/ERT but not in the placebo group.


CONCLUSIONS
Postcranial and oral bone mass were increased in postmenopausal women receiving H/ERT. Improvement in oral bone health constitutes an additional benefit of H/ERT.
Civitelli
Roberto
R
Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine and Barnes-Jewish Hospital, St Louis, MO 63110, USA. rcivitel@im.wustl.edu
Pilgram
Thomas K
TK
Dotson
Mary
M
Muckerman
Jane
J
Lewandowski
Nancy
N
Armamento-Villareal
Reina
R
Yokoyama-Crothers
Naoko
N
Kardaris
E Eugenia
EE
Hauser
Jay
J
Cohen
Sheldon
S
Hildebolt
Charles F
CF
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000517:prevention & control*; D015519:Bone Density / Q000187:drug effects*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods; D004966:Estrogens, Conjugated (USP) / Q000627:therapeutic use; D005260:Female; D005269:Femur / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control*
D004966:Estrogens, Conjugated (USP); D017258:Medroxyprogesterone Acetate