Safety and efficacy of estrogen therapy in preventing bone loss in primary biliary cirrhosis.
OBJECTIVE
Estrogen therapy has been found to be useful in the treatment of postmenopausal osteoporosis. However, concern about its potential for worsening cholestasis has limited its use in postmenopausal women with primary biliary cirrhosis. The aim of the present study was to determine the safety as well as the efficacy of estrogen replacement therapy with respect to bone mass in postmenopausal women with primary biliary cirrhosis.


METHODS
Bone mineral density of the lumbar spine (measured using dual energy x-ray absorptiometry) of 46 unselected postmenopausal women with primary biliary cirrhosis receiving estrogen replacement therapy was compared with 46 age-matched women with primary biliary cirrhosis not receiving estrogen replacement therapy, and with the expected normal bone mineral density adjusted for age and ethnic group.


RESULTS
The mean duration of follow-up was 4.8 +/- 0.4 yr. Treatment with estrogens resulted in a significantly lower rate of bone loss (0.002 g/cm(2)/yr +/- 0.028 vs 0.009 g/cm(2)/yr +/- 0.020, p = 0.05). Worsening cholestasis attributable to estrogen replacement therapy did not occur in any patient. One patient (2%) discontinued therapy because of side effects.


CONCLUSIONS
Estrogen replacement therapy in postmenopausal patients with primary biliary cirrhosis is safe and may be effective in decreasing the rate of bone loss.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905-0001, USA.
K V Narayanan
KV
Menon
Paul
P
Angulo
Gwen M
GM
Boe
Keith D
KD
Lindor
D000328:Adult; D000367:Age Factors; D000368:Aged; D015519:Bone Density / Q000187:drug effects; D002779:Cholestasis / Q000139:chemically induced*; D015331:Cohort Studies; D000075202:Contraindications; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors