Postmenopausal femur bone loss: effects of a low dose hormone replacement therapy.
OBJECTIVE
Previous studies indicate that low-dose hormone replacement therapy (LD-HRT) can relieve vasomotor symptoms and prevent spine bone loss.


METHODS
In the present study, we evaluated the effects of a low dose of conjugated equine estrogens (CEE; 0.3 mg) associated with different progestins in continuous combined scheme [2.5 mg of medroxyprogesterone acetate (n=25), 5 mg dydrogesterone (n=27), 2.5 mg nomegestrol (n=11)] as single group, on femur bone mineral density (BMD) and bone metabolism in young postmenopausal women (<or=56 years). All women were supplemented with 1 g of calcium per day, and compared with women treated with 1 g of calcium per day alone (control group, n=15). There were no significant differences in age, body mass index (BMI), hormone values, bone metabolism markers and femur BMD in the treatment and control groups before the study.


RESULTS
In calcium-treated women serum plasma osteocalcin (BGP) and hydroxyproline/creatinine urinary excretion (OHP/Cr) remained stable during all the observation period. In this group, femoral neck, Ward's triangle and trochanter BMD showed a progressive and significant (P<0.05) decrease. In the LD-HRT group, a significant (P<0.05) decrease in serum BGP and OHP/Cr was observed. In these women, the values of these markers of bone turnover at 36 months were significantly (P<0.01) different from those of calcium-treated women. During the LD-HRT administration, all BMD measures did not show any significant modifications. In these women, treated with LD-HRT the BMD values were significantly (P<0.05) different from those measured in calcium-treated women in all the femur sites of measurements. In the control group, BMI significantly (P<0.05) increased from baseline value with a weight gain of 3%, while in the LD-HRT group, BMI did not change after 36 months of treatment and the 1.3% gain in body weight was not significant. LD-HRT was effective in reducing menopausal clinical symptoms and provided a favorable bleeding profile, and minimal side effects.


CONCLUSIONS
LD-HRT was effective in reducing menopausal clinical symptoms and minimal and transient side effects were reported. In addition, the 0.30 mg/day of CEE, in addition to a proper calcium supplementation, irrespective of the progestin used, can provide effective protection against activation of bone turnover and femur osteopenia.
Gambacciani
Marco
M
Department of Obstetrics and Gynecology, University of Pisa, Via Roma 67, 56100 Pisa, Italy. margamba@tin.it
Ciaponi
Massimo
M
Cappagli
Barbara
B
Monteleone
Patrizia
P
Benussi
Caterina
C
Bevilacqua
Gemma
G
Genazzani
Andrea Riccardo
AR
D004359:Drug Therapy, Combination; D004394:Dydrogesterone / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D004966:Estrogens, Conjugated (USP) / Q000627:therapeutic use; D005260:Female; D005269:Femur; D006801:Humans; D008535:Megestrol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000517:prevention & control; D045167:Progesterone Congeners / Q000627:therapeutic use; D011446:Prospective Studies
D004966:Estrogens, Conjugated (USP); D045167:Progesterone Congeners; C047637:nomegestrol; D004394:Dydrogesterone; D008535:Megestrol