The effect on cartilage of different forms of application of postmenopausal estrogen therapy: comparison of oral and transdermal therapy.
The effect on urine C-telopeptides of type II collagen (uCTX-II) of oral and transdermal estradiol treatment was compared using samples from two randomized, double-blind, placebo-controlled trials. A total of 171 healthy, Danish postmenopausal women, 45-65 years of age completed the 2-year study periods. The uCTX-II marker assessed cartilage degradation, and this response was compared with the effect on urine C-telopeptides of type I collagen (uCTX-I), considered a specific marker of bone resorption. Doses in the oral estradiol treatment groups (continuous combined therapy) were 1 mg 17-beta-estradiol+1 mg drosperinone or 1 mg 17-beta-estradiol+2 mg drosperinone or 1 mg 17-beta-estradiol+3 mg drosperinone or placebo. Doses in the transdermal estradiol treatment groups (continuous combined therapy) were 45 microg 17-beta-estradiol+30 levonorgestrel or 45 microg 17-beta-estradiol+40 microg levonorgestrel or placebo. The effect of oral and transdermal estradiol therapy on cartilage degradation was reflected as a decrease of 19-30% in uCTX-II (P=0.02 and P=0.003 vs. placebo) after 1 year of treatment. uCTX-I decreased 70% (P<0.0001 vs. placebo) reflecting a pronounced effect on bone resorption that was consistent with a 2-year increase in spine and hip BMD of 7-8% and 4-6%, respectively. The results indicate that different regimens of postmenopausal HRT both have an effect on cartilage and bone thus protecting against osteoporosis and osteoarthritis (OA). However, long-term clinical trials are needed to further investigate this issue.
Ravn
Pernille
P
Center for Clinical and Basic Research, Ballerup Byvej 222, DK-2750 Ballerup, Denmark. CCBR_Ballerup@CCBR.DK
Warming
Lise
L
Christgau
Stephan
S
Christiansen
Claus
C
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000368:Aged; D000736:Androstenes / Q000008:administration & dosage / Q000494:pharmacology; D015519:Bone Density / Q000187:drug effects; D002356:Cartilage / Q000187:drug effects* / Q000378:metabolism; D024042:Collagen Type I / Q000378:metabolism / Q000652:urine; D024043:Collagen Type II / Q000378:metabolism / Q000652:urine; D003718:Denmark; D004311:Double-Blind Method; D004958:Estradiol / Q000008:administration & dosage / Q000494:pharmacology; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D006801:Humans; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage / Q000494:pharmacology; D010446:Peptide Fragments / Q000378:metabolism / Q000652:urine; D016896:Treatment Outcome
D000736:Androstenes; D024042:Collagen Type I; D024043:Collagen Type II; D004967:Estrogens; D000451:Mineralocorticoid Receptor Antagonists; D010446:Peptide Fragments; D004958:Estradiol; C035144:drospirenone