[Low dose estrogen replacement therapy (ERT) for postmenopausal hemodialysis (HD) patients].
We studied the short-time effects of low dose estradiol (E2) on bone metabolism in hemodialysis (HD) patients. We prescribed transdermal E2 (0.36 mg every other day) to 17 non-diabetic postmenopausal osteoporotic HD patients and measured intact parathyroid hormone (iPTH), serum NTX (sNTX), intact osteocalcin (iOC), and bone resorptive cytokines including IL-6 and TNF-alpha. Serum E2 increased from 20 to approximately 40 pg/mL, which is comparable to that of male HD patients. Three-month treatment decreased serum calcium by 0.7 mg/dL followed by a significant elevation of iPTH and iOC. Despite the increase of iPTH, collagen breakdown product, sNTX did not change significantly, implying decreased skeletal sensitivity to PTH resorbing effect. IL-6 and TNF-alpha decreased, but this trend was not statistically significant. Bone pain and/or pain from carpal tunnel syndrome resolved by ERT. We needed to dose-up active vitamin D to control enhanced iPTH. Our data suggests that E2 attenuates the resorbing effect of PTH and stimulates bone formation, also in HD patients.
Hamano
Takayuki
T
Department of Nephrology, Osaka University Postgraduate School of Medicine.
Fujii
Naohiko
N
Ito
Takahito
T
Imai
Enyu
E
Mikami
Satoshi
S
Katayama
Masaya
M
Obi
Yasue
Y
D015415:Biomarkers / Q000097:blood; D001862:Bone Resorption; D002117:Calcitriol / Q000008:administration & dosage; D003094:Collagen / Q000097:blood; D024042:Collagen Type I; D004958:Estradiol / Q000008:administration & dosage*; D015914:Estrogen Replacement Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D015675:Osteocalcin / Q000097:blood; D010012:Osteogenesis; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism; D010281:Parathyroid Hormone / Q000097:blood; D010455:Peptides / Q000097:blood; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D012727:Sex Characteristics
D015415:Biomarkers; D024042:Collagen Type I; D010281:Parathyroid Hormone; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D015675:Osteocalcin; D004958:Estradiol; D003094:Collagen; D002117:Calcitriol