title: The effect of transvaginal estradiol on bone in aged women: a randomised controlled trial.
abstract: OBJECTIVE
  To investigate the effect of transvaginal estradiol on bone mineral density and bone metabolism.
  
  
  METHODS
  One hundred and fifteen women (mean age 73.8+/-3.2 years) were randomly assigned to a 2-year open-label parallel group clinical trial and were treated with either transvaginal estradiol (7.5 microg/24h), or no estradiol. Both groups received 400 IU vitamin D and 500 mg calcium/day. The bone mineral density (BMD) was assessed in the hip and spine using DXA technique and in the heel using DXL technique.
  
  
  RESULTS
  The intention to treat analysis showed that the increase in BMD in the estradiol group was significant at total hip by 0.6% (P=0.04) while the control group decreased in their BMD by 0.7%. At lumbar spine the estradiol group increased in BMD by 2.6% (P=0.011) while the control group increased by 2.2%. Bone turnover markers and PTH-levels decreased while 25-OH vitamin D levels increased in both groups, a probable effect of the calcium and vitamin D supplementation. The bone resorption marker CTx decreased more significantly in the treatment group (P=0.016).
  
  
  CONCLUSIONS
  The transvaginal estradiol treatment of 7.5 microg/24h had a small but significant effect on the BMD of total hip and lumbar spine after a follow-up of 2 years.
authors.affiliation: Centre for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden. helena.salminen@ki.se
authors.forename: Helena S
authors.initials: HS
authors.lastname: Salminen
authors.forename: Maria E
authors.initials: ME
authors.lastname: Sääf
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Johansson
authors.forename: Hans
authors.initials: H
authors.lastname: Ringertz
authors.forename: Lars-Erik
authors.initials: LE
authors.lastname: Strender
mesh_terms: D015502:Absorptiometry, Photon; D000282:Administration, Intravaginal; D000368:Aged; D000375:Aging / Q000378:metabolism*; D015519:Bone Density / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004958:Estradiol / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000378:metabolism; D010024:Osteoporosis / Q000378:metabolism / Q000517:prevention & control; D010384:Pelvic Bones / Q000187:drug effects / Q000378:metabolism; D014807:Vitamin D / Q000378:metabolism
chemical_list: D008055:Lipids; D014807:Vitamin D; D004958:Estradiol; D002118:Calcium