Effect of Menopausal Hormone Therapy on Bone Mineral Density in Chinese Women: A 2-Year, Prospective, Open-Label, Randomized-Controlled Trial

Abstract

BackgroundThis study was designed to explore the effect of menopausal hormone therapy (MHT) on bone mineral density (BMD) in Chinese women.Material/MethodsThis was a prospective, open-label, randomized-controlled clinical trial. We randomly assigned 123 postmenopausal women to 3 groups: group A received 0.625 mg conjugated equine estrogen (CEE) plus 100 mg micronized progesterone (MP), group B received 0.3 mg CEE daily plus 100 mg MP, and group C received 0.625 mg CEE daily plus 10 mg dydrogesterone (DHG). All subjects received a 2-year intervention and drugs were given in a continuous sequential pattern.ResultsNinety-six patients were followed up. At 1 year, groups A and B gained 2.31% and 1.95% BMD, respectively (P<0.01); at 2 years, groups B and C gained 2.37% and 4.15% BMD (P<0.01) respectively. At 2 years, group A gained 3.28% BMD in the femoral neck and 3.77% BMD in Ward’s triangle (P<0.05). At 1 year, group B lost 2.14% BMD in the trochanter and 1.20% BMD in the total hip (P<0.05); at 2 years, group B lost 1.51% BMD in the total hip (P<0.01). ALP, Ca, P, and Ca/Cr levels were all decreased in the 3 groups (P<0.05). The changes in Cr level at 1 and 2 years were not significant when compared with baseline in all groups (P>0.05).ConclusionsBoth lower-dose and standard-dose CEE increased lumbar BMD, sustain femoral neck BMD, and Ward’s triangle BMD, while there was a reduced bone turnover rate. Standard-dose CEE combined with MP can increase BMD at these 2 sites. CEE combined with MP is recommended because it has better clinical benefits.

N-myc Downstream-Regulated Gene 2 (NDRG2) Promotes Bone Morphogenetic Protein 2 (BMP2)-Induced Osteoblastic Differentiation and Calcification by Janus Kinase 3 (JAK3)/Signal Transducer and Activator of Transcription 3 (STAT3) Signaling Pathway

“…Hormone replacement treatment (HRT) is usually used in postmenopausal osteoporosis (PMOP) therapy. However, long-term use of chemical synthetic hormones may cause hyperplasia and cancerization of the reproductive system and the occurrence of cardiovascular and cerebrovascular diseases [11][12][13].…”

A Review: Mechanistic Insights Into the Effect of Thyroid Disorders on Estrogen Level and Bone Mineral Density

“…2.31% and 1.95% in bone mineral density of group A and B. There is an elevation in bone mineral density of lumbar, femoral neck and ward triangle with both lower and standard doses of CEE with a reduced bone turnover [72].…”

“…In postmenopausal women there is a rapid bone loss, accelerates continuously after menopause. In postmenopausal women, it seems that bone resorption exceeds than its formation due to the declining level of estrogen hence women of postmenopausal age are more susceptible to osteoporosis [72]. Estrogen shield, bone loss by suppression of inflammatory cytokines such as interleukin (IL-1, IL-6), slowing bone decay, and hence reducing fracture risk [73].…”

Clinical Pharmacists in Chronic Care

“…Hormone replacement therapy (HRT) is not first-line therapy position for osteoporosis, but is best for prevention of osteoporosis [157]. However, different types of estrogen or progestogen, as well as different formulations, doses, timing of initiation, durations of therapy, and patient characteristics, may play different roles in the effects of HRT [158]. Pharmacist-physician collaboration is associated with higher treatment rates of osteoporosis [159].…”