Regional and total skeletal measurements in the early postmenopause

The skeletal effects of two therapies for endometriosis that produce hypo-oestrogenism in 23 premenopausal women have been studied. Eleven women received goserelin 3.6 mg monthly by subcutaneous implant and 12 women received danazol 600 mg daily, orally, both for 6 months. Goserelin causes a small decline in spinal bone density, but a greater loss of density in the proximal femur. Preliminary results show no evidence that bone loss is reversible after stopping therapy. Danazol treatment is not associated with loss of bone. Prolonged or repeated courses of treatment with goserelin alone could lead to a clinically significant adverse effect on the skeleton.

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“…BD varies in different anatomical sites, and specific regional measurements are therefore necessary for proper skeletal evaluation [8],…”

Section: Discussionmentioning

confidence: 99%

A Comparison of the Skeletal Effects of Goserelin and Danazol in Premenopausal Women with Endometriosis

et al. 1989

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“…These measurements correspond poorly with those in the more clinically relevant sites, the spine and most importantly, the hip (15). With the introduction of newer scanning techniques such as dual photon absorptiometry (DPA) and dual energy X-ray absorptiometry (DEXA), oestrogens have been shown to conserve bone in the lumbar spine ( 1 0 , l l ) and, more recently, in the femoral neck (1 1) (Fig.…”

Section: Osteoporosismentioning

confidence: 99%

The Long-Term Risks and Benefits of Hormone Replacement Therapy

et al. 1991

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Summary There is increasing awareness that the long‐term consequences of ovarian failure can be prevented or reduced with appropriate hormone replacement therapy (HRT). After the menopause, there is a rapid loss of trabecular bone resulting in a one in two lifetime risk of osteoporotic fracture. HRT prevents this bone loss and decreases the incidence of fracture. A minimum of 5 years treatment is recommended for significant benefit. Epidemiological evidence is accumulating that post‐menopausal oestrogen therapy reduces the risk of cardiovascular disease and stroke by between 30 and 70% even in the presence of established risk factors. Given the prevalence of cardiovascular disease, this is likely to be one of the principle benefits of HRT in the next decade. Concerns about the long‐term safety of HRT have focused on endometrial and breast cancer. The increase in risk of endometrial cancer associated with oestrogen only therapy is abolished with the sequential addition of a progestogen for 10–12 days each cycle. The possible effect of HRT on breast cancer risk has to be considered against the background of a one in 12 lifetime risk of developing this disease. The epidemiological studies investigating this relationship are reviewed in this paper. There is a broad consensus that 5–6 years duration of HRT does not increase breast cancer risk. Longer durations of therapy (10–15 years) have been reported to increase this risk although not all the data are in agreement. Other factors, such as family history and benign breast disease, may also influence the risk of breast cancer. The potential benefits of HRT on mortality and morbidity are enormous. Against this is a possible small increase in breast cancer risk with long‐term usage. Greater awareness of the long term consequences of the menopause and the potential benefits of HRT should be encouraged so that women can make informed decisions about their need for HRT.

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“…Early postmenopausal bone loss due to lack of estrogens occurs primarily in trabecular bone at the spine and forearm [4]. There is, however, some conflicting evidence on the estrogen dependence of the mineral content of the proximal femur [4,5]. Moreover, almost no information is available about the effect of estrogen deficiency on peripheral weightbearing bones such as the tibia.…”

Section: Introductionmentioning

confidence: 99%

Bone mineral density in young women with long-standing amenorrhea: Limited effect of hormone replacement therapy with ethinylestradiol and desogestrel

et al. 1994

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To assess bone mineral density (BMD) at different skeletal sites in women with hypothalamic or ovarian amenorrhea and the effect of estrogen-gestagen substitution on BMD we compared BMD of 21 amenorrheic patients with hypothalamic or ovarian amenorrhea with that of a control population of 123 healthy women. All amenorrheic patients were recruited from the outpatient clinic of the Division of Gynecological Endocrinology at the University of Berne, a public University Hospital. One hundred and twenty-three healthy, regularly menstruating women recruited in the Berne area served as a control group. BMD was measured using dual-energy X-ray absorptiometry (DXA). At each site where it was measured, mean BMD was lower in the amenorrheic group than in the control group. Compared with the control group, average BMD in the amenorrheic group was 85% at lumbar spine (p < 0.0001), 92% at femoral neck (p < 0.02), 90% at Ward's triangle (p < 0.03), 92% at tibial diaphysis (p < 0.0001) and 92% at tibial epiphysis (p < 0.03). Fifteen amenorrheic women received estrogen-gestagen replacement therapy (0.03 mg ethinylestradiol and 0.15 mg desogestrel daily for 21 days per month), bone densitometry being repeated within 12-24 months. An annual increase in BMD of 0.2% to 2.9% was noted at all measured sites, the level of significance being reached at the lumbar spine (p < 0.0012) and Ward's triangle (p < 0.033). In conclusion BMD is lower in amenorrheic young women than in a population of normally menstruating, age-matched women in both mainly trabecular (lumbar spine, Ward's triangle, tibial epiphysis) and mainly cortical bone (femoral neck, tibial diaphysis).(ABSTRACT TRUNCATED AT 250 WORDS)

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Regional and total skeletal measurements in the early postmenopause

Cited by 4 publications

References 9 publications

A Comparison of the Skeletal Effects of Goserelin and Danazol in Premenopausal Women with Endometriosis

A Comparison of the Skeletal Effects of Goserelin and Danazol in Premenopausal Women with Endometriosis

The Long-Term Risks and Benefits of Hormone Replacement Therapy

Bone mineral density in young women with long-standing amenorrhea: Limited effect of hormone replacement therapy with ethinylestradiol and desogestrel

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