Skeletal effects of oral oestrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women.

Abstract

Study objective-To compare oral and implanted oestrogens for their effects in preventing postmenopausal osteoporosis.Design-Non-randomised cohort study of postmenopausal women treated with oral or depot oestrogens and postmenopausal controls.Setting-Gynaecological endocrine clinic in tertiary referral centre.Patients-Oral treatment group of 37 postmenopausal women (mean age 57*5 years, median 8-75 years from last menstrual period), compared with 41 women given oestrogen implants (mean age 56-2 years, median 9-5 years from last menstrual period) and 36 controls (mean age 51-8 years, median 2.0 years from last menstrual period). Weight was not significantly different among the groups.Interventions-Oral treatment group was given continuous treatment with cyclic oestrogen and progesterone preparations (Prempak C or Cycloprogynova) for a median of 8-0 years. Implant group was given subcutaneous implants of oestradiol 50 mg combined with testosterone 100 mg, on average six monthly for a median of 8 5 years. Controls were not treated.End point-Significant increase in bone density. Measurements and main results-Bone density measured by dual beam photon absorptiometry was 1*02 (SD 0-13) g hydroxyapatite/cm2 in implant group versus 0-89 (0-11) in oral group (p<001) and 0-87 (0-14) in controls (p<0.01). Serum oestradiol concentration in implant group was (median) 725 pmolIl versus 170 pmolIl in oral group (p<001) and 99 pmol/l in controls (p<0-01). Serum follicular stimulating hormone was median 1 IU/I (range 1-11) in implant group (equivalent to premenopausal values) versus 43 (4-94) IU/I in oral group (p<0-01) and 72 (28-99) IU/I in controls (p<0-01).Conclusions-Subcutaneous oestrogen is more effective than oral oestrogen in preventing osteoporosis, probably owing to the more physiological (premenopausal) serum oestradiol concentrations achieved. It also avoids problems of compliance that occur with oral treatment. IntroductionPeak bone mass is achieved in the fourth decade of life in both men and women, after which it decreases with age. The rate at which bone is lost accelerates in women after the menopause to the extent that they have lost half of their skeletal calcium by the age of 70. This leads to the excess of osteoporotic fractures in

Is dehydroepiandrosterone a hormone?

“…Similarly, subcutaneous E 2 and testosterone implants have been found to be more efficient than oral estrogen in preventing osteoporosis in postmenopausal women (Savvas et al 1988). Although the difference observed in that study has been attributed to the different routes of administration of the estrogen, the cause of the difference could well be the action of testosterone.…”

“…A predominant role of androgens in bone physiology is well documented (Chesnut et al 1983, Need et al 1987, Savvas et al 1988, Davis et al 1995, Raisz et al 1996, Labrie et al 1997b, Martel et al 1998, Baulieu et al 2000, Figure 8 Schematic representation of the very important contribution of the precursor DHEA of adrenal origin to total androgenic activity in postmenopausal women with a parallel minor contribution of testosterone (TESTO) of ovarian and adrenal origins. By intracrine mechanisms, DHEA is transformed into testosterone and DHT in peripheral tissues and then into the inactive metabolites ADT and 3 -diol before transformation into the water soluble glucuronide derivatives ADT-G, 3 -diol-3 G and 3 -diol-17 G by the UGTs 2B7, 2B15 and 2B17.…”

A clinical trial on the effects of a combination of elcatonin (Carbocalcitonin) and conjugated estrogens on vertebral bone mass in early postmenopausal women

“…In conclusion, therefore, a conjugated estrogens/ calcitonin combination has been shown to increase vertebral bone mass to levels previously recorded only with very high doses of estrogen [24]. The combination presents exciting possibilities and seems a very safe therapeutic regimen; there is good patient acceptability.…”

Prevention of fractures in the elderly: A review

“…In 20 recent prospective and randomized studies, a difference of approximately 3 percent a year compared to a control group was found (Nachtigall et al 1979, Genant et al 1982. Sanvig Christensen et al 1982, Christiansen and Rodbro 1984, Linday et al 1984, Jensen et al 1987, Riis et al 1987, Munk-Jensen et al 1988, Riis et al 1988, Savvas et al 1988, Adami et al 1989, Ribot et al 1989, Hirvonen et al 1990, Stevenson et al 1990, Gallagher et al 1991, McNeeley et al 1991, Casteol-Branco et al 1992, Ettinger et al 199213, Lufkin et al 1992, Field et al 1993 (Table 3). However, all except one of these investigators (Lufkin et al 1992) have started the treatment at menopause and, in most studies, subjects have not been selected because of a low bone mass.…”