Sunday, September 9, 2018

Do Estrogens improve bone mass in osteoporotic women over ten years of menopause

A retrospective analysis of 24 patients with established osteoporosis and with ten or more years of menopause treated with conjugated estrogen, progesterone and calcium followed for one year has been performed. Treated women received 0.625 mg/day of conjugated estrogen from day 1 to 25, 5 mg/day of medroxiprogesterone from day 13 to 25, of each cycle, plus calcium (500 - 1000 mg/day), during one year (12 cycles). As control group was used 18 age-matched that received only calcium (500 a 1000 mg/day). All patients had at least two dual-photon spine and proximal femur (neck, Ward's triangle and trocanter) densities measurements performed 12 months apart.

Estrogen treatment was associated with increased bone mineral density at spine and trochanter. Control group did not present any statistically change after one year in any site studied. We concluded that women with ten or more years of menopause and established osteoporosis treated with replacement hormonal therapy and calcium results in improvement of bone mineral density. These data support that women with ten or more years of menopause respond to estrogen replacement therapy with absolute increments in bone density similar to those seen in younger women, in the early menopause.

Prevention of postmenopausal bone loss remains a well-recognized indication for estrogen replacement therapy. It has been repeatedly demonstrated that estrogen replacement in either oophorectomized or early postmenopausal women stabilizes spinal bone density by inhibiting bone remodeling and preventing the accelerated bone loss associated with estrogen deficiency. Since bone mineral density (BMD) is an important determinant of the risk of fracture, it is not surprising that several case-control studies have associated estrogen replacement in postmenopausal women with reduced rates of hip, wrist, or vertebral fractures.

However, the role of estrogens in the treatment of established postmenopausal osteoporosis is not as clear. New studies show that estrogens increases spine density and, this benefit is likely long lasting. The efficacy of estrogen in women with more than 10 or more years of menopause has been uncertain although improved bone mineral density (BMD) in this setting has recently been demonstrated.

We retrospectively reviewed our clinic-based experience with a treatment for moderate to severe osteopenia using calcium, estrogen and progesterone in women with ten or more than 10 years of menopause. The response to treatment was assessed with measurements of spinal and proximal femur BMD.

 Treatment with conjugated equine estrogen and progesterone results in increased bone mass in patients with classical postmenopausal osteoporosis after ten years of menopause.

Our data also support that the same dose of estrogen used to prevent bone loss in immediate postmenopausal women is also sufficient to slow the most aggressive bone loss that might be expected in patients with established osteoporosis.

More studies using only estrogen without progesterone, with more subjects, during more time need to be done in order to shed light in this new approach of treatment of older women with established osteoporosis.