Prevention of early postmenopausal bone loss: controlled 2‐year study in 315 normal females

Abstract

With the aim of preventing postmenopausal bone loss, a placebo-controlled double-blind trial of 2 years duration was performed. We randomized 315 healthy volunteers in their early natural menopause to seven treatment and three placebo groups: 17 beta-oestradiol, oestriol and sequential norethisteron (hormones); bendroflumethiazide 5 mg/day (thiazide); hormones and thiazide; sodium fluoride 20 mg/day; vitamin D3 2000 IU/day (D3); fluoride and D3; and 1 alpha (OH) vitamin D3 0.25 microgram/day (1 alpha D3). All participants were given daily calcium supplement of 500 mg. Every 3 months we measured the bone mineral content (BMC) of both forearms by photon absorptiometry and chemical quantities in blood and 48 h urinary collections. The study was completed by 264 (84%). The combined placebo groups showed a linear fall in BMC reaching 3.3% after 2 years (P < 0.001). Hormones and hormones and thiazide led to a 2.5% gain in BMC (P < 0.01). Thiazide alone postponed the BMC fall for 6 months. After 2 years the thiazide group showed a BMC fall of 1.5% (P < 0.05), less than that of the placebo group (P < 0.05). BMC declined by 3.6%, 4.5%, 3.7% and 3.7% during the respective use of fluoride, D3, fluoride and D3 and 1 alpha D3. Nevertheless, the urinary calcium excretion during 1 alpha D3 and D3 treatment was 1--1.5 mmol/day higher than in the placebo groups. Apparently, there is no real alternative to oestrogen/gestagen in the prevention of postmenopausal osteoporosis.

Sex steroids and bone mass. A study of changes about the time of menopause.

“…Estrogen therapy has also been shown to reduce the rate of bone loss after natural menopause (6), as well as to reduce the incidence of vertebral deformities (5, 7). Some case-control studies have suggested that serum estrogens may be lower in patients with crush fractures (8), whereas others have found no such effect (9-1 1).…”

Bone mineral density after adjuvant chemotherapy for premenopausal breast cancer

“…This dramatic temporary increase in the rate of bone loss around natural menopause or after bilateral ovariectomy has been ascribed to a ceasing protection from bone loss by ovarian hormones (Riggs et al, 1981(Riggs et al, , 1982(Riggs et al, , 1986Genant et al, 1982;Johnston et al, 1985;Richelson et al, 1984). Oestrogen replacement therapy effectively prevents osteoporosis in post-menopausal women if started within a few years after menopause (Riis, 1987;Lindsay et al, 1976;Christiansen et al, 1980;Recker et al, 1977).…”

“…This dramatic temporary increase in the rate of bone loss around natural menopause or after bilateral ovariectomy has been ascribed to a ceasing protection from bone loss by ovarian hormones (Riggs et al, 1981(Riggs et al, , 1982(Riggs et al, , 1986Genant et al, 1982;Johnston et al, 1985;Richelson et al, 1984). Oestrogen replacement therapy effectively prevents osteoporosis in post-menopausal women if started within a few years after menopause (Riis, 1987;Lindsay et al, 1976;Christiansen et al, 1980;Recker et al, 1977).Adjuvant chemotherapy in premenopausal women treated for breast cancer frequently leads to diminished ovarian function and premature menopause (Henderson, 1987). Since early menopause is one of the strongest predictors of osteoporosis (Richelson et al, 1984), we anticipated that the widely used adjuvant chemotherapy regimen of cyclophosphamide, methotrexate and 5-fluorouracil (CMF), might seriously precipitate osteoporosis.…”

Terapêutica de reposição hormonal na osteoporose da pós menopausa

“…Os progestágenos sintéticos ou naturais combinados com estrógeno têm sido utilizados com êxito na prevenção e tratamento da osteoporose, já que seus efeitos no osso não se contrapõem (21). Os progestágenos derivados 19-nor, como por exemplo, a noretisterona, o efeito anabólico, pode reduzir os índices de reabsorção sem modificar os de formação com incremento do osso trabecular (22).…”