V. Meta-Analysis of the Efficacy of Hormone Replacement Therapy in Treating and Preventing Osteoporosis in Postmenopausal Women

Wells, George; Tugwell, Peter; Shea, Beverley; Guyatt, Gordon; Peterson, Joan; Zytaruk, Nicole; Robinson, Vivian; Henry, David; O’Connell, Diane; Cranney, Ann

doi:10.1210/er.2001-5002

Cited by 494 publications

(348 citation statements)

References 77 publications

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“…In the present study, use of ERT was associated with a lower concentration of a marker for bone collagen (PINP) synthesis compared with controls. This has been shown by others (58). The higher BMD in ERT users in the present study might be explained by an increase in the synthesis of mature bone collagen tissue, even though ERT seems to reduce the synthesis of new collagen molecules (indicated by lower s-PINP).…”

Section: Bone Turnover and Bmdsupporting

confidence: 81%

“…Bone mass density (BMD) decreases by age, especially after menopause, whereas tendon crosssectional area (CSA) is greater in postmenopausal women compared with young women (35). In postmenopausal women, estrogen replacement therapy (ERT) preserves bone mass (58), and the presence of estrogen, estrogen receptors, and mechanical loading has synergistic positive effects on bone mass (9,55). The effect of combined ERT and physical training on tendons is elusive.…”

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confidence: 99%

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Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women

Hansen

Kongsgaard²,

Holm³

et al. 2009

Journal of Applied Physiology

121

114

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Flyvbjerg A, Langberg H, Kjaer M. Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women. J Appl Physiol 106: 1385-1393, 2009. First published October 16, 2009 doi:10.1152/japplphysiol.90935.2008.-The knowledge about the effect of estradiol on tendon connective tissue is limited. Therefore, we studied the influence of estradiol on tendon synthesis, structure, and biomechanical properties in postmenopausal women. Nonusers (control, n ϭ 10) or habitual users of oral estradiol replacement therapy (ERT, n ϭ 10) were studied at rest and in response to one-legged resistance exercise. Synthesis of tendon collagen was determined by stable isotope incorporation [fractional synthesis rate (FSR)] and microdialysis technique (NH2-terminal propeptide of type I collagen synthesis). Tendon area and fibril characteristics were determined by MRI and transmission electron microscopy, whereas tendon biomechanical properties were measured during isometric maximal voluntary contraction by ultrasound recording. Tendon FSR was markedly higher in ERT users (P Ͻ 0.001), whereas no group difference was seen in tendon NH2-terminal propeptide of type I collagen synthesis (P ϭ 0.32). In ERT users, positive correlations between serum estradiol (sestradiol) and tendon synthesis were observed, whereas change in tendon synthesis from rest to exercise was negatively correlated to s-estradiol. Tendon area, fibril density, fibril volume fraction, and fibril mean area did not differ between groups. However, the percentage of medium-sized fibrils was higher in ERT users (P Ͻ 0.05), whereas the percentage of large fibrils tended to be greater in control (P ϭ 0.10). A lower Young's modulus (GPa/%) was found in ERT users (P Ͻ 0.05). In conclusion, estradiol administration was associated with higher tendon FSR and a higher relative number of smaller fibrils. Whereas this indicates stimulated collagen turnover in the resting state, collagen responses to exercise were negatively associated with s-estradiol. These results indicate a pivotal role for estradiol in maintaining homeostasis of female connective tissue. connective tissue; tendon fibrils; insulin-like growth factor-I; extracellular matrix; bone CROSS-SECTIONAL FINDINGS INDICATE that sex hormones influence tendon biomechanical properties (36), extracellular matrix adaptability in response to mechanical loading (11,21,36,41,59), and the risk of sustaining soft tissue injuries (11,24,25).Estrogen receptors have been localized in ligaments (32, 33), and tendons express transcripts for estrogen receptors (23). Nevertheless, the effect of estrogen on tendon and ligament turnover is not clarified. Thus an inhibiting effect (34, 60), no effect (51), and a stimulating effect (32) on collagen synthesis and fibroblast proliferation in vitro have been observed in anterior cruciate ligament (ACL) tissue samples. These contrasting findings are probably related to the variation between animal species and the applied methods. This ...

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Section: Bone Turnover and Bmdsupporting

confidence: 81%

mentioning

confidence: 99%

Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women

Hansen

Kongsgaard²,

Holm³

et al. 2009

Journal of Applied Physiology

121

114

View full text Add to dashboard Cite

show abstract

“…Several studies from the 1970s reported that treatment with estrogen alone or estrogen plus progestogen at the time of menopause prevented accelerated bone loss (9,10). According to a meta-analysis published in 2002, preparations of estrogen with or without progestogen were significantly more effective than placebo in preserving and increasing BMD (11). Several follow-up studies demonstrated that discontinuation of estrogen therapy caused bone loss similar to that seen in early menopause (24).…”

Section: Ovx Ert Ovx E+p Rtmentioning

confidence: 99%

“…Clinical trials evaluating the changes of bone microarchitecture during postmenopausal osteoporosis and the effects of therapuetic agents on these changes are needed. The hormone replacement therapy (HRT) is known to prevent accelerated bone loss (9,10) and improve bone mass in postmenopausal osteoporosis (11). In addition to improvement in BMD, fractures were decreased with hormone therapy (12).…”

Section: Introductionmentioning

confidence: 99%

Osteoprotective effect of hormone therapy on bone microarchitecture before impaired bone mineral density in ovariectomized rats

Terzi¹,

Çırpan²,

Terzi³

et al. 2012

J Turkish German Gynecol Assoc

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ÖzetObjective: We aimed to determine the effect of hormone replacement therapy on bone microarchitecture in ovariectomized rats. Material and Methods:In the Animal Ethics Committee approvedstudy, the effect of treatment with 17 β-estradiol 50 μg/kg and medroxyprogesterone 2.5 mg/kg on bone architecture and bone mineral density in rats versus ovariectomized control rats over the course of 20 days were evaluated. Femoral and lumbar bone mineral density levels and morphometric measurements were performed.Results: There were no significant differences in the femoral and lumbar bone mineral density levels between the groups. In the intact control group, the trabecular structures were significantly superior to those in the other groups. Additionally, the osteoblast count was significantly higher while the osteoclast count was significantly lower than in all other groups. Two parameters reflecting trabecular bone microarchitecture, which include the trabecular count and the trabecular area, demonstrated significant improvement in the hormone replacement group when compared to the ovariectomized control group. In the hormone replacement groups, the osteoblast count was significantly higher while the osteoclast count was significantly lower than in the ovariectomized control group. Conclusion:We suggest that offering estrogen alone or in combination with progestogen can be a beneficial approach in preventing early postmenopausal bone loss regardless of bone mineral density. (J Turkish-German Gynecol Assoc 2012; 13: 261-6)

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“…Estrogen replacement therapy reduces bone resorption by decreasing serum levels of osteoclast-stimulating cytokines and up-regulating transforming growth factor beta, which inhibits bone resorption by decreasing the activity of osteoclasts and increasing their apoptosis. [2] Estrogen prevents postmenopausal bone loss, improves bone density, [3][4][5][6][7] reduces the incidence of vertebral fractures in postmenopausal women 472…”

Section: Introductionmentioning

confidence: 99%

The Effect of Alendronate, Risedronate, and Raloxifene on Renal Functions, Based on the Cockcroft and Gault Method, in Postmenopausal Women

et al. 2007

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Background. Oral alendronate, risedronate, and raloxifene are effective treatment options in the management of postmenopausal osteoporosis. There is little previously reported about the renal safety profiles of these three agents in osteoporosis. We aimed to assess the risk of renal toxicity associated with oral alendronate, risedronate, and raloxifene in the treatment of osteoporosis, prospectively. Methods. One hundred and twentyseven patients with osteoporosis and osteopenia according to lumbar or femoral-neck bone mineral density t score were enrolled in the study. The patients were randomized to alendronate 70 mg once weekly (n = 47), risedronate 35 mg once weekly (n = 44), or raloxifene 60 mg per day (n = 36) for one year. Preliminary screening included medical history, physical examination, lumbar and femoral bone mineral densitometry measurement, and blood biochemical tests, including renal function tests. The biochemical markers were then assessed at the end of 12 months. Results. There was no significant difference between basal and final renal function parameters of each group. Also these parameters did not differ between the three groups after 12 months of treatment period. Conclusions. These results demonstrate that alendronate, risedronate, and raloxifene are all safe drugs for renal functions in the treatment of osteoporosis.

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V. Meta-Analysis of the Efficacy of Hormone Replacement Therapy in Treating and Preventing Osteoporosis in Postmenopausal Women

Abstract: HRT has a consistent, favorable and large effect on bone density at all sites. The data show a nonsignificant trend toward a reduced incidence in vertebral and nonvertebral fractures.

Cited by 494 publications

References 77 publications

Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women

Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women

Osteoprotective effect of hormone therapy on bone microarchitecture before impaired bone mineral density in ovariectomized rats

The Effect of Alendronate, Risedronate, and Raloxifene on Renal Functions, Based on the Cockcroft and Gault Method, in Postmenopausal Women

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