Therapeutics & Drug Briefs

BMD Response to Estrogen Replacement in Women

Source: Villareal DT, et al. JAMA. 2001;286:815-820.

The role of estrogen and progesterone replacement (HRT) for osteoporosis (OSPS) prevention is well established. Most data have accrued from relatively younger women, (ie, < 75 years old). Whether HRT provides equally beneficial OSPS effects for more senior women has not been well documented, since most data in older women is from observational studies.

In this placebo-controlled trial, Villareal and associates randomized 67 women who were considered especially high risk because of their relative frailty, to combination therapy with conjugated estrogens (0.625 mg QD) plus medroxyprogesterone acetate (5 mg QD for 13 consecutive days every third month) for 9 months. Bone mineral density (BMD) was measured at the lumbar spine and femur. Bone turnover markers were also measured. More than 90% of the women were osteopenic or osteoporotic at baseline.

BMD at the lumbar spine, and femoral neck, were statistically significantly improved in women who received HRT (eg, at the femoral neck) BMD increased 2.5%, as compared with a decrease in BMD in the placebo group. Bone turnover markers were similarly favorably affected. These data encouragingly support the concept that age should not be a barrier for consideration of HRT in at-risk menopausal women.