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Abstract
Objective: To re-examine the minimal effective dose of conjugated estrogen (CEE)-progestin
hormone replacement on postmenopausal bone loss. Design: A 2-year, prospective, open label, randomized study. Setting: Department of Obstetrics and Gynecology of a university hospital. Participants: Fifty-two postmenopausal or oophorectomized women. Intervention: One of the following regimens was continuously administered for 2 years: (1) CEE
0.625 mg/day, (2) CEE 0.625 mg + medroxyprogesterone (MPA) 2.5 mg/day, (3) CEE 0.31
mg + MPA 2.5 mg/day and (4) control. Measurements: Lumbar spine and femoral BMD by dual energy X-ray absorptiometry (DXA), a monthly
based incidence of bleeding, serum lipids, PTH, calcitonin, Al-p, and osteocalcin.
Results: Of the 52 patients enrolled in this study, 49 patients completed the 1 year of therapy
and 36 completed the 2- year study. The control group showed a significant decrease
in lumbar BMD over the 2 years (P < 0.05). The % changes in lumbar BMD at 2 years of CEE alone, CEE 0.625 + MPA and
CEE 0.31 + MPA were 8.52% (95% confidence intervals; 4.61 ∼ 12.4%), 7.4% (0.60 ∼ 14.2%)
and 3.20% (0.61 ∼ 5.84%), respectively, and were significantly higher than pretreatment
values. The incidence of bleeding was significantly lower in women taking CEE 0.31
mg + MPA. HDL cholesterol increased in women taking CEE 0.625 mg alone or with MPA.
No significant changes in lipid profiles were seen in the control or in the group
of women taking CEE 0.31 mg + MPA. Conclusions: Continuous hormone replacement therapy (HRT) using 0.31 mg of CEE and 2.5 mg of
MPA is effective in increasing lumbar BMD in postmenopausal or oophorectomized women
and can be an appropriate option for women with a normal lipid profile or those women
wishing to eliminate unscheduled bleeding.
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References
- Quantitative computed tomography of vertebral spongiosa: a sensitive method for detecting early bone loss after oophorectomy.Ann Intern Med. 1982; 97: 699-705
- The minimum effective dose of estrogen for prevention of postmenopausal bone loss.Obstet Gynecol. 1984; 63: 759-763
- Physician's Resource manual on osteoporosis. A decisionmaking guide. National Osteoporosis Foundation. Co. Medica Inc, 1987
- Conference report. Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med. 90. 1991: 107-110
- Biological effects of various doses of conjugated equine estrogens in postmenopausal women.J Clin Endocrinol Metab. 1980; 51: 620-625
- Continuous combined conjugated equine estrogen-progestogen therapy: effects and endometrial histologic diagnosis.Am J Obstet Gynecol. 1992; 167: 1-7
- Bleeding patterns in postmenopausal women taking continuous combined or sequential regimens of conjugated estrogens with medroxyprogesterone acetate.Obstet Gynecol. 1994; 83: 686-692
- Pre- and postmenopausal bone mineral density of the spine and proximal femur in Japanese women assessed by dual-energy X-ray absorptiometry: a crosssectional study.J Bone Miner Res. 1993; 8: 183-189
- Vertebral bone mineral analysis: an integrated approach with CT.Radiology. 1987; 164: 419-423
- The physiological and clinical significance of bone histomorphometric date.in: Recker RR Bone Histomorphometry. Techniques and Interpretation. CRC Press, Boca Raton, FL1982: 143-223
- Comparison of single- and dual-photon absorptiometry in postmenopausal bone mineral loss.J Nucl Med. 1985; 26: 1257-1262
- Postmenopausal bone loss is prevented by treatment with low-dosage estrogen with calcium.Ann Int Med. 1987; 106: 40-45
- Effects of 2 years of hormone replacement upon bone mass, serum lipids and lipoproteins.Maturitas. 1994; 19: 13-23
- Effect of progestin therapy on cortical and trabecular bone: comparison with estrogen.Am J Med. 1991; 90: 171-178
- The effects of various regimens of hormone therapy on serum cholesterol and triglyceride concentrations in postmenopausal women.Br J Obstet Gynecol. 1980; 87: 552-560
- Effect of estrogen/progestin potency on lipid/lipoprotein cholesterol.New Engl J Med. 1983; 308: 862-867
- Continuous low-dose oestrogen and progestogen hormone replacement therapy: a randomised trial.Med J Aust. 1993; 19: 102-106
- Efficacy of a continuous estrogen-progestin regimen in the menopausal patient.Obstet Gynecol. 1987; 69: 929-932
- Endometrial histology and bleeding paterns after 8 years of continuous combined estrogen and progestogen therapy.Obstet Gynecol. 1991; 78: 1008-1010
- Continuous combined hormonal replacement therapy and the risk of endometrial cancer.Menopause: J N Am Menopause Soc. 1994; 1: 57-59
- The ‘red queen’ and endometrial hyperplasia.Fertil Steril. 1994; 61 (Letter): 401-402
- Continuous combined oestrogen/progestin therapy is well tolerated and increases bone density at the hip and spine in post-menopausal osteoporosis.Clin Endocrinol. 1994; 40: 671-677
Article info
Publication history
Accepted:
January 20,
1997
Received in revised form:
December 17,
1996
Received:
October 10,
1996
Identification
Copyright
© 1997 Published by Elsevier Inc.
