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Postmenopausal bone loss: does HRT always work?

J C Stevenson1, T C Hillard, B Lees

  • 1Wynn Institute for Metabolic Research, London, U.K.

International Journal of Fertility and Menopausal Studies
|January 1, 1993
PubMed
Summary
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A 3-year study found that while most women maintained bone density with hormone replacement therapy (HRT), about 12% experienced proximal femur bone loss. Further research is needed to identify these women and explore higher estrogen doses.

Area of Science:

  • Endocrinology
  • Bone Metabolism
  • Pharmacology

Background:

  • Hormone replacement therapy (HRT) is used to manage menopausal symptoms and prevent bone loss.
  • Both oral and transdermal routes of HRT administration are available, with differing pharmacokinetic profiles.
  • Individual responses to HRT can vary, necessitating studies to identify potential non-responders.

Purpose of the Study:

  • To compare the effects of oral versus transdermal HRT on bone mineral density.
  • To assess bone loss at the spine and proximal femur over a 3-year period.
  • To identify potential factors associated with bone loss in women receiving HRT.

Main Methods:

  • A randomized controlled trial involving 66 women comparing oral conjugated equine estrogens with oral dl-norgestrel versus transdermal 17 beta-estradiol with transdermal norethisterone acetate.

Related Experiment Videos

  • Bone density was measured using dual-photon absorptiometry at the spine and proximal femur.
  • Compliance was monitored, and side effects, bleeding patterns, gonadal steroid levels, and lipoproteins were recorded.

    • Main Results:

    • Only 2% of women experienced significant vertebral bone loss, while approximately 12% lost bone density in the proximal femur.
    • Women who lost bone were closer to menopause but did not differ in body mass or lifestyle.
    • Both HRT groups showed similar serum estradiol levels and responses in bone biochemical markers and lipoproteins.

    Conclusions:

    • Standard doses of HRT are effective in preventing vertebral bone loss for most women.
    • A small proportion of women may not conserve proximal femur bone density with standard HRT doses.
    • Further investigation is needed to identify specific biochemical markers for predicting non-response and to evaluate higher estrogen doses.