| Decrease in Bone Mineral Density on Postmenopausal Hormone Replacement Therapy. |
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Jae Woo Lee, Hyoung Moo Park, Jung Ho Seo, Min Hur |
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Department of Obstetrics and Gynecology, College of Medicine, Chung-Ang University, Seoul, Korea. |
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| Abstract |
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Osteoporosis is characterized by low bone mass and microarchitectural deterioration of bone tissue, with subsequent increase in bone fragility and susceptibility to fracture and is one of the most significant long term sequelae of menopause. Hormone replacement therapy(HRT) with estrogen combined with or without progestogen has been the treatment of choice for preventing bone loss in postmenopausal women and epidemiologic data have confirmed that it reduces the incidence of osteoporotic fracture. Even though the use of accepted bone sparing doses of estrogen it has been presented that some proportion of postmenopausal women actually decrease bone mineral density(BMD). The purpose of this study were to evaluate the incidence of subjects with loss of BMD and the factors influencing BMD changes in these subjects compared with those of subjects with increased BMD assessed by quantitative computed tomograpy(QCT) according to age, the duration of menopaue, the baseline BMD, the bone turnover state, the type of menopause, the mode of HRT. This study who undergone in 128 postmenopausal women who were treated with HRT checked BMD by QCT for 1 year and pre-HRT and post-HRT from March 1993 to May 1995 in Chung-Ang University hospital. The results were as follows 1)The overall incidence of subjects with loss of BMD after 1 year of HRT was 33.5%. 2)The incidence of subjects with significant loss of BMD was 27.3%. 3)The comparison between the subjects with decreased and increased BMD proved significant differences(p < 0.05) in age, menopausal duration, baseline BMD and alkaline phosphatase levels. the subjects with decreased BMD after HRT were younger, closer to the menopause, had a higher baseline BMD levels and lower bone-turnover status. 4)Twenty-one out of 92 subjects with natural menopause showed decreased BMD after HRT, which comprised 22.8%. Meanwhile among the 36 subjects with surgical menopausal, 22 women, comprising 61.1%, had decreased BMD. 5)The incidence of postmenopausal women with decreased or significant decreased in BMD after HRT were the highest in normal bone status group and lower in osteoporotic group. 6)Among the subjects treated estrogen only, 62.1% showed decrease in BMD whereas 25.3% of the subjects treated with with combined estrogen and progest-ogen regimen showed decreased BMD. |
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