Skeletal effects of oral oestrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women
Savvas, M.; Studd, J.W.; Fogelman, I.; Dooley, M.; Montgomery, J.; Murby, B.
Bmj 297(6644): 331-333
1988
ISSN/ISBN: 0959-8138 PMID: 3137998 Document Number: 324909
Study objective.sbd.To oral and implanted oestrogens for their effects in preventing postmenopausal osteoporosis. Design.sbd.Non-randomised cohort study of postmenopausal women treated with oral or depot oestrogens and postmenopausal controls. Setting.sbd.Gynaecological endocrine clinic tertiary referral centre. Patients.sbd.Oral treatment group of 37 postmenopausal women (mean age 57.5 years,median 8.74 years from last menstrual period), compared with 41 women given oestrogen implants (mean age 56.2 years, median 9.5 years from last menstrual period) and 36 controls (mean age 51.8 years, median 2.0 years from last menstrual period). Weight was not significantly different among the groups. Interventions.sbd.Oral treatment group was given continuous treatment with cyclic oestrogen and progesterone preparations (Prempak C or Cycoprogynova) for a median of 8.0 years. Implant group was given subcutaneous implants of oestradiol 50 mg combined with testosterone 100 mg, on average six monthly for a median of 8.5 years. Controls were not treated. End point.sbd.Significant increase in bone density. Measurements and main results.sbd.Bone density measured by dual beam photon absorptiometry was 1.02 (SD 0.13) g hydroxyapatite/cm2 in implant group versus 0.89 (0.11) in oral group (p < 0.01) and 0.87 (0.14) in controls (p < 0.01). Serum oestradiol concentration in implant group was (median) 725 pmol/l versus 170 pmol/l in oral group (p < 0.01) and 99 pmol/l in control (p < 0.01). Serum follicular stimulating hormone was median 1 IU/l (range 1-11) in implant group(equivalent to premenopausal values) versus 43 (4-94) IU/l in oral group (p < 0.01) and 72 (28-99) IU/l in controls (p < 0.01). Conclusions.sbd.Subcutaneous oestrogen is more effective than oral oestrogen in preventing osteoporosis, probably owing to the more physiological (premenopausal) serum oestradiol concentations achieved. It also avoids problems of compliance that occur with oral treatment.