HORMONE THERAPY FOR POSTMENOPAUSAL BONE LOSS

Project: Research project

Description

Fracture incidence is a major health care problem in the Western world, and
will have an increasing impact on health care as the elderly population
increases over the next thirty years. Present costs now exceed 3 billion
dollars annually and may increase to 20 billion dollars over the next
thirty years. Previous reports have shown that long term administration of high dose
estrogen therapy prevents bone loss in postmenopausal women, and
retrospective studies have shown that previous estrogen treatment is
associated with decreased numbers of fractures. However, there is concern
about the occurrence of an increased incidence of uterine cancer and
possibly breast cancer on high doses of estrogen. Progestogens undoubtedly
reduce the incidence rate of uterine cancer to levels less than those of
untreated women. But the use of progestogens needs careful follow up since
C19 derivatives lower HDL cholesterol levels, and may adversely increase
bone loss. Our project is designed to find the minimum dose of estrogen that will
prevent bone loss, and to compare results with those in groups given a C21
progestogen alone, a combination of estrogen and progestogen, or placebo.
We should be able to detect any antagonistic or synergistic effect of
progestogens on bone. Multiple techniques for measuring bone density will be used, icnluding
single and dual photon absorptiometry, total body calcium with regional
skeletal density, computerized axial tomography and metacarpal
morphometry. These different methods should allow us to measure changes in
different regions of the skeleton and follow the separate responses of
cortical and trabecular bone to hormones. The rate of bone loss will be
compared with various biochemical markers, such as serum levels of bone GLA
protein, vitamin D, estrogen, parathyroid hormone, calcitonin, and urine
hydroxyproline excretion. Since no single test is diagnostic of rapid bone
loss we will try to identify fast losers by a combination of tests using
discriminant function analysis. We will also examine long term safety of the hormones by performing serial
endometrial biopsies and measuring HDL cholesterol levels.
StatusFinished
Effective start/end date7/1/813/31/87

Funding

  • National Institutes of Health

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Postmenopausal Osteoporosis
Estrogens
Hormones
Progestins
Bone and Bones
Uterine Neoplasms
HDL Cholesterol
Incidence
Breast Neoplasms
Delivery of Health Care
Therapeutics
Western World
Photon Absorptiometry
Calcitonin
Parathyroid Hormone
Routine Diagnostic Tests
Skeleton
Vitamin D
Bone Density
Biomarkers