The Change in Bone Mineral Density of the Lumbar Spine and Proximal Femur in Perimenopausal Women After Hormone Replacement Therapy

Kil, M D; Kwon, S C; Park, C W; Hyung, N G; Kim, J D; Baik, K D

Abstract

To estimate the effect of hormone replace therapy (HRT) for 2 years on bone mineral denstiy (BMD) of the lumbar spine and proximal femur in perimenopausal women. The HRT was designed as a combined estrogen/progestogen regimen. A total of 171 women were enrolled in the study, 82 of these women who wanted cyclic menstruation-like bleeding received HRT-A[cyclic sequential regimen of oral conjugated equine estrogen(premarin) 0.625 mg/day for 25 days and medroxyprogesterone acetate (provera) 10 mg/day for 12 days], with the remaining 89 receiving HRT-B[contiuous combined regimen of premarin 0.625 mg/day and provera 2.5 mg/day for 30 days]. Most of these women showed no contra-indications of therapy. BMD was measured (DEXA, LUNAR DPZ. USA) at the lumbar spine(L2-L4), femoral neck, femoral trochanter and Ward` triangle before the initiation of therapy and at 12 months and 24 months thereafter. The results were as follows : 1) Of the 171 patients enrolled in this study, 171 patients completed the 1 year of therapy and 50 completed the 2-year study. 2) The bone mineral densities in the femoral trochanter and Ward`s triangle were significantly elevated at 12 months and 24 months in HRT-A and HRT-B group (p<0.05). 3) The bone mineral densities in the femoral neck were significantly elevated in the sub-group of patients who received therapy within 3 years after menopause at 12 months and 24 months in both group (p<0.05). 4) The bone mineral densities in the lumbar spines, femoral neck, femoral trochanter and Ward`s triangle were significantly elevated in the sub-group of patients who received therapy within 3 years after menopause at 12 months in HRT-A group (p<0.05). But the bone mineral densities in the lumbar spines were significantly decreased at 24 months (p<0.05). In addition, the bone mineral densities in the femoral neck, femoral trochanter and Ward`s triangle were significantly increased at 24 months (p<0.05). 5) The bone mineral densities in the lumbar spines, femoral neck, femoral trochanter and Ward`s triangle were significantly elevated in the sub-group of patients who received therapy beyond 3 years after menopause at 12 months in HRT-B group (p<0.05). But the bone mineral densities in femoral neck, femoral trochanter and Ward`s triangle were significantly decreased at 24 months (p<0.05). 6) The % changes of % young-adult values of bone mineral densities in the lumbar spines, femoral neck, femoral trochanter and Ward`s triangle at 12 months and 24 months in HRT-A and HRT-B group were significantly elevated in sub-group of patients who had pretreatment % young-adult values <90 (p<0.05). From the above results, it might be suggested that HRT-A appears to be more effective in increasing the BMD of the lumbar spines and proximal femurs for patients who received therapy within 3 years after menopause at 1 year therapy and that HRT-B for patients who received therapy beyond 3 years after menopause at 1 year therapy. Thus, it might be suggested that in addition to patient`s compliance, the type of HRT may affect the response of BMD. And it also might be suggested that HRT appears to be better response for patients with low BMD than with high BMD.