Difference of Skeletal Responses to Hormone Replacement Therapy between Surgical and Natural Menopause

Suh, Y S; Park, H M; Park, S Y; Yoon, S J; Hur, M

Abstract

OBJECTIVES
surgical menopause, state of both oophorectomy, shows some different features compared to natural menopause. The purpose of this study was to compare effectiveness of hormone replacement therapy(HRT) in surgical menopause with it in natural menopause. Methods: bone mineral density was assessed in 71 surgically menopausal women at the time of starting HRT and was repeated after one year HRT. 28 were evaluated by quantitative computed tomography (QCT) and 43 were done by dual energy X ray absorptiometry (DXA). We divided the subjects into two groups according to the intervals between oophorectomy and the start of HRT(group 1: within 2 years after surgery, group 2: more than 2 years after surgery). RESULTS: QCT-group 1 included 22 subjects, QCT-group 2 included 6. In group using DXA, 33 subjects were in group 1, and 10 in group 2. In natural menopause, 76 subjects were included and their bone mineral densities were assessed pre- and post-HRT(QCT: group 1, n=13, group 2, n=13, DXA: group 1, n=32, group 2, n=18) 1) Incidences of significantly decreased BMD in spite of HRT in surgically menopaused women were 59.0% in QCT-group 1, 60.6% in spine of DXA-group 1. These incidences are higher than those of natural menopause. 2) After 1 year estrogen replacement in surgical menopause, BMD decreased 6.86% by QCT and 1.15% by DEXA. But, surgical menopause women in group 1, BMD by QCT decreased 7.89%, spine BMD by DXA decreased 2.80%, femur neck BMD decreased 3.08%. Contrary to these results, BMD of natural menopause women increased 4.33%, 2.36%, and decreased 1.83%, respectively.
CONCLUSION
Usual dosages of HRT cannot prevent acute bone loss effectively after both oophoectomized women. So, additional therapy will be prescribed to surgically menopaused women.