Savvas M, Studd JW, Fogelman I, Dooley M, Montgomery J, Murby B. Skeletal effects of oral oestrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women.
BMJ (CLINICAL RESEARCH ED.) 1988;
297:331-3. [PMID:
3137998 PMCID:
PMC1834046 DOI:
10.1136/bmj.297.6644.331]
[Citation(s) in RCA: 72] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVE
To compare oral and implanted oestrogens for their effects in preventing postmenopausal osteoporosis.
DESIGN
Non-randomised cohort study of postmenopausal women treated with oral or depot oestrogens and postmenopausal controls.
SETTING
Gynaecological endocrine clinic in tertiary referral centre.
PATIENTS
Oral treatment group of 37 postmenopausal women (mean age 57.5 years, median 8.75 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
Oral treatment group was given continuous treatment with cyclic oestrogen and progesterone preparations (Prempak C or Cycloprogynova) 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
Significant increase in bone density.
MEASUREMENTS AND MAIN RESULTS
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 less than 0.01) and 0.87 (0.14) in controls (p less than 0.01). Serum oestradiol concentration in implant group was (median) 725 pmol/l versus 170 pmol/l in oral group (p less than 0.01) and 99 pmol/l in controls (p less than 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 less than 0.01) and 72 (28-99) IU/l in controls (p less than 0.01).
CONCLUSIONS
Subcutaneous oestrogen is more effective than oral oestrogen in preventing osteoporosis, probably owing to the more physiological (premenopausal) serum oestradiol concentrations achieved. It also avoids problems of compliance that occur with oral treatment.
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