Postmenopausal Estrogen and BMD
April 30, 1997 2 minutes read
Postmenopausal Estrogen and BMD
Estrogen is felt to be the most effective agent for prevention and treatment of postmenopausal osteoporosis. Since the period of most rapid estrogen-dependent bone loss for women occurs at the onset of menopause, expert opinion generally suggests initiation of therapy at that time. Optimal duration of therapy is unknown, with recommendations from 10 years to pan-menopause.
The Rancho Bernardo Study examined 740 menopausal women aged 60- 98 who were participating in a study of osteoporosis. Five groups of estrogen use were defined: 1) never users; 2) past users begun at menopause; 3) past users begun after age 60; 4) current users begun at menopause; and 5) current users begun after age 60. Bone mineral density (BMD) was assessed at the radius using single-photon absorptiometry and at the hip and lumbar spine using dual-energy x-ray absorptiometry.
The highest BMD at all sites measured was seen in women who had begun estrogen at menopause and never stopped (mean duration of use, 20 years). Surprisingly, current users who had begun after age 60 had BMDs that were only slightly lower, and not significantly different, than their begun-at-menopause counterparts. Current users of estrogen had higher BMD levels than past users. Past users had low BMD levels, approaching those of never users, but the more recent the use, the better the BMD.
This information suggests that the best therapeutic stance should be to suggest continuous long-term estrogen therapy begun at menopause. At the same time, the very favorable BMD seen among current users begun even after age 60 suggests that we should be equally enthusiastic about instituting estrogen replacement later in the menopausal span.
Schneider D, et al. JAMA 1997;277: 543-547.
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