LETTER
Estrogen and Postmenopausal Osteoporosis
Shawn McGivney
15 January 1993 | Volume 118 Issue 2 | Pages 155-156
TO THE EDITOR:
Although I agree with Lufkin and colleagues' [1] conclusion that estrogens appear effective in the treatment of osteoporosis, several issues should be clarified. First, the selection criteria included women with existing compression fractures, a major confounding factor because they may lead to artifactual increases in bone density measurements. This factor is unlikely to pose a major problem in this study because of 1) the randomized design and 2) the demonstration that both mechanical (additional compression fractures) and metabolic measures (osteocalcin and hydroxyproline levels) also showed improvement. Nevertheless, caution is needed because bone density readings are potentially misleading, particularly in older persons with concomitant lumbar scleroses, degenerative disease, or compression fractures.
Second, the researchers reported no data on exercise or resistance weight training. Other researchers have reported exponential increases in bone density when estrogen and resistance training were combined [2], and loss of bone density when vigorous exercise was combined with amenorrhea and low estrogen levels [3, 4].
Finally, why were women who had hysterectomies included, given that progesterone could increase their risk for heart disease without potential benefit?
1. Lufkin EG, Wahner HW, O'Fallon WM, Hodgson SF, Kotowicz MA, Lane AW, et al. Treatment of postmenopausal osteoporosis with transdermal estrogen. Ann Intern Med. 1992; 117:1-9.
2. Notelovitz, et al. Estrogen therapy and variable resistance weight training increases bone mineral in surgically menopausal women. J Bone Miner Res. 1991; 6:583-90.[Medline]
3. Myburgh, et al. Low bone density is an etiologic factor for stress fractures in athletes. Ann Intern Med. 1990; 113:754-9.
4. Drinkwater, et al. Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med. 1984; 311:277-81.[Abstract]
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