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Three-Year Follow-up on Effects of Transdermal Estrogen
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TO THE EDITOR:
In a prospective clinical trial on the treatment of osteoporotic women with hormonal replacement therapy using 100 µg of transdermal estrogen per day plus progestin or placebo, we reported increases of 5.3% in lumbar spine bone mineral density and a significant decrease in vertebral fractures [1]. Hormone replacement therapy was continued for an additional 2 years in 29 of the 39 women in the treatment group, whereas the 39 women in the placebo group crossed over to receive hormone replacement therapy or withdrew from the study.
Lumbar spine bone mineral density continued to increase during follow-up, reaching an asymptote between the second and third year; the overall increase was 12% above baseline (Figure 1). Measurement of biochemical markers (serum osteocalcin, serum bone alkaline phosphatase, and urinary hydroxyproline levels) remained suppressed. Although lumbar spine bone mineral density can increase after antiresorptive therapy, this finding has been attributed to a transient remodeling [2], a process that should last only about 6 months until resorption and formation reach a new steady state. Clearly, some additional process must be invoked to explain these results.
Increases in lumbar spine bone mineral density have also been reported after bisphosphonate therapy for osteoporosis; this has led some to suggest the existence of a formation-stimulating or bone-building mechanism. Bone mineral density has been reported to increase by 4.2% after 2 years of etidronate therapy [3], by 5.3% after 18 months of pamidronate therapy [4], and by 7.3% after 18 months of alendronate therapy [5]. These increases are no greater than the increase we reported after hormone replacement therapy. Thus, claims of superiority for bisphosphonates over hormone replacement therapy with respect to bone gain should be viewed cautiously until substantial gains in lumbar spine bone mineral density with bisphosphonate therapy have been documented for periods longer than 3 years.
Edward G. Lufkin, MD
B. Lawrence Riggs, MD
Mayo Clinic and Foundation
Rochester, MN 55905
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
