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Three-Year Follow-up on the Effects of Transdermal Estrogen
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 Unpublished letters cannot be returned.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.
TO THE EDITOR:
The demonstration by Drs. Lufkin and Riggs [1] of a significant further gain in bone density of the lumbar spine in the second year of transdermal estrogen therapy is a valuable corrective to the view that this phenomenon is unique to bisphosphonate therapy. However, the authors' conclusion that the mechanism must involve something more than a remodeling transient is premature. They cite an old paper of mine [2] to the effect that the transient lasts no more than 6 months, but this estimate has been superseded. When the remodeling process is considered in three dimensions rather than in two-dimensional cross-sections [3], 12 months is a more realistic estimate in normal persons. The duration may be even longer in osteoporotic patients, especially when the remodeling rate is inhibited by treatment [4]. When the completion of secondary mineralization is taken into account, attainment of a new steady state may take as long as 2 years in some patients [5]. Only if this simpler explanation can be convincingly excluded will the continuation of bone gain for several years provide evidence that bisphosphonates (and estrogen) have a genuine anabolic effect. Regrettably, the uncertainty of mechanism has not prevented the U.S. Food and Drug Administration from allowing this unjustified claim by several pharmaceutical companies in their advertisements in the medical press.
A.M. Parfitt, MD
University of Arkansas for Medical Sciences; Little Rock, AR 72205
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
