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Subcutaneous Oestradiol Implants Have Anabolic Effect On Bone

Oestrogen implants in postmenopausal women prompt an eventual large increase in bone mineral density.

This is the suggestion of an evaluation of the anabolic effect of oestrogen on bone by researchers from the Division of Clinical Sciences (North), University of Sheffield, Sheffield, England.

In a one-year, placebo controlled study, Dr C.A. Pereda and colleagues compared the response of markers of bone formation (and resorption) and bone mineral density (BMD) to subcutaneous oestradiol implants.

The study, involving 21 postmenopausal women who had all undergone hysterectomy, found the oestrogen exerted an apparent anabolic effect, which was initially reflected by an increase in bone formation markers and later by a large increase in BMD.

The women received either 25 mg oestradiol implants or a sham procedure at baseline and at six months.

At baseline and one year, the researchers assessed the women's BMD and quantitative ultrasound (QUS). Also measured at baseline, and at four, eight, 12 and 24 weeks were bone alkaline phosphatase (bone ALP), procollagen type I N-terminal propeptide (PINP), osteocalcin (OC), free deoxypyridinoline (iFDPD), N-telopeptide of type I collagen (NTX), serum oestradiol and intact parathyroid hormone (PTH).

Outcome measures were percentage change markers of bone turnover and PTH and change in oestradiol levels over the first six months and percentage of changes in DXA and QUS over one year.

In women on oestrogen versus control subjects, PINP increased by 28 percent, bone ALP by 7 percent and OC by 9 percent in the first four weeks of treatment and then decreased significantly.

During the first year of treatment, lumbar spine (LS) and total hip (TH) BMD increased by 5.4 percent and 6.0 percent respectively, and femoral neck (FN) BMD by 3.7 percent in women on oestrogen versus control subjects.

Peak serum oestradiol level was achieved four weeks after implant insertion.

Mean PTH levels increased significantly in women on subcutaneous oestradiol.
BJOG: an International Journal of Obstetrics and Gynaecology, Vol. 109 (7) (2002) pp. 812-820. "The impact of subcutaneous oestradiol implants on biochemical markers of bone turnover and bone mineral density in postmenopausal women"

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