Bone Density Studies Find Two Useful Supplements and Risks for Elderly Women Who End HRT
Bethesda MD, 15 November 2002

Ending hormone therapy treatments may cause a decrease in bone mineral density in elderly women, according to a new study published in the November issue of The Journal of Clinical Endocrinology & Metabolism (JCEM). Two other related studies published in the same journal also demonstrate the effects of recombinant human growth hormone (HGH) treatment in osteoporotic men and oral dehydroepiandrosterone (DHEA) in treating young women with osteoporosis.

Osteoporosis is a silent disease that is responsible for more than 1.5 million hip fractures annually world wide.

Ending hormone therapy leads to rapid bone loss in elderly women

In July, researchers announced the ending of one portion of the Women's Health Initiative (WHI) study due to evidence that questioned the safety and effectiveness of the estrogen plus progestin treatment in postmenopausal women. Now, researchers led by Dr. J.C. Gallagher at Creighton University have revealed that elderly women who stop taking hormone therapy experience significant losses in their bone mineral density (BMD). These losses in BMD could lead to severe osteoporosis and fractures.

In a double-blind, randomized, placebo-controlled trial, these researchers had previously studied the effects of three different treatments in nearly 500 women ages 65-77 years over three years. One group received estrogen therapy or estrogen plus progestin therapy in women with a uterus; another received calcitriol alone; the third received a combination of calcitriol plus estrogen or estrogen plus progestin therapy.The women in all three groups experienced increases in BMD during the treatments. A two-year follow-up study evaluated how discontinuation of the therapy affected the BMD, bone markers and calcium absorption and serum parathyroid hormone (PTH) levels in the women.

Researchers found that after discontinuing the treatments for two years, women in all three treatment groups experienced rapid bone loss. A majority of the loss occurred during the first year following treatment. Additionally, increases in calcium absorption and decreases in serum PTH levels also reversed after the treatments were stopped.

"The recent hormone therapy findings in the WHI trial have caused many women to discontinue their treatments. However, until now we did not know how ending the hormone therapy would effect bone health," said Dr. Christopher Gallagher, lead investigator on the study. "Our study demonstrates the critical need for these women to work with their doctors to monitor their bone health and to consider carefully the disadvantages of discontinuing hormone therapy and to also find alternative treatments to maintain their bone mineral density if they decide to discontinue the therapy."

Men with osteoporosis benefit from human growth hormone combined with calcium and vitamin D3

While most fractures occur in postmenopausal women, the disorder also affects more than two million men. Furthermore, approximately one third of all osteoporotic fractures occur in men. Few studies have been conducted to examine the effects of human growth hormone (HGH) on osteoporosis patients. Now, a study published in the November issue of JCEM shows that HGH treatments can improve bone mineral density (BMD) in men with idiopathic osteoporosis (ie, men without any demonstrated hormonal, nutritional, or other risk factors for diminished bone density).

Dr. Peter Gillberg and researchers at the University Hospital in Upsala, Sweden studied the effects of continuous and intermittent HGH treatments on bone turnover, BMD, and bone mineral content (BMC) in 29 men between the ages of 27 and 62 who had idiopathic osteoporosis. The men also received daily doses of calcium and vitamin D3. Patients were treated for 24 months and then participated in 12 months of follow-up. After two years, BMD and BMC had increased in both groups of men. Then, after another 12 months, both the BMD and BMC had increased further. Additionally, both treatment groups experienced a decrease in their fat mass over the two year treatment period.

"Recombinant human growth hormone can be an effective treatment for men with osteoporosis," explained Dr. Gillberg. "Our study shows that the growth hormone treatments -- either continuous or intermittent -- can not only help build bone density, but can also maintain the improved bone density for at least one year after the treatment. The growth hormone treatments also caused a loss of fat in the subjects, which can lead to other health benefits. Larger and longer placebo controlled studies must now be conducted to further examine the benefits of growth hormone treatment for men and women with osteoporosis."

In young women with anorexia, DHEA aids bone health, weight gain, and psychological factors

Low bone mineral density (BMD) is a common problem for young women who suffer from anorexia nervosa. A third related study published this month in JCEM compared the effectiveness of two hormone treatments on increasing BMD in young women with anorexia. Previous studies found that hormone replacement therapy (HRT) had mixed results in improving bone health in anorexic women. Doctors at Children's Hospital in Boston sought to determine whether dehydroepiandrosterone (DHEA) would be effective in treating anorexic women, compared with HRT. They treated 61 anorexic women between the ages of 14 and 28 with either oral DHEA or conventional HRT for one year.

Initially, both groups experienced an increase in BMD and the DHEA group experienced increases in the bone formation markers. Women in both treatment groups experienced significant weight gain, which was unexpected and attenuated the BMD increases that were observed. In both groups, however, researchers found a correlation between bone formation markers and increases in weight. Additionally, the women taking DHEA experienced several psychological improvements including decreased body image concerns (24 percent), improved attitude towards eating (26 percent) and decreased anxiety (12 percent).

"Our comparison of DHEA and HRT showed no significant difference in the BMD measurements," said Dr. Clifford Rosen, one of the investigators on the study. "Yet, our research did demonstrate that DHEA has a positive psychological effect on anorexic women and may actually reverse some of the emotional disturbances that accompany the disease. Unexpectedly, DHEA also helped the women in our study gain weight, which is significant for anorexic women. This physical effect of DHEA must be further examined in the future."

According to Dr. Catherine Gordon, lead investigator on the study, "the more profound increases in bone formation markers and the anabolic factor, IGF-I, seen in the DHEA treatment group suggest a potential therapeutic advantage of this therapy, but more longitudinal research is needed."

JCEM is one of four journals published by The Endocrine Society. Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Today, The Endocrine Society's membership consists of over 10,000 scientists, physicians, educators, nurses and students, in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Bethesda, Maryland. To learn more about the Society, and the field of endocrinology, visit the Society's web site at www.endo-society.org.

Source

The Endocrine Society, via PR Newswire.