Journal ArticleDOI
The effect of low-dose continuous estrogen and progesterone therapy with calcium and vitamin D on bone in elderly women. A randomized, controlled trial.
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The primary hypothesis was that continuous administration of conjugated equine estrogen, 0.3 mg/d, combined with medroxyprogesterone, 2.5 mg/D, in elderly postmenopausal women would prevent bone loss in the spine over 3.5 years compared with placebo in the context of adequate calcium and vitamin D nutrition.Abstract:
Background: Hormone replacement therapy (HRT), the mainstay of osteoporosis prevention, is limited because of dose-related risks, side effects, and patient acceptance. The bone-sparing efficacy and tolerability of the lowest available doses of HRT have not been adequately studied in elderly women. Objective: To determine the bone-sparing effect of continuous low-dose HRT in elderly women. Design: Randomized, double-blind, placebo-controlled trial. Setting: University osteoporosis research and clinical center. Patients: 128 healthy white women (age > 65 years) with low bone mass recruited by word of mouth and by local advertisement. The principal eligibility criterion was spinal bone mineral density of 0.90 g/cm 2 or less. Intervention: Continuous therapy with conjugated equine estrogen, 0.3 mg/d, and medroxyprogesterone, 2.5 mg/d, or matching placebo. Sufficient calcium supplementation was given to bring all calcium intakes above 1000 mg/d in both groups; supplemental oral 25-hydroxyvitamin D was given to maintain serum 25-hydroxyvitamin D levels of at least 75 nmol/L in both groups. Measurements: Bone mineral density of the spine, hip, total body, and forearm; serum total alkaline phosphatase and serum osteocalcin levels at 6-month intervals; and 24-hour urine creatinine and hydroxyproline excretion at baseline, 12 months, and 42 months. Results: During 3.5 years of observation, spinal bone mineral density increased by 3.5% (P < 0.001) in an intention-to-treat analysis and by 5.2% among patients with greater than 90% adherence to therapy. Significant increases were seen in total-body and forearm bone density (P < 0.01). Symptoms related to HRT (breast tenderness, spotting, pelvic discomfort, and mood changes) were mild and short-lived. Conclusions: Continuous low-dose HRT with conjugated equine estrogen and oral medroxyprogesterone combined with adequate calcium and vitamin D provides a bone-sparing effect that is similar or superior to that provided by other, higher-dose HRT regimens in elderly women. This combination is well tolerated by most patients.read more
Citations
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Journal ArticleDOI
2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary
Alexandra Papaioannou,Suzanne N Morin,Angela M. Cheung,Stephanie A. Atkinson,Jacques P. Brown,Sidney Feldman,David A. Hanley,Anthony B. Hodsman,Sophie A. Jamal,Stephanie M. Kaiser,Brent Kvern,Kerry Siminoski,William D. Leslie +12 more
TL;DR: There has been a paradigm shift in the prevention and treatment of osteoporosis and fractures, and the focus now is on preventing fragility fractures and their negative effects.
Journal ArticleDOI
Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use.
Anthony B. Hodsman,Douglas C. Bauer,David W. Dempster,Larry Dian,David A. Hanley,Steven T. Harris,David L. Kendler,Michael R. McClung,Paul D. Miller,Wojciech P. Olszynski,Eric S. Orwoll,Chui Kin Yuen +11 more
TL;DR: There is as yet no evidence that the antifracture efficacy of PTH will be superior to the bisphosphonates, whereas cost-utility estimates suggest that teriparatide is significantly more expensive.
Journal ArticleDOI
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003.
Stephen F. Hodgson,Nelson B. Watts,John P. Bilezikian,Bart L. Clarke,T. Kenney Gray,David W. Harris,C. Conrad Johnston,Michael Kleerekoper,Robert Lindsay,Marjorie M. Luckey,Michael R. McClung,Howard R. Nankin,Steven M. Petak,Robert R. Recker,Robert J. Anderson,Donald A. Bergman,Zachary T. Bloomgarden,Richard A. Dickey,Pasquale Palumbo,Anne L. Peters,Herbert I. Rettinger,Helena W. Rodbard,Harvey A. Rubenstein +22 more
TL;DR: The AACE 2001 Medical Guidelines for Clinical Practice for the Prevention and Management of Postmenopausal Osteoporosis address the prevention, diagnosis, and management of postmenopausal osteoporo-sis, a disorder that is recognized as a major public health problem because of its physical and socioeconomic consequences.
Journal ArticleDOI
Calcium, dairy products and osteoporosis.
TL;DR: Of 52 investigator-controlled calcium intervention studies, all but two showed better bone balance at high intakes, or greater bone gain during growth, or reduced bone loss in the elderly, or reducing fracture risk, firmly establishes that high calcium intakes promote bone health.
Journal ArticleDOI
Hormone Replacement Therapy and Prevention of Nonvertebral Fractures: A Meta-analysis of Randomized Trials
TL;DR: The authors' meta-analysis of randomized controlled trials of HRT noted a statistically significant reduction in nonvertebral fractures, however, this effect may be attenuated in older women.
References
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Journal ArticleDOI
Randomized Trial of Estrogen Plus Progestin for Secondary Prevention of Coronary Heart Disease in Postmenopausal Women
Stephen B. Hulley,Deborah Grady,Trudy L. Bush,Curt D Furberg,David M. Herrington,Betty Riggs,Eric Vittinghoff +6 more
TL;DR: Treatment with oral conjugated equine estrogen plus medroxyprogesterone acetate did not reduce the overall rate of CHD events in postmenopausal women with established coronary disease and the treatment did increase the rate of thromboembolic events and gallbladder disease.
Journal ArticleDOI
Vitamin D3 and calcium to prevent hip fractures in elderly women
Marie Claire Chapuy,Monique E. Arlot,François Duboeuf,Jacqueline Brun,Bridgette Crouzet,Simone Arnaud,Pierre D. Delmas,Pierre J. Meunier +7 more
TL;DR: The effects of supplementation with vitamin D3 (cholecalciferol) and calcium on the frequency of hip fractures and other nonvertebral fractures, identified radiologically, in 3270 healthy ambulatory women are studied.
Journal ArticleDOI
The use of estrogens and progestins and the risk of breast cancer in postmenopausal women.
Graham A. Colditz,Susan E. Hankinson,David J. Hunter,Walter C. Willett,JoAnn E. Manson,Meir J. Stampfer,Charles H. Hennekens,Bernard Rosner,Frank E. Speizer +8 more
TL;DR: In this paper, the effect of adding progestins to estrogen therapy on the risk of breast cancer in postmenopausal women is investigated. But, the effect on the number of newly diagnosed invasive breast cancer cases was not quantified.
Journal ArticleDOI
Hypovitaminosis D in Medical Inpatients
Melissa K. Thomas,Donald M. Lloyd-Jones,Ravi Thadhani,Albert C. Shaw,Donald J. Deraska,Barrett T. Kitch,Eleftherios C. Vamvakas,Ian M. Dick,Richard L. Prince,Joel S. Finkelstein +9 more
TL;DR: Hypovitaminosis D is common in general medical inpatients, including those with vitamin D intakes exceeding the recommended daily allowance and those without apparent risk factors for vitamin D deficiency.
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