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HT superior to oral contraceptives for increasing BMD in premature ovarian failure
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In women with spontaneous premature ovarian failure, hormone therapy was shown to increase bone density at the lumbar spine at a greater rate vs. combined oral contraceptives or no treatment, recent study findings show.
In an open, randomized controlled trial, Beth Cartwright, MD, a clinical research fellow in the menopause research unit at McNair Center, Guy’s Hospital, London, and colleagues analyzed data from 59 women diagnosed with spontaneous premature ovarian failure within the last 3 years (confirmed by two follicle-stimulating hormone levels of at least 30 IU/L). Participants chose to be in either the no-treatment group or to be assigned to treatment; those opting for treatment were randomly assigned to HT (2 mg daily estradiol with 75 mcg levonorgestrel for 12 days per month) or combined oral contraceptive therapy (30 mgc ethinyloestradiol and 150 mcg levonorgestrel for 21 days). Women underwent DXA scans of the lumbar spine and hip and provided fasting morning blood samples to measure bone turnover markers at baseline and 6, 12 and 24 months. Primary outcome was a change in lumbar spine bone density at 2 years; changes in total hip and femoral neck BMD, and procollagen type 1 N-terminal propeptide (P1NP) and cross-linked telopeptide (CTX) levels were also assessed.
Within the cohort, 36 women (61%) completed the trial (52% in the no-treatment group; 60% in the HT group; 80% in the combined oral contraceptive group).
Researchers found that, at the lumbar spine, there was a gain in BMD observed with women assigned HT at all time points during the study; those in the no-treatment group saw a drop in BMD, and those assigned combined oral contraceptives saw no change. Bone density was maintained at the total hip over the study period in women assigned to both HT and combined oral contraceptive therapy, whereas women in the no-treatment group saw a drop in hip bone density at all time points. There were no between-group differences observed in femoral neck bone density, according to researchers.
Bone turnover markers showed similar reductions in the two treatment groups; women assigned HT and combined oral contraceptive therapy saw reductions in both P1NP and CTX at all time points during the trial. There was a trend toward greater reduction in P1NP in the HT group, researchers wrote. In the no-treatment group, bone density dropped at all sites and bone turnover markers remained relatively unchanged.
“In the [HT] group, bone density increased significantly at the lumbar spine and remained stable at the total hip and femoral neck over the course of the trial,” the researchers wrote. “In the [oral contraceptive] group, bone density remained stable at all sites. In the no-treatment group there was a decrease in bone density at all sites, and this became more pronounced as the trial progressed.”
The researchers noted that, while the sample size was small, the cohort included a distinct population (only women with spontaneous premature ovarian failure) and a high proportion of ethnic minorities.
“There are very few other trials in this area, and as such, this trial adds significantly to the body of evidence on treatment of spontaneous [premature ovarian failure] and paves the way for future research,” the researchers wrote. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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