Human Reproduction, Vol. 18, No. 8, 1737-1746,
August 2003
© 2003 European Society of Human Reproduction and Embryology
Effects of specific post-menopausal hormone therapies on bone mineral density in post-menopausal women: a meta-analysis
1 Free University of Berlin, Clinical Research Center of Women’s Health, Klingsorst 109a, D-12203 Berlin, Germany, 2 Department of Medicine, University of Lund and 3 Department of Orthopaedics, Malmö University Hospital, University of Lund, S-20502 Malmö, Sweden
4 To whom correspondence should be addressed. e-mail: martina.doeren{at}medizin.fu-berlin.de
BACKGROUND: Long-term post-menopausal hormone therapy (pHT) was often regarded as first-line therapy to prevent fractures in post-menopausal women, a recommendation under scrutiny given the benefit–risk profile of the Women’s Health Initiative results of the estrogen–progestin combination. Apart from controlled clinical studies providing data with fractures as an end point, measures of lumbar and hip bone mineral density (BMD) may be used to assess bone-related effects of pHT. The objective of this study was to conduct a systematic review of 2-year trials, published between 1990 and December 2002, and assessing changes in BMD by any estrogen including ethinyl estradiol, any estrogen plus any progestin, or tibolone. METHODS: We searched MEDLINE, EMBASE and systematic reviews. Thirty-nine randomized, prospective, controlled 2-year trials were analysed in pre-specified groups according to the profile of the compounds. RESULTS: Virtually all pHT regimens at least maintain BMD at the lumbar spine and the hip compared with baseline; there is no apparent difference between the various estrogenic compounds. Tibolone, a synthetic progestin, appears to be as effective as any estrogen. Most trials were conducted in early post-menopausal women, fewer in women with hysterectomy and/or bilateral oophorectomy. CONCLUSIONS: The size of impact on BMD does not appear to differ between tibolone and any estrogen compound studied.
Key words: bone mineral density/estrogen replacement therapy/post-menopausal hormone therapy/prevention of post-menopausal osteoporosis/tibolone
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