0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Effect of Hormone Replacement Therapy on Bone Mineral Density in Postmenopausal Women with Mild Primary Hyperparathyroidism: A Randomized, Controlled Trial

Andrew B. Grey, MD; Joanne P. Stapleton, RGON; Margaret C. Evans, BSc; Michele A. Tatnell, PhD; and Ian R. Reid, MD
[+] Article and Author Information

From the University of Auckland, Auckland, New Zealand, and Yale University, New Haven, Connecticut. Grant Support: By the Auckland Medical Research Foundation, the Health Research Council of New Zealand, and the New Zealand Lotteries Board. Acknowledgment: The authors thank Greg Gamble for statistical advice. Requests for Reprints: Ian Reid, MD, Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1, New Zealand. Current Author Addresses: Drs. Reid and Tatnell, Ms. Evans, and Ms. Stapleton: Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1, New Zealand.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;125(5):360-368. doi:10.7326/0003-4819-125-5-199609010-00002
Text Size: A A A

Background: Most patients with primary hyperparathyroidism are postmenopausal women. The presence of osteopenia in persons with mild primary hyperparathyroidism is considered an indication for parathyroidectomy. No prospective, controlled trials have assessed medical therapies for osteopenia in primary hyperparathyroidism.

Objective: To examine the effects of estrogen-progestin therapy (hormone replacement therapy) on bone mineral density and biochemical indices in postmenopausal women with mild primary hyperparathyroidism.

Design: Double-blind, randomized, placebo-controlled trial.

Setting: University teaching hospital.

Patients: 42 postmenopausal women with mild primary hyperparathyroidism.

Intervention: Patients were randomly assigned to receive either conjugated estrogens, 0.625 mg/d, and medroxyprogesterone, 5 mg/d, or placebo.

Measurements: Bone mineral densities of the total body, lumbar spine, proximal femur (femoral neck, Ward triangle, trochanter), and proximal forearm were measured every 6 months using dual-energy x-ray absorptiometry. Biochemical indices of bone turnover and calcium metabolism were measured at baseline, 6 months, and 2 years.

Results: In the placebo group, bone mineral densities of the total body and the proximal forearm decreased significantly from baseline (mean ± SE, −2.3%± 0.7% [P = 0.005] and −3.5%± 1.2% [P = 0.01], respectively). At the other sites, bone mineral density also tended to decline. In the hormone replacement therapy group, bone mineral density increased from baseline in the total body (1.3% ± 0.4%; P = 0.004), lumbar spine (5.2% ± 1.4%; P = 0.002), and femoral neck (3.4% ± 1.5%; P = 0.05). The between-group differences in bone mineral density at the end of the study ranged from 3.6% to 6.6% and were significant at all sites (P > 0.001 and P < 0.05) except for the Ward triangle (P = 0.06). In the hormone replacement therapy group, serum alkaline phosphatase levels decreased by 22% (P = 0.0004 compared with baseline), urinary hydroxyproline excretion decreased by 42% (P = 0.0004), urinary N-telopeptide excretion decreased by 54% (P = 0.001), and urinary calcium excretion decreased by 45% (P = 0.007). Hormone replacement therapy did not change levels of serum ionized calcium or intact parathyroid hormone.

Conclusions: Although hormone replacement therapy has little effect on serum calcium levels, it suppresses bone turnover, reduces urinary calcium excretion, and increases bone mineral density throughout the skeleton in postmenopausal women with mild primary hyperparathyroidism. This therapy is thus an important management option for these patients.

Figures

Grahic Jump Location
. Mean (±SE) bone mineral density (BMD) of the total body and lumbar spine in postmenopausal women with primary hyperparathyroidism who received hormone replacement therapy ( ) or placebo ( ) for 2 years. The results are expressed as a percentage of the baseline values. Changes in bone mineral density during the study were significantly more positive in the patients receiving hormone replacement therapy.
Figure 1black circleswhite circles
Grahic Jump Location
Grahic Jump Location
. Mean (±SE) bone mineral density (BMD) of the proximal femur in postmenopausal women with primary hyperparathyroidism who received hormone replacement therapy ( ) or placebo ( ) for 2 years. The results are expressed as a percentage of the baseline values. Changes in bone mineral density of the femoral neck and trochanter were significantly more positive in the patients receiving hormone replacement therapy than in the patients receiving placebo. Changes in the bone mineral density of the Ward triangle tended to be more positive in the hormone replacement therapy group.
Figure 2black circleswhite circles
Grahic Jump Location
Grahic Jump Location
. Mean (±SE) bone mineral density (BMD) of the proximal forearm in postmenopausal women with primary hyperparathyroidism who received hormone replacement therapy ( ) or placebo ( ) for 2 years. The results are expressed as a percentage of the baseline values. Changes in bone mineral density were significantly more positive in patients receiving hormone replacement therapy.
Figure 3black circleswhite circles
Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)