According to a new study, ending hormone therapy treatments may cause a decrease in bone mineral density (BMD) in elderly women. Two other related studies also demonstrate the effects of recombinant human growth hormone (HGH) treatment in osteoporotic men and oral dehydroepiandrosterone (DHEA) in treating young women with osteoporosis.
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 - estrogen therapy or estrogen plus progestin therapy in women with a uterus; calcitriol alone; and a combination of calcitriol plus estrogen or estrogen plus progestin therapy in nearly 500 women ages 65-77 years for three years.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 and 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."
Osteoporosis is a silent disease that is responsible for more than 1.5 million hip fractures annually world wide.Most fractures occur in postmenopausal women, however, 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 (i.e. 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."
Low bone mineral density (BMD) is a common problem for young women who suffer from anorexia nervosa.A third related study 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 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 per cent), improved attitude towards eating (26 per cent) and decreased anxiety (12 per cent).
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."