CONTINUOUS COMBINED OESTROGEN/PROGESTIN THERAPY IS WELL TOLERATED AND INCREASES BONE-DENSITY AT THE HIP AND SPINE IN POSTMENOPAUSAL OSTEOPOROSIS

OBJECTIVES Although oestrogen/progestin therapy is effective prophylaxis against post-menopausal osteoporosis, its efficacy in the treatment of established disease is uncertain. In addition, cyclical oestrogen/progestin regimens are associated with low rates of patient acceptance. The present study assesses the acceptability of, and skeletal response to, continuous combined hormone replacement therapy in osteoporotic late post-menopausal women. DESIGN Retrospective, controlled study. PATIENTS One hundred and four osteoporotic late post-menopausal women treated with continuous combined hormone replacement therapy (5 mg medroxyprogesterone acetate daily and either 0.625 mg oral conjugated oestrogens or 50 mu g transdermal oestradiol daily) were followed for an average of 1 year (range 2-38 months). Control subjects were 19 healthy normal women matched for menopausal age and weight. MEASUREMENTS Adverse effects and compliance rate were monitored. Baseline and 1-year measurements of lumbar spine bone mineral density (BMD) were performed using dual-energy X-ray absorptiometry in 51 women, 22 of whom also had measurements at 2 years. Twenty-eight women had proximal femur scans at baseline and 1 year. RESULTS Eighty-six per cent of women continued to take continuous combined hormone replacement therapy at the end of follow-up. Mastalgia (44%) and vaginal bleeding (29%), the most common side-effects, were minor and self-limiting in virtually all women. Spinal BMD increased by 7.1 +/- 0.8% (mean +/- SEM P < 0.001) at 1 year and by 8.9 +/- 1.5% (P < 0.001) at 2 years. In the proximal femur, BMD increased by 2.9 +/- 0.9% at the femoral neck (P = 0.01) and by 2.5 +/- 0.9% (P = 0.001) at the trochanter at 1 year. BMD tended to decline in the control group. Among the women taking hormone replacement therapy, the increase in spinal BMD was similar in those treated with 0.3-0.44 mg/day of conjugated equine oestrogens to those receiving 0.45-0.625 mg/day. CONCLUSION Continuous combined hormone replacement therapy is an acceptable therapy to osteoporotic late post-menopausal women and produces substantial increases in lumbar spine and proximal femoral bone mineral density.