METABOLIC EFFECTS OF CORTICOSTEROID-THERAPY IN POSTMENOPAUSAL WOMEN

Vertebral compression fractures occur in about 8% of post-menopausal women and are associated with a diminished volume of trabecular bone as judged by iliac crest biopsy. These patients differ from age-matched controls in having significantly lower calcium absorption, plasma oestrone and androstenedione levels and lower plasma testosterone levels. Their urinary hydroxyproline is increased and their skin thickness is reduced. The low plasma oestrone levels do not appear to be due to impaired conversion of androstenedione to oestrone, but are probably the result of the low plasma androstenedione levels themselves. The increased bone resorption can be corrected by oestrogen therapy and the malabsorption of calcium can be corrected with 1α-OHD3 or 1,25(OH)2D3 therapy. Post-menopausal women on corticosteroid therapy have even lower plasma androgen and oestrogen levels due to suppression of ACTH secretion. This abnormality, combined with malabsorption of calcium secondary to corticosteroid therapy, probably explains the high incidence of osteoporosis in this population. The malabsorption of calcium can be corrected in this group also by vitamin D metabolites. The hormone levels can be raised by ACTH administration or by the oral administration of androstenedione or dehydroepiandrosterone. © 1979.