72 women with significantly increased
bone resorption were evaluated (urinary
hydroxyproline/
creatinine > or = 21.9 mmol/mol, mean age, 53.7 +/- 6.3 years, time since menopause 6.1 +/- 2.6 years). All patients received daily 500 mg Ca2+ and 400 IU
vitamin D supplement. 48 patients with
osteopenia and 24 patients with
osteoporosis were randomly allocated to treatment with open-label
17 beta-estradiol (50 micrograms transdermally or 2 mg orally) or
calcitonin (200 IU every other day). Bone mass was measured by dual-energy x-ray absorptiometry (DPX-L, Lunar, C.V., 1.10 +/- 0.55% and 1.41 +/- 0.55%, lumbar spine and femoral neck, respectively) every six month for 2.5 year, bone stiffness was measured by ultrasound (Achilles, Lunar, C.V., 3.88 +/- 1.95%).
Biochemical markers of bone turnover (plasma
osteocalcin and
tartrate-resistant acid phosphatase, serum bone specific
alkaline phosphatase and urinary
hydroxyproline) were measured before and after 6, 12 and 24 month of treatment. Patients who received
17 beta-estradiol experienced significant increases (p < 0.05) in bone mass on the first and second year (by 2.6% and 2.1% at lumbar spine, 1.1% and 1.0%, at femoral neck, and 2.3% and 2% at the heel). A significant positive correlation was found between rates of bone mass change in all sites (p < 0.001). No statistically significant bone changes were found in
calcitonin treated patients. In
17 beta-estradiol treated patients,
biochemical markers of bone turnover decreased by 40-50% to the mean values in premenopausal women. In
calcitonin treated patients,
biochemical markers reached the upper normal limit.
CONCLUSIONS: