Effect of Premature Ovarian Failure (POF) on Bone Mass and Bone Remodeling. Hormonal Treatment Response

S. MASTAGLIA; A BAGUR; M. ROYER; M. SOTO; B. OLIVERI; C. ONETO; M. CORTELEZZI; M. NOLTING

Denver - Colorado

Congreso; 31th Anual Meeting ASBMR; 2009

American Society for Bone and Mineral Research

The POF is characterized by hypoestrogenemia, amenorrhea and elevated gonadotropinsbefore 40 years. Decreases of estrogen levels develop osteoporosis. The aims of thestudy were: 1) to evaluate the effect of POF on bone mineral density (BMD) and boneremodeling 2) to compare the effect of treatment with oral contraceptives (OC)(ethinylestradiol 30mcg/drosperinine 5mg) vs. hormonal replacement treatment (HRT)(continuous estradiol (E2) 2mg/ cyclical natural progesterone 200?g) on BMD inwomen with POF establish by: E2 <20pg/ml (11±6ng/ml) y FSH >25UI/ml(85±31UI/ml) in two samples with an interval of 30-90 days between them. Twentytwowomen (X±DS) of 35±4 years and BMI 25±5 kg/m2 were invited to participate inthe study. Exclusion criteria: medication or medical conditions that affect bonemetabolism, HRT and OC during the last year, immune diseases, contraindication toreceive hormonal treatment, primary and secondary amenorrhea, and/or anovulationdisorders. BMD of lumbar spine (LS) and total femur (TF) were measured by DXA.Calcium, phosphorus, FSH, E2, creatinine, crosslaps (CTX) and bone alkalinephosphatase (BAP) were measurement in serum. Calcium and creatinine weredetermined in 24hs urine sample. Baseline study: The table 1 shows bone turnovermarkers.Twenty-nine patients (6/21) presented an increment of CTX (602±135 ng/ml) accordinggender and age. The LS BMD was lower than control group (1,087vs. 1,180g/cm2 p<0,05). Six of 21 patients showed LS BMD below -2SD by gender and age.Longitudinal Study: the patients received HRT or OC according with their wish ofpregnancy (7/12 HRT y 5/12 OC). Twelve patients could be evaluated at the end of thestudy: 1 pregnancy was obtained during the study and 1 patient developed a cholecistitisand 7 had poor compliance. In both groups were observed a significant increment in LSBMD (1.09 vs.1.12g/cm2 p<0.03) and without change in TF BMD (0.955 vs.0.964g/cm2; ns). A decrease of CTX was observed (450±184 vs. 265±170 p<0,04). Nosignificant differences in BAP and E2 levels and by type of hormonal treatment wereobserved. No adverse events related to hormonal treatment were reported. FOP patientsshow a reduction of bone formation rate and only a small group presented an incrementin bone resorption rate. Hormonal treatments increase LS BMD and protect TFassociated with a decrease of bone resorption. Both were effective and safe treatmentsfor improving BMD in women diagnosed with POF.Disclosures: NoneAttachments