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

MASTAGLIA S,; BAGUR A,; ROYER M; SOTO M; OLIVERI B; ONETTO C; CORTELEZZI M; NOLTING M

Denver, Colorado, USA

Congreso; 31st Annual Meeting of the American Society for Bone and Mineral Research; 2009

The American Society for Bone and Mineral Research

The POF is characterized by hypoestrogenemia, amenorrhea and elevated gonadotropins before 40 years. Decreases of estrogen levels develop osteoporosis. The aims of the study were: 1) to evaluate the effect of POF on bone mineral density (BMD) and bone remodeling 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 in women 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. Twenty- two women (X±DS) of 35±4 years and BMI 25±5 kg/m2 were invited to participate in the study. Exclusion criteria: medication or medical conditions that affect bone metabolism, HRT and OC during the last year, immune diseases, contraindication to receive hormonal treatment, primary and secondary amenorrhea, and/or anovulation disorders. BMD of lumbar spine (LS) and total femur (TF) were measured by DXA. Calcium, phosphorus, FSH, E2, creatinine, crosslaps (CTX) and bone alkaline phosphatase (BAP) were measurement in serum. Calcium and creatinine were determined in 24hs urine sample. Baseline study: The table 1 shows bone turnover markers. Twenty-nine patients (6/21) presented an increment of CTX (602±135 ng/ml) according gender 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 of pregnancy (7/12 HRT y 5/12 OC). Twelve patients could be evaluated at the end of the study: 1 pregnancy was obtained during the study and 1 patient developed a cholecistitis and 7 had poor compliance. In both groups were observed a significant increment in LS BMD (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). No significant differences in BAP and E2 levels and by type of hormonal treatment were observed. No adverse events related to hormonal treatment were reported. FOP patients show a reduction of bone formation rate and only a small group presented an increment in bone resorption rate. Hormonal treatments increase LS BMD and protect TF associated with a decrease of bone resorption. Both were effective and safe treatments for improving BMD in women diagnosed with POF. n Age (y) sCTX (182-411ng/ml) BAP (31-95UI/l) POF 21 35±4 391±174 41±11 Control 10 35±2 296±110 65±16 p ns ns 0,001 ns: no significant