Objective : To evaluate the changes of bone mineral density (BUD) at spine and femur and the incidence of women with significant bone loss according to sites, techniques of measurement and duration of hormone replacement in surgically-induced menopausal women on estrogen replacement therapy (ERT) with minimal conventional estrogen dosage.
Design : retrospective clinical study
Setting Menopause clinic at Department of Obstetrics and Gynecology Yong-San Hospital, Chung-Ang University
Subjects : 47 women with surgically-induced menopause on continuos ERT
Intervention : 47 women with surgical menopause (mean age 41.5±3.6), had been treated with ERT by using minimal conventional estrogen dosage, conjugated equine estrogen WEE) 0.625 mg daily soon after castration operation and checked BMD annually by quantitative computed tomography and/or dual energy x-ray absorptiometry from January 1992 to August 1996. Main outcome measures : The changes of BMD at spine and femur were measured Significant bone loss was defined if the rate of annual bone loss was above 2.396 at 1% precision and above 4.7% at 2% precision of densitometry.
Results: No significant changes of BUD were noted at spine and femur on annual basis during ERT. The mean percent loss of spinal BMD measured by QCT was 7.76% in first year of ERT, which was 2.5 times greater than that of spinal BMD by DXA and similar to mean percent loss by Ward´s BMD by DXA.
Overall incidence of women with significant bone loss at spine was 60.47%(61.54% by QCT and 58.82% by DXA respectively) during the 1st year of ERT. Increasing duration of ERT decreased the incidence of significant bone loss, down to 20% in the 4th year of ERT.
Incidence of subjects with significant bone loss at femur was various, depending upon the studied sites of femur. Most frequent incidence was noted at Ward´s area, comprising 62.5%, followed by 50% at femur neck and 25% at trochanteric area at 1st year of ERT.
Conclusion: Nearly half of women with surgically-induced menopause had significant bone loss when checked BMD at femur and spine, during the 1st postoperative year, in spite of ERT with conventional estrogen dosage. CEE 0.625 mg daily. Increasing duration of ERT reduced the incidence of significant bone loss.
Additive or alternative measures should be considered for prevention of significant bone loss in considerable proportion of women with early surgically-induced menopause.
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