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Hormone Treatment Restores Bone Density in Young Women With Menopause-Like Condition

NIH study shows way to improve bone health for patients with primary ovarian insufficiency

Researchers have found that hormone replacement therapy in young women with primary ovarian insufficiency (POI) led to increases in their bone mineral density (BMD), restoring levels to normal. The study was supported by the National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health.

The new findings — published in the Journal of Clinical Endocrinology & Metabolism — provide important treatment information for women with POI and their physicians, the authors say.

Spontaneous POI, which affects 1% of women by age 40, occurs when the ovaries stop producing sufficient estrogen in the absence of a known cause, such as anorexia, a chromosome abnormality, or chemotherapy. It is typically characterized by irregular or absent menstrual cycles, hot flashes, and fertility problems. Women with POI have abnormally low levels of reproductive hormones, including estradiol, a type of estrogen produced by the ovary, as well as testosterone, a predominantly male hormone, but also produced by women in smaller amounts. They also have reduced BMD, which can lead to osteoporosis and bone fractures.

Using bone density scans of the hip and lower spine, researchers measured the effects of two hormone replacement regimens on the BMD of women with POI who were between the ages of 18 and 42. A total of 145 women with POI were randomly assigned to one of two treatment groups: one group received a 100-mcg estradiol patch, progestin pills, and a 150-mcg testosterone patch, and the other group received a 100-mcg estradiol patch, progestin pills, and a placebo patch. For comparison, the scientists also measured BMD in 70 untreated women with normal ovarian function.

Both hormone treatment regimens led to significant increases in BMD in the treatment groups. When the study began, women with POI had significantly lower hip and spine levels compared to the control group. By the study’s end, both BMD measures had increased to the same levels as those of women without the condition.

However, the addition of testosterone in the treatment regimen did not prove to be statistically significant in helping increase BMD. According to co-author Dr. Lawrence M. Nelson, further studies with a larger number of women are needed to produce statistically valid results regarding whether testosterone replacement could benefit women with POI.

“While hormone replacement therapy’s effect on bone mineral density has been studied in postmenopausal women, there is limited research on the effects of this therapy in younger women,” said lead author Dr. Vaishali B. Popat. “This study provides important evidence that hormone replacement therapy with an appropriate dose of estradiol delivered via a skin patch combined with oral progestin can improve bone density to normal in women with primary ovarian insufficiency.”

Source: NIH; June 9, 2014.

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