Abstract
BackgroundOsteoporosis affects elderly patients of both sexes. It is characterized by an increased fracture risk due to defective remodeling of the bone microarchitecture. It affects in particular postmenopausal women due to their decreased levels of estrogen. Preclinical studies with animals demonstrated that loss of estrogen had a negative effect on bone healing and that increasing the estrogen level led to a better bone healing. We asked whether increasing the estrogen level in menopausal patients has a beneficial effect on bone mineral density (BMD) during callus formation after a bone fracture.MethodsTo investigate whether estrogen has a beneficial effect on callus BMD of postmenopausal patients, we performed a prospective double-blinded randomized study with 76 patients suffering from distal radius fractures. A total of 31 patients (71.13 years ±11.99) were treated with estrogen and 45 patients (75.62 years ±10.47) served as untreated controls. Calculated bone density as well as cortical bone density were determined by peripheral quantitative computed tomography (pQCT) prior to and 6 weeks after the surgery. Comparative measurements were performed at the fractured site and at the corresponding position of the non-fractured arm.ResultsWe found that unlike with preclinical models, bone fracture healing of human patients was not improved in response to estrogen treatment. Furthermore, we observed no dependence between age-dependent bone tissue loss and constant callus formation in the patients.ConclusionsTransdermally applied estrogen to postmenopausal women, which results in estrogen levels similar to the systemic level of premenopausal women, has no significant beneficial effect on callus BMD as measured by pQCT, as recently shown in preclinical animal models.Trial registrationLow dose estrogen has no significant effect on bone fracture healing measured by pQCT in postmenopausal women, DRKS00019858. Registered 25th November 2019 - Retrospectively registered. Trial registration number DRKS00019858.
Highlights
Osteoporosis affects elderly patients of both sexes
Estrogen treatment of mice with bone fractures led to enhanced healing, i.e. the chondrocyte areas were larger, callus mineralization was increased, and the neocortex was thicker when compared to untreated control animals [4, 8,9,10,11,12,13]
The estrogen values of all patients prior to the estrogen application or the placebo-treatment were in the range of ≤ 30 ng/l, indicating that all individuals were in post menopause [21]
Summary
Osteoporosis affects elderly patients of both sexes It is characterized by an increased fracture risk due to defective remodeling of the bone microarchitecture. It affects in particular postmenopausal women due to their decreased levels of estrogen. Estrogen treatment of mice with bone fractures led to enhanced healing, i.e. the chondrocyte areas were larger, callus mineralization was increased, and the neocortex was thicker when compared to untreated control animals [4, 8,9,10,11,12,13]. Estrogen treatment led to beneficial effects on the biomechanical properties of the bones [4] These observations are in line with the observation that osteoporotic patients sustain a prolonged and impaired healing process after bone fracture as compared to non-osteoporotic patients [14]
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