Abstract
Background The aim of this exploratory study was to establish whether we could improve skeletal health with a physiological regimen of SSR in young women with premature ovarian failure (POF). Patients and Methods In an open-label randomised controlled crossover trial, 34 women with POF were randomised to 4-week cycles of pSSR (transdermal oestradiol, 100µg daily for week 1, 150µg for weeks 2-4; vaginal progesterone, 200mg twice-daily weeks 3-4) or sHRT (oral ethinyloestradiol 30µg and 1.5mg norethisterone daily for weeks 1-3, week 4 pill-free) for 12 months. Bone mineral density (BMD) was measured by DEXA at study entry and after each 12-month treatment period. Blood samples for hormones and markers of bone formation (bone alkaline phosphatase, BALP, and Type I collagen N-terminal propeptide, PINP) and bone resorption (CrossLaps) were collected pre/post washout and after 3, 6 and 12 months of each treatment. Results 18 women, mean 27 (range 19-39) years, completed the study. Both regimens caused similar suppression of LH and FSH. Mean baseline lumbar spine BMD z-score was -0.89 (95% CI -1.27 to -0.51) and increased by +0.17 (CI +0.07 to +0.27) in response to pSSR (P=0.003) compared with +0.07 (CI -0.03 to +0.18) during standard HRT (P=0.2). During pSSR, the increment in lumbar spine BMD z-score was related positively to oestradiol (r = +0.49, P =0.04) and inversely to FSH (r = -0.65, P =0.004). Bone formation markers, BALP and P1NP, increased in the pSSR arm (ANOVA P<0.001) but decreased in the sHRT arm (P<0.01). Both treatments suppressed the bone resorption marker, CrossLaps (P <0.001). Conclusion We conclude that pSSR over 12 months has a beneficial affect on bone mass acquisition on the lumbar spine in women with POF, mediated by increased bone formation and decreased bone resorption. Keywords Ovarian failure, sex hormone replacement, bone mineral density, bone turnover markers.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
