POSTMENOPAUSAL BONE LOSS AND RESPONSE TO HORMONE REPLACEMENT THERAPY INDEPENDENT OF CLIMACTERIC SYMPTOMS

In a large group of unselected postmenopausal women, we investigated t he predictive value of climacteric complaints for future bone loss. We reviewed data on 143 healthy, early postmenopausal women, who had par ticipated in two placebo-controlled trials of the effects of different hormonal replacement regimens on bone mass, receiving either continuo us estradiol valerate (E(2)V) and cyproterone acetate or sequential E( 2)V and levonorgestrel, medroxyprogesterone acetate, or desogestrel. F ollow-up examinations were done every 3 months, and 118 women (85%) co mpleted the 2-year study. Bone mass was measured in the distal forearm (BMCarm) and the lumbar spine by photon and x-ray absorptiometry; bon e turnover was estimated by measurements of plasma bone Gla protein, s erum alkaline phosphatase, and fasting urinary hydroxyproline and calc ium corrected for creatinine (FuHPr/Cr). Menopausal complaints were sc ored according to the Kupperman index and flush scores separately. At baseline, levels of serum estradiol and bone turnover parameters were independent of the Kupperman index and flush score. A slight negative relationship was seen between menopausal complaints and HPr/Cr only (r = -0.18; p < 0.05). In the placebo group there was no relationship be tween the spontaneous rates of bone loss during the 2 years and either the initial Kupperman index or flush score. The responses in both bon e compartments to hormone replacement therapy (HRT) were also unrelate d to the initial level of menopausal complaints. After 2 years the res ponses to HRT in bone turnover parameters and BMCarm were independent of menopausal complaints. We conclude that there is no evidence of a r elationship between the severity of menopausal complaints and the rate of bone loss or the response to HRT. Women with severe menopausal com plaints are a target group for HRT because of the symptom relief, but those requiring HRT for prevention of osteoporosis must be identified by other means.