CONTINUOUS COMBINED OESTROGEN PROGESTIN THERAPY IS WELL TOLERATED ANDINCREASES BONE-DENSITY AT THE HIP AND SPINE IN POSTMENOPAUSAL OSTEOPOROSIS/

OBJECTIVES Although oestrogen/progestin therapy is effective prophylax is against post-menopausal osteoporosis, its efficacy in the treatment of established disease is uncertain. In addition, cyclical oestrogen/ progestin regimens are associated with low rates of patient acceptance . The present study assesses the acceptability of, and skeletal respon se to, continuous combined hormone replacement therapy in osteoporotic late post-menopausal women. DESIGN Retrospective, controlled study. P ATIENTS One hundred and four osteoporotic late post-menopausal women t reated with continuous combined hormone replacement therapy (5 mg medr oxyprogesterone acetate daily and either 0.625 mg oral conjugated oest rogens or 50 mu g transdermal oestradiol daily) were followed for an a verage of 1 year (range 2-38 months). Control subjects were 19 healthy normal women matched for menopausal age and weight. MEASUREMENTS Adve rse effects and compliance rate were monitored. Baseline and 1-year me asurements of lumbar spine bone mineral density (BMD) were performed u sing dual-energy X-ray absorptiometry in 51 women, 22 of whom also had measurements at 2 years. Twenty-eight women had proximal femur scans at baseline and 1 year. RESULTS Eighty-six per cent of women continued to take continuous combined hormone replacement therapy at the end of follow-up. Mastalgia (44%) and vaginal bleeding (29%), the most commo n side-effects, were minor and self-limiting in virtually all women. S pinal BMD increased by 7.1 +/- 0.8% (mean +/- SEM P < 0.001) at 1 year and by 8.9 +/- 1.5% (P < 0.001) at 2 years. In the proximal femur, BM D increased by 2.9 +/- 0.9% at the femoral neck (P = 0.01) and by 2.5 +/- 0.9% (P = 0.001) at the trochanter at 1 year. BMD tended to declin e in the control group. Among the women taking hormone replacement the rapy, the increase in spinal BMD was similar in those treated with 0.3 -0.44 mg/day of conjugated equine oestrogens to those receiving 0.45-0 .625 mg/day. CONCLUSION Continuous combined hormone replacement therap y is an acceptable therapy to osteoporotic late post-menopausal women and produces substantial increases in lumbar spine and proximal femora l bone mineral density.