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https://hdl.handle.net/2440/47506
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Type: | Journal article |
Title: | A randomized trial comparing hormone replacement therapy (HRT) and HRT plus calcitriol in the treatment of postmenopausal osteoporosis with vertebral fractures: benefit of the combination on total body and hip density |
Author: | Gutteridge, D. Holzherr, M. Retallack, R. Price, R. Will, R. Dhaliwal, S. Faulkner, D. Stewart, G. Stuckey, B. Prince, R. Criddle, R. Drury, P. Tran, L. Bhagat, C. Kent, G. Jamrozik, K. |
Citation: | Calcified Tissue International, 2003; 73(1):33-43 |
Publisher: | Springer |
Issue Date: | 2003 |
ISSN: | 0171-967X 1432-0827 |
Statement of Responsibility: | D. H. Gutteridge, M. L. Holzherr, R. W. Retallack, R. I. Price, R. K. Will, S. S. Dhaliwal, D. L. Faulkner, G. O. Stewart, B. G. A. Stuckey, R. L. Prince, R. A. Criddle, P. J. Drury, L. Tran, C. I. Bhagat, G. N. Kent and K. Jamrozik |
Abstract: | We report a prospective, randomized, multicenter, open-label 2-year trial of 81 postmenopausal women aged 53-79 years with at least one minimal-trauma vertebral fracture (VF) and low (T-score below - 2) lumbar bone mineral density (BMD). Group HRT received piperazine estrone sulfate (PES) 0.625 – 1.25 mg/d ± medroxyprogesterone acetate (MPA) 2.5 – 5 mg/d; group HRT/D received HRT plus calcitriol 0.25 µg bd. All with a baseline dietary calcium (Ca) of <1 g/d received Ca carbonate 0.6 g nocte. Final data were on 66 – 70 patients. On HRT/D, significant (P < 0.001) BMD increases from baseline by DXA were at total body – head, trochanter, Wards, total hip, intertrochanter and femoral shaft (% group mean 4.2, 6.1, 9.3, 3.7, 3.3 and 3.3%, respectively). On HRT, at these 6 sites, significant s were restricted to the trochanter and Wards. Significant advantages of HRT/D over HRT were in BMD of total body (- head), total hip and trochanter (all P = 0.01). The differences in mean at these sites were 1.3, 2.6 and 3.9%. At the following, both groups improved significantly -lumbar spine (AP and lateral), forearm shaft and ultradistal tibia/fibula. The weightbearing, site — specific benefits of the combination associated with significant suppression of parathyroid hormone—suggest a beneficial effect on cortical bone. Suppression of bone turnover was significantly greater on HRT/D (serum osteocalcin P = 0.024 and urinary hydroxyproline/creatinine ratio P = 0.035). There was no significant difference in the number of patients who developed fresh VFs during the trial (HRT 8/36, 22%; HRT/D 4/34, 12% - intention to treat); likewise in the number who developed incident nonvertebral fractures. This is the first study comparing the 2 treatments in a fracture population. The results indicate a significant benefit of calcitriol combined with HRT on total body BMD and on BMD at the hip, the major site of osteoporotic fracture. |
Keywords: | BMD by DXA Estrogen +/– calcitriol Osteoporotic fracture PTH suppression |
Provenance: | Published online: 14 April 2003 |
Rights: | © Springer-Verlag 2003 |
DOI: | 10.1007/s00223-002-2023-4 |
Published version: | http://dx.doi.org/10.1007/s00223-002-2023-4 |
Appears in Collections: | Aurora harvest 6 General Practice publications |
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