Calcified Tissue International

, Volume 33, Issue 1, pp 575–581 | Cite as

Factors in response to treatment of early postmenopausal bone loss

  • Claus Christiansen
  • Richard B. Mazess
  • Ib Transbøl
  • Grethe Finn Jensen


Bone mineral content (BMC) was measured by125I photon absorptiometry every 3 months in 264 normal females (45–54 years) over a 2-year period together with serum samples for calcium, phosphate, magnesium, creatinine, alkaline phosphatases, potassium, and protein. A 48-h urinary calcium and creatinine measurement was obtained. The subjects were divided into 7 treatment groups and 3 placebo groups. Five of the treatments (thiazide, vitamin D3, fluoride + vitamin D3, fluoride, and 1αD3) were ineffective at the doses used; the annual loss of compact bone was 1.5–2.2% (-X=1.8%), similar to the loss seen with placebos. Estrogen and estrogen + thiazide, in contrast, produced a 1.34% annual increase of BMC.

The subjects were divided into groups with low, medium, and high initial BMC. Also, individual regressions for bone change were calculated and the subjects were divided into groups of responders, maintainers, and losers (annual change of >0%, 0 to −1%, and >−1%, respectively).

The initial BMC status did not consistently affect bone or biochemical responses to the therapeutic agents. Estrogen was effective even in subjects with high BMC, whereas the other agents did not inhibit bone loss even in subjects with low initial BMC. Virtually all subjects responded to estrogen positively; in contrast we could not identify a subset of “responders” with any of the other treatments. Time since menopause appeared to influence the bone changes, although it was not a significant effect given the sample size. Bone loss in groups not treated with estrogens was 2%/year at 20 months after menopause with a decline to 1.3%/year at 45 months post-menopause. There was no apparent decline in the bone response to estrogen during the first 4 years after menopause, and in fact bone response tended to increase with time.

Key words

Osteoporosis Vitamin D Bone mineral Estrogen Aging Thiazide Fluoride Calcium 


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  1. 1.
    Mazess, R. B., Cameron, J. R.: Bone mineral content in normal U.S. whites. In R. B. Mazess (ed.): International Conference on Bone Mineral Measurement, pp. 228–238. DHEW Publ., Washington D.C., 1974Google Scholar
  2. 2.
    Smith, D. M., Khairi, M. R. A., Johnston, C. C., Jr.: The loss of bone mineral with aging and its relationship to risk of fracture, J. Clin. Invest.56:311–318, 1975PubMedGoogle Scholar
  3. 3.
    Meema, H. E., Bunker, M. L., Meema, S.: Loss of compact bone due to menopause, Obstet. Gynecol.26:333–343, 1965PubMedGoogle Scholar
  4. 4.
    Meema, H. E., Meema, S.: Compact bone mineral density of the normal human radius, Acta Radiol. Oncol.17:342–352, 1978Google Scholar
  5. 5.
    Donath, A., Indermuhle, P., Baud, R.: Mineralometrie osseuse, mesuree par l'absorption des photons d'une source d'125I, Radiol. Clin. Biol.43:393–400, 1974PubMedGoogle Scholar
  6. 6.
    Dequeker, J.: Bone Loss in Normal and Pathological Conditions. Leuven University Press, Leuven, Belgium, 1972Google Scholar
  7. 7.
    Garn, S. M., Rohmann, C. G., Wagner, B.: Bone loss as a general phenomenon in man, Fed. Proc.26:1729–1736, 1967PubMedGoogle Scholar
  8. 8.
    Christiansen, C., Rodbro, P., Jensen, H.: Bone mineral content in the forearm measured by photon absorptiometry, Scand. J. Clin. Lab. Invest.35:323–330, 1975PubMedGoogle Scholar
  9. 9.
    Lindsay, R., Aitken, J. M., Andersen, J. B., Hart, D. M., MacDonald, E. B., Clarke, A. C.: Long-term prevention of post-menopausal osteoporosis by oestrogen, LancetI:1038–1041, 1976CrossRefGoogle Scholar
  10. 10.
    Horsman, A., Gallagher, J. C., Simpson, M., Nordin, B. E. C.: Prospective trial of oestrogen and calcium in postmenopausal women, Br. Med. J.2:789–792, 1977PubMedGoogle Scholar
  11. 11.
    Mazess, R. B., Christiansen, C.: A comparison of BMC results from Denmark and the U.S., Scand. J. Clin. Lab. Invest. (submitted)Google Scholar
  12. 12.
    Aitken, J. M., Hart, D. M., Lindsay, R.: Oestrogen replacement therapy for prevention of osteoporosis after oophorectomy, Br. Med. J.3:515–518, 1973PubMedCrossRefGoogle Scholar
  13. 13.
    Christiansen, C., Christensen, M. S., McNair, P., Hagen, C., Stocklund, K. E., Transbøl, I.: Prevention of early postmenopausal bone loss, Eur. J. Clin. Invest.10:273–279, 1980PubMedCrossRefGoogle Scholar
  14. 14.
    Christiansen, C., Rødbro, P.: Long-term reproducibility of bone mineral content measurements, Scand. J. Clin. Lab. Invest.37:321–323, 1977PubMedGoogle Scholar
  15. 15.
    Newton-John, H. F., Morgan, D. B.: The loss of bone with age, osteoporosis, and fractures, Clin. Orthop.71:229–252, 1970PubMedGoogle Scholar
  16. 16.
    Doyle, F.: Involutional osteoporosis, Clin. Endocrin. Metab.1:143–167, 1972CrossRefGoogle Scholar
  17. 17.
    Saville, P. D.: Observations on 80 women with osteoporotic spine fractures. In U.S. Barzel (ed.): Osteoporosis, pp. 38–45. Grune & Stratton, New York, 1970Google Scholar
  18. 18.
    Riggs, B. L., Jowsey, J., Goldsmith, R. S., Kelly, P. J., Hoffman, D. L., Arnaud, C. D.: Short- and long-term effects of estrogen and synthetic anabolic hormone in post-menopausal osteoporosis, J. Clin. Invest.51:1659–1663, 1972PubMedGoogle Scholar
  19. 19.
    Nordin, B. E. C.: Metabolic Bone and Stone Disease. Williams & Wilkins Co., Baltimore, 1973Google Scholar
  20. 20.
    Hulth, A. G., Nilsson, B. E., Westlin, N. E., Wiklund, P. E.: Alkaline phosphatase in women with osteoporosis, Acta Med. Scand.206:201–203, 1979PubMedCrossRefGoogle Scholar
  21. 21.
    Hulth, S. G., Nilsson, B. E., Westlin, N. E., Wiklund, P. E.: Bone biopsy in women with spinal osteoporosis, Acta Med. Scand.206:205–206, 1979PubMedCrossRefGoogle Scholar
  22. 22.
    Frost, H. M.: Bone Remodeling and Its Relationship to Metabolic Bone Disease. Charles C. Thomas, Springfield, Ill., 1973Google Scholar
  23. 23.
    Parfitt, A. M.: Quantum concept of bone remodeling and turnover: implications for the pathogenesis of osteoporosis, Calcif. Tissue Int.28:1–5, 1979PubMedGoogle Scholar
  24. 24.
    Franke, J., Rempel, H., Franke, M.: Three years experience with sodium-fluoride therapy of osteoporosis, Acta Orthop. Scand.45:1–20, 1974PubMedCrossRefGoogle Scholar
  25. 25.
    Meunier, P. J., Bressot, C., Vignon, E., Edouard, C., Alexandre, C., Courpron, P., Laurent, J.: Radiological and histological evaluation of post-menopausal osteoporosis treated with sodium fluoride-vitamin D-calcium. Preliminary results, In B. Courvaisier, A. Donath, C. A. Baud (eds.): Fluoride and Bone, pp. 263–276. Hans Huber Publ., Bern, 1978Google Scholar
  26. 26.
    Ringe, J. D., Kruse, H. P., Kuhlencordt, F.: Long term treatment of primary osteoporosis by sodium fluoride. In B. Courvaisier, A. Donath, C. A. Baud (eds.): Fluoride and Bone, pp. 228–232. Hans Huber Publ., Bern, 1978Google Scholar
  27. 27.
    Crilly, R. G., Horsman, A., Marshall, D. H., Nordin, B. E. C.: Postmenopausal and corticosteroid-induced osteoporosis, Front. Horm. Res.5:53–75, 1978Google Scholar
  28. 28.
    Meema, S., Bunker, M. L., Meema, H. E.: Preventive effect of estrogen on postmenopausal bone loss, Arch. Intern. Med.135:1436–1440, 1975CrossRefPubMedGoogle Scholar
  29. 29.
    Recker, R. R., Saville, P. D., Heaney, R. P.: Effects of estrogens and calcium carbonate on bone loss in post-menopausal women, Ann. Intern. Med.87:649–655, 1977PubMedGoogle Scholar
  30. 30.
    Nachtigall, L. E., Nachtigall, R. H., Nachtigall, R. D., Beckman, E. M.: Estrogen replacement therapy. I. A 10-year prospective study in the relationship to osteoporosis, J. Am. Col. Obstet. Gynecol.53:277–281, 1979Google Scholar

Copyright information

© Springer-Verlag 1981

Authors and Affiliations

  • Claus Christiansen
    • 1
  • Richard B. Mazess
    • 2
  • Ib Transbøl
    • 3
  • Grethe Finn Jensen
    • 1
  1. 1.Department of Clinical Chemistry, Glostrup HospitalUniversity of CopenhagenGlostrupDenmark
  2. 2.Department of Radiology (Medical Physics)University of WisconsinMadisonUSA
  3. 3.Division of Endocrinology, Department of Internal Medicine, Hvidovre HospitalUniversity of CopenhagenHvidovreDenmark

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