Hormone Replacement for Prevention and Treatment of Osteoporosis

What are the Options?
  • J. Zochling
  • P. N. Sambrook
Part of the Endocrine Updates book series (ENDO, volume 8)


Osteoporosis has been defined as a condition characterized by low bone mass and microarchitectural deterioration of bone tissue, resulting in bone fragility and susceptibility to fracture (1). Hence the most important clinical sequel is fracture, a source of significant pain, disability and health care costs.


Bone Mineral Density Postmenopausal Woman Bone Loss Vertebral Fracture Fracture Risk 
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  1. 1.
    Cooper C. Epidemiology of Osteoporosis. Osteoporosis 1999 Suppl. 2: S2 - S8CrossRefGoogle Scholar
  2. 2.
    WHO Study Group on Assessment of Fracture Risk and its Application to Screening for Post Menopausal Osteoporosis. Assessment of fracture risk and its application in screening for post menopausal osteoporosis: report of a WHO study group. Geneva: WHO, 1994. (WHO technical series 843).Google Scholar
  3. 3.
    Parfitt AM. Quantum concept of bone remodeling and turnover: Implications for the pathogenesis of osteoporosis. Calcif Tissue Int 1979; 28: 1–2PubMedCrossRefGoogle Scholar
  4. 4.
    Parfitt AM, Mathews CHE, Villaneuva AR, Kleerekoper M, Frame B, Rao DS. Relationships between surface volume, and thickness of iliac trabecular bone in aging and in osteoporosis. J Clin Invest 1983; 72: 1396–1409PubMedCrossRefGoogle Scholar
  5. 5.
    Heaney RP, Recker RR, Saville PD. Menopausal changes in calcium balance performance. J Lab Clin Med 1978; 92: 953–63PubMedGoogle Scholar
  6. 6.
    Quigley ME, Martin RL, Burnier AM, Brooks P. Estrogen therapy arrests bone loss in elderly women. Am J Obstet Gynecol 1987; 156: 1516–23PubMedGoogle Scholar
  7. 7.
    Oursler MJ, Osdoby P, Pyfferoen J, Riggs BL, Spelsberg TC. Avian osteoclasts as estrogen target cells. Proc Natl Acad Sci USA 1991; 88: 6613–17PubMedCrossRefGoogle Scholar
  8. 8.
    Oursler MJ, Pederson L, Pyfferoen J, Osdoby P, Fitzpatrick L, Spelsberg TC. Estrogen modulation of avian osteoclast lysosomal gene expression. Endocrinol 1993; 132: 1373–80CrossRefGoogle Scholar
  9. 9.
    Rizzoli R, Bonjour J-P. Determinants of peak bone mass and mechanisms of bone loss. Osteoporos Int 1999; Supp1. 2:S 17 - S23Google Scholar
  10. 10.
    Kimble RB, Vannice JL, Bloedow DC, Thompson RC, Hopfer W, Kung UT, Brownfield C, Pacifici R. Interleukin-1 receptor antagonist decreases bone loss and bone resorption in ovariectomized rats. J Clin Invest 1994; 93: 1959–67PubMedCrossRefGoogle Scholar
  11. 11.
    Ammann P, Rizzoli R, Bonjour JP, Bourrin S, Meyer MJ, Vassalli P. Transgenic mice expressing soluble tumour necrosis factor-receptor are protected against bone loss caused by estrogen deficiency. J Clin Invest 1997; 99: 1699–703PubMedCrossRefGoogle Scholar
  12. 12.
    Pacifici R, Rifas L, McCracken R, Vered I, McMurtry C, Avioli LV, Peck WA. Ovarian steroid treatment blocks a postmenopausal increase in blood monocyte interleukin-1 release. Proc Natl Acad Sci USA 1989; 86: 2398–2402PubMedCrossRefGoogle Scholar
  13. 13.
    Pacifici R. Estrogen, cytokines, and pathogenesis of postmenopausal osteoporosis. J Bone Min Res 1996; 11: 1043–51CrossRefGoogle Scholar
  14. 14.
    National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: NHMRC, Aus Info 1999.Google Scholar
  15. 15.
    Gotfredsen A, Nilas L, Rus BJ, Thomsen K, Christiansen C. Bone changes occurring spontaneously and caused by oestrogen in early postmenopausal women: a local or generalised phenomenon? BMJ 1986; 292: 1098–1100PubMedCrossRefGoogle Scholar
  16. 16.
    Lindsay R, Hart DM, Forrest C, Baird C. Prevention of spinal osteoporosis in oophorectomized women. Lancet 1980; 1151–4Google Scholar
  17. 17.
    Lindsay R, Hart DM, Aitken JM, MacDonald EB, Anderson JB, Clarke AC. Long-term prevention of postmenopausal osteoporosis by oestrogen. Evidence for an increased bone mass after delayed onset of oestrogen treatment. Lancet 1976;i:1038–41Google Scholar
  18. 18.
    Lindsay R, Hart DM, MacLean A, Clark AC, Kraszewski A, Garwood J. Bone response to termination of oestrogen treatment. Lancet 1978;i:1325–27Google Scholar
  19. 19.
    Al-Azzawi F, Hart DM, Lindsay R. Long term effect of oestrogen replacement therapy on bone mass as measured by dual photon absorptiometry. BMJ 1987; 294: 1261–2PubMedCrossRefGoogle Scholar
  20. 20.
    Nachtigall LE, Nachtigall RH, Nachtigall RD, Beckman EM. Estrogen replacement therapy. 1. A 10-year prospective study in the relationship to osteoporosis. Obstet Gynecol 1979; 53: 277–81PubMedGoogle Scholar
  21. 21.
    Christiansen C, Christiansen MS, McNair P, Hagen C, Stocklund KE, Transbol IB. Prevention of early postmenopausal bone loss: controlled 2-year study in 315 normal females. Eur J Clin Inv 1980; 10: 2739Google Scholar
  22. 22.
    Horsman A, Jones M, Francis R, Nordin C. The effect of estrogen dose on postmenopausal bone loss. N Engl J Med 1983; 309: 1405–7PubMedCrossRefGoogle Scholar
  23. 23.
    Recker RR, Saville PD, Heaney RP. Effect of estrogens and calcium carbonate on bone loss in postmenopausal women. Ann Intn Med 1977; 87: 649–55Google Scholar
  24. 24.
    Ettinger B, Genant HK, Camm CE. Postmenopausal bone loss is prevented by treatment with low-dosage estrogen with calcium. Ann Intern Med 1987; 106: 40–5PubMedGoogle Scholar
  25. 25.
    Annamento-Villareal R, Civitelli R. Estrogen action on the bone mass of postmenopausal women is dependent on bone mass and initial bone density. J Clin Endocrinol Metab 1995; 80: 776–82CrossRefGoogle Scholar
  26. 26.
    Christiansen C, Christiansen MS, Transbol IB. Bone mass in postmenopausal women after withdrawal of estrogen/gestagen replacement therapy. Lancet 1981; 459–61Google Scholar
  27. 27.
    Munk-Jensen N, Nielsen SP, Obel EB, Eriksen PB. Reversal of postmenopausal vertebral bone loss by oestrogen and progestogen: a double blind placebo controlled study. BMJ 1988; 296: 1150–2PubMedCrossRefGoogle Scholar
  28. 28.
    The Writing Group for the PEPI Trial. Effects of hormone therapy on bone mineral density. Results from the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial. JAMA 1996; 276: 1389–96CrossRefGoogle Scholar
  29. 29.
    Gordan GS, Picchi J, Roof BS. Antifracture efficacy of long-term estrogens for osteoporosis. Trans Assoc Am Physicians 1973; 86: 326–332PubMedGoogle Scholar
  30. 30.
    Hutchinson TA, Polansky SM, Feinstein AR. Post-menopausal oestrogens protect against fractures of hip and distal radius. A case-control study. Lancet 1979;Google Scholar
  31. 31.
    Weiss NS, Ure CL, Ballard JH, Williams AR, Daling JR. Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med 1980; 303: 1195–8PubMedCrossRefGoogle Scholar
  32. 32.
    Johnson RE, Specht EE. The risk of hip fracture in postmenopausal females with and without estrogen drug exposure. Am J Public Health 1981; 71: 138–144PubMedCrossRefGoogle Scholar
  33. 33.
    Kreiger N, Kelsey L, Holford TR, O’Connor T. Am epidemiologic study of hip fracture in postmenopausal women. Am J Epidemiol 1982; 116: 141–8PubMedGoogle Scholar
  34. 34.
    Williams AR, Weiss NS, Ure CL, Ballard J, Daling JR. Effect of weight, smoking, and estrogen use on the risk of hip and forearm fractures in postmenopausal women. Obstet Gynecol 1982; 60: 695–99PubMedGoogle Scholar
  35. 35.
    Paganini-Hill A, Chao A, Ross RK, Henderson BE. Exercise and other factors in the prevention of hip fracture: The Leisure World study. Epidemil 1991; 2: 16–25CrossRefGoogle Scholar
  36. 36.
    Hammond CB, Jelovsed FR, Lee KL, Creasman WT, Parker RT. Effects of long-term estrogen replacement therapy. I. Metabolic effects. Am J Obstet Gynecol 1979; 133: 525–36PubMedGoogle Scholar
  37. 37.
    Ettinger B, Genant HK, Cann CE. Long-term estrogen replacement therapy prevents bone loss and fractures. Ann Intern Med 1985; 102: 319–24PubMedGoogle Scholar
  38. 38.
    Kiel DP, Felsen DT, Anderson JJ, Wilson PWF, Moskowitz MA Hip fracture and the use of estrogens in postmenopausal women. The Framingham Study. N Eng J Med 1987; 317: 1169–74Google Scholar
  39. 39.
    Naessen T, Persson I, Adami HO, Bergstrom R, Bergkvist L. Hormone replacement therapy and the risk for first hip fracture. A prospective, population-based cohort study. Ann Intern Med 1990; 113: 95103Google Scholar
  40. 40.
    Maxim P, Ettinger B, Spitalny GM. Fracture protection provided by long-term estrogen treatment. Osteoporos Int 1995; 5: 23–9PubMedCrossRefGoogle Scholar
  41. 41.
    Cauley JA, Seeley DG, Ensrud K, Ettinger B, Black D, Cummings SR, for the Study of Osteoporotic Fractures Research Group. Estrogen replacement therapy and fractures in older women. Ann Intern Med 1995; 122: 9–16PubMedGoogle Scholar
  42. 42.
    Michaelsson K, Baron JA, Farahmand BY, Johnell O, Magnusson C, Persson PG, Persson I, Ljunghall S. Hormone replacement therapy and risk of hip fracture: population based case-control study. Brit Med J 1998; 316: 1858–63PubMedCrossRefGoogle Scholar
  43. 43.
    Grady D, Rubin SM, Petitti DB, Fox CS, Black D, Ettinger B, Ernster VL. Cummings SR. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 1992; 117: 1016–37PubMedGoogle Scholar
  44. 44.
    Lufkin EG, Wahner HW, O’Fallon WM, Hodgson SF, Kotowicz MA, Lane AW, Judd HL, Caplan R11. Riggs BL. Treatment of postmenopausal osteoporosis with transdermal estrogen. Ann Intern Med 1992; 117: 1–9PubMedGoogle Scholar
  45. 45.
    Shipman AJ, Guy GWG, Smith I, Ostlere S, Greer W, Smith R. Vertebral bone mineral density, content and area in 8789 normal women aged 33–73 years who have never had hormone replacement therapy. Osteoporos Int 1999; 9: 420–26PubMedCrossRefGoogle Scholar
  46. 46.
    Schneider DL, Barrett-Connor EL, Morton DJ. Timing of postmenopausal estrogen for optimal bone mineral density: the Rancho Bernardo Study. JAMA 1997; 277: 543–47PubMedCrossRefGoogle Scholar
  47. 47.
    Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, Palermo L, Prineas R, Rubin SM, Scott JC, Vogt T, Wallace R, Yates AJ, LaCroix, AZ. Effect of alendronate of risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998; 280: 2077–82PubMedCrossRefGoogle Scholar
  48. 48.
    Cummings SR, Black D, Barrett-Connor E, Scott J, Wallace RB. Alendronate and Fracture Prevention. JAMA 1999; 282: 324–5PubMedCrossRefGoogle Scholar
  49. 49.
    Felson DT, Zhang Y, Hannan MT, Kiel DP, Wilson PWF, Anderson JJ. The effect of postmenopausal estrogen therapy on bone density in elderly women. N Eng J Med 1993; 329: 1141–46CrossRefGoogle Scholar
  50. 50.
    Kanis JA. Osteoporosis. Blackwell Science Ltd. 1994 Christiansen C, Rus BJ. 17ß-estradiol and continuous norethisterone: A unique treatment for established osteoporosis in elderly women. J Clin Endocrinol Metab 1990; 71: 836–41PubMedCrossRefGoogle Scholar
  51. 51.
    Wimalawansa SJ. A four-year randomized controlled trial of hormone replacement and bisphosphonate, alone or in combination, in women with postmenopausal osteoporosis. Am J Med 1998; 104: 219–26PubMedCrossRefGoogle Scholar
  52. 52.
    Windeler J, Lange S. Events per person year — a dubious concept. BMJ 1995; 310: 454–56PubMedCrossRefGoogle Scholar
  53. 53.
    Weinstein L, Bewtra C, Gallagher JC. Evaluation of a continuous combined low-dose regimen of estrogen-progestin for treatment of the menopausal patient. Am J Obstet Gynecol 1990; 162: 1534–42PubMedGoogle Scholar
  54. 54.
    SperoffL, Rowan J, Symons J, Genant H, Wilbom W, for the CHART Study Group. The comparative effect on bone density, endometrium, and lipids of Continuous Hormones As Replacement Therapy (CHART study). A randomized controlled trial. JAMA 1996; 276: 1397–1403CrossRefGoogle Scholar
  55. 55.
    Abdalla HI, Hart DMcK, Lindsay R, Leggate I, Hooke A. Prevention of bone mineral loss in postmenopausal women by norethisterone. Obstet Gynecol 1985; 66: 789–92PubMedGoogle Scholar
  56. 56.
    Riffs BJ, Thomsen K, Strom V, Christiansen C. The effect of percutaneous estradiol and natural progesterone on postmenopausal bone loss. Am J Obstet Gynecol 1987: 156: 61–5Google Scholar
  57. 57.
    Cooper C, Stakkestad JA, Radowicki S, Hardy P, Pilate C, Dain MP, Deimos PD for The International Sudy Group. Matrix delivery transderrnal 17beta-estradiol for the prevention of bone loss in postmenopausal women. Osteoporos Int 1999; 9: 358–66PubMedCrossRefGoogle Scholar
  58. 58.
    Lindsay R, Hart DM, Clark DM. The minimum effective dose of estrogen for prevention of postmenopausal bone loss. Obstet Gynecol 1984; 63: 759PubMedGoogle Scholar
  59. 59.
    Genant HK, Cann CE, Ettinger B, Gordan GS. Quantitative computed tomography of vertebral spongiosa: A sensitive method for detecting early bone loss after oophorectomy. Ann hit Med 1982; 97: 699–705Google Scholar
  60. 60.
    Gordan GS. Prevention of bone loss and fractures in women. Maturitas 1984; 6: 225–42PubMedCrossRefGoogle Scholar
  61. 61.
    Genant HK et al. Effect of estrone sulfate on postmenopausal bone loss. Obstet Gynecol 1990; 76: 579PubMedGoogle Scholar
  62. 62.
    Hams ST, Genant HK, Baylink DJ, Gallagher C, Karp SK, McConnell EM, Stoll RW. The effects of estrone (Ogen) on spinal bone density of postmenopausal women. Arch Intern Med 1991; 151: 1980–84CrossRefGoogle Scholar
  63. 63.
    Cummings SR, Browner WS, Bauer D, Stone K, Ensrud K, Jamal S, Ettinger B. Endogenous hormones and the risk of hip and vertebral fractures among older women. N Engl J Med 1998; 339: 733–38PubMedCrossRefGoogle Scholar
  64. 64.
    Ribot C, Tremollieres F, Pouilles JM, Louvet JP, Peyon R. Preventive effects of transdermal administration of 17beta-estradiol on postmenopausal bone loss: a 2-year prospective study. Gynecol Endocrinol 1989; 3: 259–68PubMedCrossRefGoogle Scholar
  65. 65.
    Reginster JY, Sarlet N, Deroisy R, Albert A, Gaspard U, Franchimont P. Minimal levels of serum estradiol prevent postmenopausal bone loss. Calcif Tissue Int 1992; 51: 340–3PubMedCrossRefGoogle Scholar
  66. 66.
    Doren M. An assessment of hormone replacement therapy to prevent postmenopausal osteoporosis. Osteoporos Int 1999 Suppl. 2: S53 - S61Google Scholar
  67. 67.
    Gillespie WJ, Henry DA, O’Connell DL, Robertson J. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis (Cochrane Review). In: The Cochrane Library, Issue 1, 2000. Oxford: Update Software.Google Scholar
  68. 68.
    Lips P, Graafmans WC, Ooms ME, Bezemer PD, Bouter LM. Vitamin D supplementation and fracture incidence in elderly persons: a randomized, placebo-controlled clinical trial. Ann Int Med 1996; 124: 400–406PubMedGoogle Scholar
  69. 69.
    Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Dehnas PD, Meunier PJ. Vitamin D3 and calcium to provent hip fractures in the elderly women. N Engl J Med 1992; 327: 1637–42PubMedCrossRefGoogle Scholar
  70. 70.
    Tilyard MW, Spears GF, Thomson J, Dovey S. Treatment of postmenopausal osteoporosis with calcitriol or calcium. N Engl J Med 1992; 326: 357–62PubMedCrossRefGoogle Scholar
  71. 71.
    Caniggia A, Delling G, Nuti R, Lore F, Vattimo A. Clinical, biochemical and histological results of a double-blind trial with 1,25-dihydroxyvitamin D3, estradiol and placebo in post-menopausal osteoporosis. Acta Vitaminologica et Enzymologica 1984; 6: 117–28PubMedGoogle Scholar
  72. 72.
    Gallagher JC, Riggs BL, Recker RR, Goldgar D. The effect of calcitriol on patients with postmenopausal osteoporosis with special referenceto fracture frequency. Proc Soc Expt Biol Med 1989; 191: 287–92Google Scholar
  73. 73.
    Dawson-Hughes B, Jacques P, Shipp C. Dietary calcium intake and bone loss from the spine in healthy postmenopausal women. Am J Clin Nutrit 1987; 46: 685–7PubMedGoogle Scholar
  74. 74.
    Dawson-Hughes B, Dalla GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 1991; 323: 878–83CrossRefGoogle Scholar
  75. 75.
    Liberman UA, Weiss SR, Broli J, Minne HW, QuanH, Bell NH, Rodriguez-Portales J, Downs RW, Dequeker J, Favus M, Seeman E, Recker RR, Capizzi T, Santora AC, Lombardi A, Shah RV, Hirsch LT, Karpf DB, for the Alendromate Phase 111 Osteoporosis Treatment Study Group. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Eng J Med 1995; 333: 1437–43CrossRefGoogle Scholar
  76. 76.
    Pols HAP, Felsenberg D, Hanley DA, Stepan J, Munoz-Torres M, Wilkin TJ, Qin-sheng G, Galich AM, Vandormael K, Yates AJ, Stych B, for the Fosamax International Trial Study Group. Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results from the FOSIT Study. Osteoporos Int 1999; 9: 461–68CrossRefGoogle Scholar
  77. 77.
    Chesnut CH 3`d, McClung MR, Ensrud KE, Bell NH, Genant HK, Harris ST, Singer FR, Stock JL, Yood RA, Delmas PD, Kher U, Pryor-Tillotson S, Santora AC. Alendronate treatment of the postmenopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodeling. Am J Med 1995;99:144–52Google Scholar
  78. 78.
    Hosking D, Chilvers CED, Christiansen C, Ravn P, Wasnich R, Ross P, McClung M, Balske A, Thompson D, Daley M Yates AJ, for the Early Postmenopausal Intervention Cohort Study Group. Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. N Eng J Med 1998; 338: 485–92CrossRefGoogle Scholar
  79. 79.
    Schneider PF, Fischer M, Allolio B, Felsenberg D, Schroder U, Semler J, Ittner JR. Alendronate increases bone density and bone strength at the distal radius in postmenopausal women. J Bone Min Res 1999; 14: 1387–93CrossRefGoogle Scholar
  80. 80.
    McClung M, Clemmensen B, Daifotis A, Gilchrist NL, Eisman J, Weinstein RS, El Hajj Fuleihan G, Reda C, Yates Al, Ravn P. Alendronate prevents postmenopausal bone loss in women without osteoporosis: a double-blind, randomized, controlled trial. Ann Int Med 1998; 128: 253–61PubMedGoogle Scholar
  81. 81.
    Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Tomer JC, Quandt SA, Reiss TF, Ensrud KE, for the Fracture Intervention Trial Research Group. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996; 348: 1535–41PubMedCrossRefGoogle Scholar
  82. 82.
    Hochberg MC, Ross PD, Black D, Cummings SR, Genant HK, Nevitt MC, Barrett-Connor E, Musliner T, Thompson D. Larger increases in bone mineral density during alendronate therapy are associated with a lower risk of new vertebral fractures in women with postmenopausal osteoporosis. Fracture Intervention Trial Research Group. Arthr Rheum 1999; 42: 1246–54CrossRefGoogle Scholar
  83. 83.
    Ensrud KE, Black DM, Palermo L, Bauer DC, Barrett-Connor E, Quandt SA, Thompson DE, Karpf DB. Treatment with alendronate prevents fractures in women at highest risk: results from the Fracture Intervention Trial. Arch Intern Med 1997; 157: 2617–24PubMedCrossRefGoogle Scholar
  84. 84.
    Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH, Brown J, Eriksen EF, Hoseyni MS, Axelrod DW, Miller PD, for the Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 1999; 282: 1344–52PubMedCrossRefGoogle Scholar
  85. 85.
    Lindsay R, Cosman F, Lobo RA, Walsh BW, Harris ST, Reagan JE, Liss CL, Melton ME, Byrnes CA. Addition of alendronate to ongoing hormone replacement therapy in the treatment of osteoporosis: a randomized, controlled clinical trial. J Clin Endocrinol Metab 1999; 84: 3076–81PubMedCrossRefGoogle Scholar
  86. 86.
    Christiansen C. Sex steroid analogs. Osteoporos Int 1999 Suppl. 2: S62 - S65Google Scholar
  87. 87.
    Draper MW, Flowers DE, Huster WJ, Neild JA, Harper KD, Arnaud C. A controlled trial of raloxifene (LY139481) HCI: impact on bone turnover and serum lipid profile in healthy postmenopausal women. J Bone Min Res 1996; 11: 835–42CrossRefGoogle Scholar
  88. 88.
    Delmas PD, Bjamason NH, Mitlak BH, Ravoux AC, Shah AS, Huster WJ, Draper M, Christiansen C. Effects of raloxifene on bone mineral density. Serum cholesterol concentrations and uterine endometrium in postmenopausal women. N Eng J Med 1999; 337: 1641–7CrossRefGoogle Scholar
  89. 89.
    Lufkin EG, Whitaker MD, Nickelsen T, Argueta R, Caplan RH, Knickerbocker RK, Riggs BL. Treatment of established postmenopausal osteoporosis with raloxifene: a randomized trial. J Bone Min Res 1998; 13: 1747–54CrossRefGoogle Scholar
  90. 90.
    Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR, for the Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: Results from a 3-year randomized clinical trial. JAMA 1999; 282: 637–45Google Scholar
  91. 91.
    Cummings SR, Eckert S, Krueger KA, Grady K, Powles TJ, Caulet JA, Norton L, Nickelsen T, Bja reason NH, Morrow M, Lippman ME, Black D, Blusman JE, Costa A, Jordan VC. The effect of raloxifene on risk of breast cancer in postmenopausal women: Results from the MORE randomized trial. JAMA 1999; 281: 2189–97PubMedCrossRefGoogle Scholar
  92. 92.
    Beardsworth SA, Kearney CE, Purdie DW. Prevention of postmenopausal bone loss at lumbar spine and upper femur with tibolone: a two-year randomised controlled trial. Br J Obstet Gynaecol 1999; 106: 678–83PubMedCrossRefGoogle Scholar
  93. 93.
    Pavlov PW, Ginsburg J, Kicovic PM, van der Schaaf DB, Prelevic G, Bennik HJ. Double-blind, placebo-controlled study of the effects of tibolone on bone mineral density in postmenopausal osteoporotic women with and without previous fractures. Gynecol Endocrinol 1999; 13: 230–37PubMedCrossRefGoogle Scholar
  94. 94.
    Nieves JW, Komar L, Cosman F, Lindsay R. Calcium potentiates the effect of estrogen and calcitonin on bone mass: review and analysis. Am J Clin Nutr 1998; 67: 18–24PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • J. Zochling
    • 1
  • P. N. Sambrook
    • 1
  1. 1.Royal North Shore HospitalSydneyAustralia

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