Skip to main content
PMC home page
Gut logoLink to Gut
. 1993 Nov;34(11):1543–1546. doi: 10.1136/gut.34.11.1543

Hormone replacement therapy prevents bone loss in patients with inflammatory bowel disease.

D Clements 1, J E Compston 1, W D Evans 1, J Rhodes 1
PMCID: PMC1374419  PMID: 8244141

Abstract

Patients with inflammatory bowel disease have an increased prevalence of osteoporosis, and suffer high rates of spinal bone loss. Hormone replacement therapy (HRT) is effective in the treatment and prevention of osteoporosis but has not been studied in patients with inflammatory bowel disease. A two year prospective study of HRT in inflammatory bowel disease was performed in 47 postmenopausal women aged 44 to 67 years with ulcerative colitis (25) or Crohn's disease (22). Patients had radial and spinal bone density measured annually by single photon absorptiometry and quantitative computed tomography respectively. The mean (95% confidence intervals) annual change in radial bone density was +1.42%/yr (+0.58 to +2.26; P < 0.005) and for spinal bone +2.60%/yr (+1.06 to +4.15; p < 0.005). There was no significant correlation between rates of change of bone density at the two sites, or between the rates of change and the initial bone density either in the radius or spine. Twelve patients were given prednisolone during the study, and their rates of change for spinal bone density were lower, but values were not statistically significantly different from those who did not receive corticosteroids. Changes in bone density for patients with ulcerative colitis and Crohn's disease were not significantly different. The change in bone density did not correlate with the patients' age or number of years after the menopause. It is concluded that HRT is effective in prevention of bone loss in postmenopausal women with inflammatory bowel disease.

Full text

PDF
1544

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cann C. E., Genant H. K., Kolb F. O., Ettinger B. Quantitative computed tomography for prediction of vertebral fracture risk. Bone. 1985;6(1):1–7. doi: 10.1016/8756-3282(85)90399-0. [DOI] [PubMed] [Google Scholar]
  2. Cann C. E., Genant H. K. Precise measurement of vertebral mineral content using computed tomography. J Comput Assist Tomogr. 1980 Aug;4(4):493–500. doi: 10.1097/00004728-198008000-00018. [DOI] [PubMed] [Google Scholar]
  3. Clements D., Motley R. J., Evans W. D., Harries A. D., Rhodes J., Coles R. J., Compston J. E. Longitudinal study of cortical bone loss in patients with inflammatory bowel disease. Scand J Gastroenterol. 1992 Dec;27(12):1055–1060. doi: 10.3109/00365529209028138. [DOI] [PubMed] [Google Scholar]
  4. Compston J. E., Evans W. D., Crawley E. O., Evans C. Bone mineral content in normal UK subjects. Br J Radiol. 1988 Jul;61(727):631–636. doi: 10.1259/0007-1285-61-727-631. [DOI] [PubMed] [Google Scholar]
  5. Compston J. E., Judd D., Crawley E. O., Evans W. D., Evans C., Church H. A., Reid E. M., Rhodes J. Osteoporosis in patients with inflammatory bowel disease. Gut. 1987 Apr;28(4):410–415. doi: 10.1136/gut.28.4.410. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Crawley E. O., Evans W. D., Owen G. M. A theoretical analysis of the accuracy of single-energy CT bone-mineral measurements. Phys Med Biol. 1988 Oct;33(10):1113–1127. doi: 10.1088/0031-9155/33/10/002. [DOI] [PubMed] [Google Scholar]
  7. Duursma S. A., de Raadt M., Raymakers J. A., Haspels A. A. Is 1 mg of estradiol valerate or 0.625 mg of conjugated estrogens sufficient for all women to prevent menopausal bone loss? Gynecol Endocrinol. 1992 Sep;6(3):205–209. doi: 10.3109/09513599209015556. [DOI] [PubMed] [Google Scholar]
  8. Ettinger B., Genant H. K., Cann C. E. Long-term estrogen replacement therapy prevents bone loss and fractures. Ann Intern Med. 1985 Mar;102(3):319–324. doi: 10.7326/0003-4819-102-3-319. [DOI] [PubMed] [Google Scholar]
  9. Genant H. K., Baylink D. J., Gallagher J. C., Harris S. T., Steiger P., Herber M. Effect of estrone sulfate on postmenopausal bone loss. Obstet Gynecol. 1990 Oct;76(4):579–584. [PubMed] [Google Scholar]
  10. Genant H. K., Cann C. E., Ettinger B., Gordan G. S. Quantitative computed tomography of vertebral spongiosa: a sensitive method for detecting early bone loss after oophorectomy. Ann Intern Med. 1982 Nov;97(5):699–705. doi: 10.7326/0003-4819-97-5-699. [DOI] [PubMed] [Google Scholar]
  11. Genant H. K., Mall J. C., Wagonfeld J. B., Horst J. V., Lanzi L. H. Skeletal demineralization and growth retardation in inflammatory bowel disease. Invest Radiol. 1976 Nov-Dec;11(6):541–549. doi: 10.1097/00004424-197611000-00007. [DOI] [PubMed] [Google Scholar]
  12. Gotfredsen A., Nilas L., Riis B. J., Thomsen K., Christiansen C. Bone changes occurring spontaneously and caused by estrogen in early postmenopausal women: a local or generalised phenomenon? Br Med J (Clin Res Ed) 1986 Apr 26;292(6528):1098–1100. doi: 10.1136/bmj.292.6528.1098. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hahn T. J., Boisseau V. C., Avioli L. V. Effect of chronic corticosteroid administration on diaphyseal and metaphyseal bone mass. J Clin Endocrinol Metab. 1974 Aug;39(2):274–282. doi: 10.1210/jcem-39-2-274. [DOI] [PubMed] [Google Scholar]
  14. Horsman A., Gallagher J. C., Simpson M., Nordin B. E. Prospective trial of oestrogen and calcium in postmenopausal women. Br Med J. 1977 Sep 24;2(6090):789–792. doi: 10.1136/bmj.2.6090.789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Hui S. L., Slemenda C. W., Johnston C. C., Jr Baseline measurement of bone mass predicts fracture in white women. Ann Intern Med. 1989 Sep 1;111(5):355–361. doi: 10.7326/0003-4819-111-5-355. [DOI] [PubMed] [Google Scholar]
  16. Hutchinson T. A., Polansky S. M., Feinstein A. R. Post-menopausal oestrogens protect against fractures of hip and distal radius. A case-control study. Lancet. 1979 Oct 6;2(8145):705–709. doi: 10.1016/s0140-6736(79)90640-8. [DOI] [PubMed] [Google Scholar]
  17. Jensen G. F., Christiansen C., Transbøl I. Treatment of post menopausal osteoporosis. A controlled therapeutic trial comparing oestrogen/gestagen, 1,25-dihydroxy-vitamin D3 and calcium. Clin Endocrinol (Oxf) 1982 May;16(5):515–524. doi: 10.1111/j.1365-2265.1982.tb02769.x. [DOI] [PubMed] [Google Scholar]
  18. Kiel D. P., Felson D. T., Anderson J. J., Wilson P. W., Moskowitz M. A. Hip fracture and the use of estrogens in postmenopausal women. The Framingham Study. N Engl J Med. 1987 Nov 5;317(19):1169–1174. doi: 10.1056/NEJM198711053171901. [DOI] [PubMed] [Google Scholar]
  19. Lindsay R., Hart D. M., Aitken J. M., MacDonald E. B., Anderson J. B., Clarke A. C. Long-term prevention of postmenopausal osteoporosis by oestrogen. Evidence for an increased bone mass after delayed onset of oestrogen treatment. Lancet. 1976 May 15;1(7968):1038–1041. doi: 10.1016/s0140-6736(76)92217-0. [DOI] [PubMed] [Google Scholar]
  20. Lindsay R., Hart D. M., Clark D. M. The minimum effective dose of estrogen for prevention of postmenopausal bone loss. Obstet Gynecol. 1984 Jun;63(6):759–763. [PubMed] [Google Scholar]
  21. Lindsay R., Hart D. M., Forrest C., Baird C. Prevention of spinal osteoporosis in oophorectomised women. Lancet. 1980 Nov 29;2(8205):1151–1154. doi: 10.1016/s0140-6736(80)92592-1. [DOI] [PubMed] [Google Scholar]
  22. Lindsay R., Tohme J. F. Estrogen treatment of patients with established postmenopausal osteoporosis. Obstet Gynecol. 1990 Aug;76(2):290–295. [PubMed] [Google Scholar]
  23. Lufkin E. G., Wahner H. W., O'Fallon W. M., Hodgson S. F., Kotowicz M. A., Lane A. W., Judd H. L., Caplan R. H., Riggs B. L. Treatment of postmenopausal osteoporosis with transdermal estrogen. Ann Intern Med. 1992 Jul 1;117(1):1–9. doi: 10.7326/0003-4819-117-1-1. [DOI] [PubMed] [Google Scholar]
  24. Lukert B. P., Johnson B. E., Robinson R. G. Estrogen and progesterone replacement therapy reduces glucocorticoid-induced bone loss. J Bone Miner Res. 1992 Sep;7(9):1063–1069. doi: 10.1002/jbmr.5650070909. [DOI] [PubMed] [Google Scholar]
  25. Lukert B. P., Raisz L. G. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med. 1990 Mar 1;112(5):352–364. doi: 10.7326/0003-4819-112-5-352. [DOI] [PubMed] [Google Scholar]
  26. Marslew U., Overgaard K., Riis B. J., Christiansen C. Two new combinations of estrogen and progestogen for prevention of postmenopausal bone loss: long-term effects on bone, calcium and lipid metabolism, climacteric symptoms, and bleeding. Obstet Gynecol. 1992 Feb;79(2):202–210. [PubMed] [Google Scholar]
  27. Motley R. J., Crawley E. O., Evans C., Rhodes J., Compston J. E. Increased rate of spinal trabecular bone loss in patients with inflammatory bowel disease. Gut. 1988 Oct;29(10):1332–1336. doi: 10.1136/gut.29.10.1332. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. 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. Obstet Gynecol. 1979 Mar;53(3):277–281. [PubMed] [Google Scholar]
  29. Paganini-Hill A., Ross R. K., Gerkins V. R., Henderson B. E., Arthur M., Mack T. M. Menopausal estrogen therapy and hip fractures. Ann Intern Med. 1981 Jul;95(1):28–31. doi: 10.7326/0003-4819-95-1-28. [DOI] [PubMed] [Google Scholar]
  30. Pigot F., Roux C., Chaussade S., Hardelin D., Pelleter O., Du Puy Montbrun T., Listrat V., Dougados M., Couturier D., Amor B. Low bone mineral density in patients with inflammatory bowel disease. Dig Dis Sci. 1992 Sep;37(9):1396–1403. doi: 10.1007/BF01296010. [DOI] [PubMed] [Google Scholar]
  31. Prince R. L., Smith M., Dick I. M., Price R. I., Webb P. G., Henderson N. K., Harris M. M. Prevention of postmenopausal osteoporosis. A comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Engl J Med. 1991 Oct 24;325(17):1189–1195. doi: 10.1056/NEJM199110243251701. [DOI] [PubMed] [Google Scholar]
  32. Recker R. R., Saville P. D., Heaney R. P. Effect of estrogens and calcium carbonate on bone loss in postmenopausal women. Ann Intern Med. 1977 Dec;87(6):649–655. doi: 10.7326/0003-4819-87-6-649. [DOI] [PubMed] [Google Scholar]
  33. Ribot C., Tremollieres F., Pouilles J. M., Louvet J. P., Peyron R. Preventive effects of transdermal administration of 17 beta-estradiol on postmenopausal bone loss: a 2-year prospective study. Gynecol Endocrinol. 1989 Dec;3(4):259–267. doi: 10.3109/09513598909152465. [DOI] [PubMed] [Google Scholar]
  34. Ringe J. D., Rehpenning W., Kuhlencordt F. Physiologische Anderung des Mineralgehalts von Radius und Ulna in Abhängigkeit von Lebensalter und Geschlecht. Rofo. 1977 Apr;126(4):376–380. doi: 10.1055/s-0029-1230598. [DOI] [PubMed] [Google Scholar]
  35. Ryde S. J., Clements D., Evans W. D., Motley R., Morgan W. D., Evans C., Rhodes J., Compston J. E. Total body calcium in patients with inflammatory bowel disease: a longitudinal study. Clin Sci (Lond) 1991 Apr;80(4):319–324. doi: 10.1042/cs0800319. [DOI] [PubMed] [Google Scholar]
  36. Sanchez-Ramos L., Robertson E. G., Beydoun S. Importance of sinusoidal fetal heart rate pattern. Am J Obstet Gynecol. 1982 Dec 1;144(7):863–865. doi: 10.1016/0002-9378(82)90375-1. [DOI] [PubMed] [Google Scholar]
  37. Sorenson J. A., Cameron J. R. A reliable in vivo measurement of bone-mineral content. J Bone Joint Surg Am. 1967 Apr;49(3):481–497. [PubMed] [Google Scholar]
  38. Spector T. D., Brennan P., Harris P. A., Studd J. W., Silman A. J. Do current regimes of hormone replacement therapy protect against subsequent fractures? Osteoporos Int. 1992 Sep;2(5):219–224. doi: 10.1007/BF01624144. [DOI] [PubMed] [Google Scholar]
  39. WALLACH S., HENNEMAN P. H. Prolonged estrogen therapy in postmenopausal women. J Am Med Assoc. 1959 Nov 21;171:1637–1642. [PubMed] [Google Scholar]
  40. Wasnich R. D., Ross P. D., Heilbrun L. K., Vogel J. M. Prediction of postmenopausal fracture risk with use of bone mineral measurements. Am J Obstet Gynecol. 1985 Dec 1;153(7):745–751. doi: 10.1016/0002-9378(85)90338-2. [DOI] [PubMed] [Google Scholar]
  41. Weiss N. S., Ure C. L., Ballard J. H., Williams A. R., Daling J. R. Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med. 1980 Nov 20;303(21):1195–1198. doi: 10.1056/NEJM198011203032102. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES