Rapid Increase in Lumbar Spine Bone Density in Osteopenic Women by High-Dose Intramuscular Estrogen-Progestogen Injections

Summary

This prospective pilot study has been carried out to assess the effect of high parenteral doses of estrogens and progestogens on lumbar spine bone density in osteopenic women. Thirteen osteopenic women received 40 mg estradiol valerate and 250 mg hydroxyprogesterone caproate by intramuscular injections once a week for 6 months (so called “pseudopregnancy”). One g oral calcium was added. Six out of the 13 patients (49.5 ± 4.8 y were peri- and postmenopausal = group A. Seven patients (21.5 ± 2.2y) suffered from primary and secondary amenorrhea, in 4 out of them due to gonadal dysgenesis = group B. Estradiol was measured by commercial radioimmunoassay. Bone density was determined by dual-energy X-ray absorptiometry (DEXA) of the upper 4 lumbar vertebrae. Lumbar spine bone density as well as estradiol serum levels were measured before and 3 and 6 months after therapy, respectively. Estradiol increased from 34.8 ± 7.5 pg/ml to 3226 ± 393pg/ml after 3 months and to 2552 ± 254 pg/ml after 6 months, respectively, in group A. Bone density increased by 15.3 ± 3.6% within the first 3 months to a total of 18.8 ± 3.9% after 6 months, respectively. Two patients we have controlled for two years, maintained this increase. In group B estradiol increased from 27.8 ± 6.5 pg/ml to 3028 ± 728 after 3 and to 2491 ± 684 pg/ml after 6 months. Bone density in this group increased by 11.8 ± 1.9% within 3 and to a total of 18.2 ± 2.8% after 6 months. Conclusions: Intramuscular injections of high doses of both estrogens and progestogens may be an effective means in the treatment of osteopenia caused by peri- and postmenopausal estrogen deficiency and in gonadal dysgenesis where substitution doses of estrogens and progestogens may be not sufficient to guarantee satisfactory response.

Key words

Osteopenia - Osteoporosis - Bone Density - DEXA - Estrogens - Pseudopregnancy - Gonadal Dysgenesis