Medroxyprogesterone acetate enhances the spinal bone mineral density response to oestrogen in late post‐menopausal women

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Abstract
OBJECTIVES The relative contributions of administered oestrogen and progestin to protection of the post‐menopausal skeleton remain unclear. We have compared the effect on spinal bone mineral density of continuous combined oestrogen/medroxyprogesterone therapy with that of unopposed oestrogen in late post‐menopausal women. DESIGN Observational study. SUBJECTS Seventy‐three osteoporotic post‐menopausal women attending the Auckland Hospital Bone Clinic. Twenty‐three hysterectomized women were treated with unopposed oestrogen (0.625 mg oral conjugated oestrogens daily), and 50 non‐hysterectomized women were treated with continuous combined oestrogen/medroxyprogesterone therapy (5 mg medroxyprogesterone acetate and 0.625 mg oral conjugated oestrogens daily). MEASUREMENTS Baseline and one‐year measurements of lumbar spine bone mineral density were performed using dual‐energy X‐ray absorptiometry. RESULTS After one year of therapy, spinal bone mineral density increased by 6.6% (95% confidence interval 5.6–7.6, P < 0.001 vs baseline) in the combined oestrogen/medroxyprogesterone therapy group, compared to 4.0% (CI 2.4–5.7, P < 0.001 vs baseline) in the unopposed oestrogen group (difference between means 2.6% (CI 0.8–4.4, P < 0.01). CONCLUSION In osteoporotic post‐menopausal women, one year of continuous combined oestrogen/medroxyprogesterone therapy is associated with a 65% greater increment in spinal bone mineral density than is observed in response to unopposed oestrogen. The prescription of combined oestrogen/progestin therapy should be considered in osteoporotic post‐menopausal women who have undergone hysterectomy, in order to maximize the skeletal protection provided by hormone replacement therapy.

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