June 23, 2014

Restoring Bone Density in Women with Ovarian Disorder

A woman smiling, with other woman in the background.

Hormone replacement therapy restored bone mineral density to normal in young women with primary ovarian insufficiency (POI). The findings provide important treatment information for women with POI and their physicians.

Spontaneous POI affects 1 in 100 women by age 40. With no apparent cause, the ovaries of affected women don’t work normally. They stop regularly releasing eggs and produce low levels of reproductive hormones, including estradiol (a type of estrogen) and testosterone (a predominantly male hormone that is also produced by women in smaller amounts). Women with POI have hot flashes, fertility problems, and irregular or no menstrual cycles. They also have reduced bone mineral density, which can lead to osteoporosis and bone fractures.

Hormone replacement therapy regimens have been well studied and optimized to improve bone health in postmenopausal women. But there has been limited research on the effects of these therapies in younger women. A team led by Drs. Vaishali B. Popat and Lawrence M. Nelson of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) tested the effects of hormone replacement therapy on bone health in young women with POI. The trial was done at NIH’s Clinical Center in Bethesda, Maryland.

The team enrolled 145 women with POI between the ages of 18 and 42. The women were randomly assigned to 2 groups. One received an estradiol patch, progestin pills, and a testosterone patch. The other received an estradiol patch, progestin pills, and an inactive placebo patch. The researchers used bone density scans of the hip and lower spine to measure the effects of the regimens. For comparison, the scientists also measured bone mineral density in an untreated group of 70 women with normal ovarian function. Results were published online on June 6, 2014, in the Journal of Clinical Endocrinology & Metabolism.

Both hormone treatment regimens led to increases in bone mineral density at 3 years. When the study began, women with POI had significantly lower hip and spine bone mineral density levels than those in the control group. By the study’s end, bone density measures in both treatment groups had increased to the same level as the women without POI.

The group receiving a testosterone patch didn’t gain further benefits over those with a placebo patch. Studies with a greater number of women would be needed to learn whether testosterone replacement might benefit women with POI, the researchers note.

“While hormone replacement therapy’s effect on bone mineral density has been studied in postmenopausal women, there is limited research on the effects of this therapy in younger women,” Popat says.

“This study showed that not only could hormone treatment reduce the rate at which women with POI lose bone mineral density, but it could actually restore bone density to normal levels,” Nelson adds.

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References: Bone Mineral Density in Young Women With Primary Ovarian Insufficiency: Results of a Three-Year Randomized Controlled Trial of Physiological Transdermal Estradiol and Testosterone Replacement. Popat VB, Calis KA, Kalantaridou SN, Vanderhoof VH, Koziol D, Troendle JF, Reynolds JC, Nelson LM. J Clin Endocrinol Metab. 2014 Jun 6:jc20134145. [Epub ahead of print]. PMID: 24905063.

Funding: NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and Procter & Gamble.