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Oestrogens in prevention and treatment of osteoporosis
ABSTRACTS / Bone 43 (2008) S17–S25
S21
Conclusions: The painful vertebrae can be determined by signal intensity changes of MR images on different series. Selecting painful vertebrae to be treated by KP can make patients with multiple-level VCFs gain an excellent efficacy.
maintain a positive influence on bone indices such as bone mineral density. Furthermore, it has been shown, that HRT has a positive effect on osteoarthritis and the integrity of intervertebral disks.
doi:10.1016/j.bone.2008.07.064
doi:10.1016/j.bone.2008.07.066
SY2b-1 SERMS and tibolone: Recent advances Steven R. Cummings San Francisco Coordinating Center, CPMC Research Institute and UC San Francisco, USA
SY2b-3 Prevention of osteoporosis in early menopause Santiago Palacios Palacios' Institute of Woman's Health, Madrid, Spain
Estrogen receptors are found in most tissues and estrogen has profound effects on many systems. SERMs interact with estrogen receptors and have been developed with a goal of reducing the risk of vertebral and nonvertebral fractures while decreasing the risk of breast cancer and – perhaps – cardiovascular disease, without increasing the risk of endometrial cancer. To date, all SERMs increased the risk of venous thromboembolism. There is also hope that an ‘Ideal SERM’ would also relieve, or have little or no effect, on hot flushes. Raloxifene has succeeded on several counts: it decreases the risk of vertebral fractures and breast cancer, but does not decrease the risk of other types of fractures or CVD. A new SERM, Basodoxifene, decreases the risk of vertebral fractures to the same degree as does Raloxifene and probably has no effect on the risk of nonvertebral fractures. Its effect on risk of breast cancer is not certain. It is intended to be combined with conjugated estrogen and trials of the efficacy and safety of this combination have not yet been reported. Lasofoxifene may increase BMD and decrease LDL cholesterol and c-reactive protein more than does raloxifene. The PEARL trial was designed to test its effects on risk of fractures, breast cancer, and cardiovascular disease. Arzoxifene is a new SERM that is being tested in Phase III trials that will be completed in 2009. Tibolone has been used for many years in at least 90 countries for treatment of menopausal symptoms. It's metabolites have estrogenic, androgenic and progestogenic effects. Tibolone also has the unique property of improving libido. The LIFT trial showed that, in older postmenopausal women, tibolone decreased the risk of vertebral and nonvertebral fractures and, surprisingly, also decreased the risk of breast cancer. It should not be used, however, in elderly women because it also increases the risk of stroke. doi:10.1016/j.bone.2008.07.065
SY2b-2 Oestrogens in prevention and treatment of osteoporosis Martin H. Birkhäuser Division of Gynaecological Endocrinology and Reproductive Medicine, Department of Ob/Gyn, Inselspital, University of Bern, Switzerland Today, it is often wrongly believed that HRT should not be used for bone protection because of its unfavourable safety profile. However, evidence shows that HRT is effective in the prevention of all osteoporosis-related fractures, even in patients at low risk of fracture. Although no head-to-head studies have compared HRT to bisphosphonates in terms of fracture reduction, there is no evidence to suggest that bisphosphonates or any other antiresorptive therapy is superior to HRT. It is therefore suggested that, in 50–59-year-old postmenopausal women, HRT is a cost-effective first-line treatment in the prevention of osteoporotic fractures. Even lower than standard-dose preparations
Objective: To review the data on prevention of osteoporosis in early menopause. We tried to answer the following questions: Is early menopause a risk factor for osteoporosis and fractures?; and Is it possible to prevent early menopause; Are there effective measures to prevent osteoporosis in women with early menopause? Results: Several studies show that women with early menopause (under 45) natural or surgical, have lower BMD when compared with age matched women. Different studies show between 13 and 20% lower spine density in early menopause compared with an agematched groups with normal menopause. Population-based studies show that early menopause is associated with increased incidence of osteoporosis and two to threefold increases in fractures. Furthermore, there are data which suggest that early menopause before age 45 is associated with increased mortality. Natural early menopause is difficult to prevent, but easy to diagnose. Another question is in relation with the risks and benefits of elective oophorectomy. The benefits of oophorectomy are ovarian cancer prevention, breast cancer prevention and preventive risk of future oophorectomy. In addition, the benefits of ovarian conservation are lower rates of cardiovascular diseases, osteoporosis and fractures, short-term memory impairment, hypoactive sexual desire disorder, psychological well-being problems, urogenital atrophy, menopausal symptoms and ocular changes. The use of hormonal therapy can protect all of these problems, and it is clearly demonstrated that it protects against bone loss, osteoporosis and fractures. It is highly advisable, unless there is a contraindication, to recommend the use of hormonal therapy in a preventive and therapeutic concept, to all women with early menopause, at least until 50 years. There are no data concerning prevention of loss of bone mass and fractures in early menopause with another type of antiresorptives. Conclusions: There is a clear association between early menopause, bone loss, osteoporosis and risk of fractures. The decision whether or not to have an elective oophorectomy is an important medical decision that warrants a thoughtful dialogue with women before making the decision. Prevention is achieved by an early diagnosis of early menopause and bone mass, a healthy life style, adequate calcium and vitamin D intake and HRT after individual discussions about the risks and benefits. doi:10.1016/j.bone.2008.07.067
SY2b-4 Efficacy and safety of bazedoxifene in postmenopausal Asian women Ling Xu 1, Keh-Sung Tsai 2 , Ghi Su Kim 3 , Yiyong Wu 4 , Pascale Vincendon 5 , Arkadi Chines 6 , Ginger Constantine 6 1 Peking Union Medical College Hospital, Beijing, China 2 National Taiwan University Hospital, Taipei, Taiwan, Republic of China 3 Asan Medical Center, Seoul, Korea 4 Beijing Hospital, Beijing, China 5 Wyeth Research, Paris, France 6 Wyeth Research, Collegeville, PA, USA
S21
Conclusions: The painful vertebrae can be determined by signal intensity changes of MR images on different series. Selecting painful vertebrae to be treated by KP can make patients with multiple-level VCFs gain an excellent efficacy.
maintain a positive influence on bone indices such as bone mineral density. Furthermore, it has been shown, that HRT has a positive effect on osteoarthritis and the integrity of intervertebral disks.
doi:10.1016/j.bone.2008.07.064
doi:10.1016/j.bone.2008.07.066
SY2b-1 SERMS and tibolone: Recent advances Steven R. Cummings San Francisco Coordinating Center, CPMC Research Institute and UC San Francisco, USA
SY2b-3 Prevention of osteoporosis in early menopause Santiago Palacios Palacios' Institute of Woman's Health, Madrid, Spain
Estrogen receptors are found in most tissues and estrogen has profound effects on many systems. SERMs interact with estrogen receptors and have been developed with a goal of reducing the risk of vertebral and nonvertebral fractures while decreasing the risk of breast cancer and – perhaps – cardiovascular disease, without increasing the risk of endometrial cancer. To date, all SERMs increased the risk of venous thromboembolism. There is also hope that an ‘Ideal SERM’ would also relieve, or have little or no effect, on hot flushes. Raloxifene has succeeded on several counts: it decreases the risk of vertebral fractures and breast cancer, but does not decrease the risk of other types of fractures or CVD. A new SERM, Basodoxifene, decreases the risk of vertebral fractures to the same degree as does Raloxifene and probably has no effect on the risk of nonvertebral fractures. Its effect on risk of breast cancer is not certain. It is intended to be combined with conjugated estrogen and trials of the efficacy and safety of this combination have not yet been reported. Lasofoxifene may increase BMD and decrease LDL cholesterol and c-reactive protein more than does raloxifene. The PEARL trial was designed to test its effects on risk of fractures, breast cancer, and cardiovascular disease. Arzoxifene is a new SERM that is being tested in Phase III trials that will be completed in 2009. Tibolone has been used for many years in at least 90 countries for treatment of menopausal symptoms. It's metabolites have estrogenic, androgenic and progestogenic effects. Tibolone also has the unique property of improving libido. The LIFT trial showed that, in older postmenopausal women, tibolone decreased the risk of vertebral and nonvertebral fractures and, surprisingly, also decreased the risk of breast cancer. It should not be used, however, in elderly women because it also increases the risk of stroke. doi:10.1016/j.bone.2008.07.065
SY2b-2 Oestrogens in prevention and treatment of osteoporosis Martin H. Birkhäuser Division of Gynaecological Endocrinology and Reproductive Medicine, Department of Ob/Gyn, Inselspital, University of Bern, Switzerland Today, it is often wrongly believed that HRT should not be used for bone protection because of its unfavourable safety profile. However, evidence shows that HRT is effective in the prevention of all osteoporosis-related fractures, even in patients at low risk of fracture. Although no head-to-head studies have compared HRT to bisphosphonates in terms of fracture reduction, there is no evidence to suggest that bisphosphonates or any other antiresorptive therapy is superior to HRT. It is therefore suggested that, in 50–59-year-old postmenopausal women, HRT is a cost-effective first-line treatment in the prevention of osteoporotic fractures. Even lower than standard-dose preparations
Objective: To review the data on prevention of osteoporosis in early menopause. We tried to answer the following questions: Is early menopause a risk factor for osteoporosis and fractures?; and Is it possible to prevent early menopause; Are there effective measures to prevent osteoporosis in women with early menopause? Results: Several studies show that women with early menopause (under 45) natural or surgical, have lower BMD when compared with age matched women. Different studies show between 13 and 20% lower spine density in early menopause compared with an agematched groups with normal menopause. Population-based studies show that early menopause is associated with increased incidence of osteoporosis and two to threefold increases in fractures. Furthermore, there are data which suggest that early menopause before age 45 is associated with increased mortality. Natural early menopause is difficult to prevent, but easy to diagnose. Another question is in relation with the risks and benefits of elective oophorectomy. The benefits of oophorectomy are ovarian cancer prevention, breast cancer prevention and preventive risk of future oophorectomy. In addition, the benefits of ovarian conservation are lower rates of cardiovascular diseases, osteoporosis and fractures, short-term memory impairment, hypoactive sexual desire disorder, psychological well-being problems, urogenital atrophy, menopausal symptoms and ocular changes. The use of hormonal therapy can protect all of these problems, and it is clearly demonstrated that it protects against bone loss, osteoporosis and fractures. It is highly advisable, unless there is a contraindication, to recommend the use of hormonal therapy in a preventive and therapeutic concept, to all women with early menopause, at least until 50 years. There are no data concerning prevention of loss of bone mass and fractures in early menopause with another type of antiresorptives. Conclusions: There is a clear association between early menopause, bone loss, osteoporosis and risk of fractures. The decision whether or not to have an elective oophorectomy is an important medical decision that warrants a thoughtful dialogue with women before making the decision. Prevention is achieved by an early diagnosis of early menopause and bone mass, a healthy life style, adequate calcium and vitamin D intake and HRT after individual discussions about the risks and benefits. doi:10.1016/j.bone.2008.07.067
SY2b-4 Efficacy and safety of bazedoxifene in postmenopausal Asian women Ling Xu 1, Keh-Sung Tsai 2 , Ghi Su Kim 3 , Yiyong Wu 4 , Pascale Vincendon 5 , Arkadi Chines 6 , Ginger Constantine 6 1 Peking Union Medical College Hospital, Beijing, China 2 National Taiwan University Hospital, Taipei, Taiwan, Republic of China 3 Asan Medical Center, Seoul, Korea 4 Beijing Hospital, Beijing, China 5 Wyeth Research, Paris, France 6 Wyeth Research, Collegeville, PA, USA