Korean J Bone Metab Search


Korean Journal of Bone Metabolism 2003;10(1):71-78.
The Effect of HRT on BMD in Postmenopausal Osteoarthritis Patients
폐경 후 퇴행성 관절염 환자에서 골밀도에 대한 여성호르몬 대체요법의 영향
성균관대학교 의과대학 삼성제일병원 류마티스 센터1, 삼성제일병원 가정의학과2, 을지대학교 가정의학과3, 삼성제일병원 내분비내과4
Osteoarthritis (OA) has been well described as an estrogen dependent disease in women by its increased prevalence among postmenopaual women. However, studies so far have come to a vague conclusion that estrogen may prevent OA incidences only on certain anatomic sites presumably the knee and the hip joints. HRT prevent bone loss and further increase bone mineral density in postmenopausal women and thus, it is the treatment of choice in postmenopausal osteoporosis. Dissociation between positive influence on bone gain by estrogen and decreased incidence of OA in these patients has raised a question whether estrogen and increased BMD may have different pathologic mechanism.
We have prospectively intervened normal and OA group of women with various previous HRT to look for its effect on bone mineral density.
OA prevalence defined by clinical and radiological ACR criteria on knee were lower among those who had been treated with hormone (OR: 0.1). Hormone replacement for one year reduced new OA incidence significantly (RR: 0.2 p<0.001). BMD change has been calculated as change from the initial BMD in percent. HRT increased BMD significantly in both normal and OA patients. The difference in spine BMD change compared with HRT and non HRT group, the magnitude of increase was greater in HRT group without OA whereas it was increased less in HRT group with OA. However, HRT significantly increased BMD on both non OA and OA patients on femur neck.
These findings suggest that HRT significantly reduces the OA prevalence and incidence and there may be site specific different metabolic characteristics when OA patients are treated with HRT. We found the improvement of BMD after HRT in OA patients, however, the increment of BMD was not significant compared to that of OA patients without HRT. We also suggest further study to examine the bone markers for extensive explanation and understanding bone metabolism in OA patients.
Key Words: Hormone replacement therapy, Osteoarthritis, Bone mineral density, Menopause


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