Effect of etidronate disodium on bone turnover following surgical menopause |
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| Authors: | M L Smith I Fogelman D M Hart E Scott J Bevan I Leggate |
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| Institution: | (1) Departments of Medicine and Nuclear Medicine, Royal Infirmary, Glasgow;(2) Department of Gynaecology, Stobhill Hospital, Glasgow;(3) Department of Norwich Eaton Pharmaceuticals, Stobhill Hospital, Norwich, New York, USA;(4) Department of Biochemistry, Stobhill Hospital, Glasgow;(5) Present address: Department of Nuclear Medicine, Addenbrooke's Hospital, Hills Road, Cambridge, UK |
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| Abstract: | Summary A longitudinal study was performed to document the effect of surgical menopause and postmenopausal etidronate disodium therapy
on several nonhistomorphometric indices of bone turnover. Twenty healthy, premenopausal women undergoing oophorectomy for
nonmalignant conditions were studied preoperatively and at 3 monthly intervals postoperatively. Sequential measurements of
serum calcium (Ca), alkaline phosphatase (AP), bone Gla protein (BGP), and urinary calcium and hydroxyproline excretion, expressed
as a ratio of urinary creatinine (UCa/Cr and UOHp/Cr, respectively) were obtained. Twenty-four-hour whole body retention of
diphosphonate (WBR) and radial bone density were also measured. When a postoperative increase in bone turnover was observed,
patients were randomized to receive either 400 mg etidronate disodium daily or placebo for 3 months. Oophorectomy was associated
with a significant increase in WBR, Ca, AP, and BGP and an insignificant rise in UCa/Cr. A variable pattern of UOHp/Cr was
seen. Patients on placebo maintained these elevated levels of Ca, BGP, and UCa/Cr. WBR and AP continued to rise. Etidronate
disodium therapy resulted in a fall towards premenopausal levels in WBR, Ca, and UCa/Cr. AP and BGP were unchanged. Three
months after stopping etidronate, BGP fell significantly and the decrease in Ca was maintained; however, WBR and UCa/Cr had
returned towards pretreatment values. Bone density measurements did not change significantly. An increase in several of the
indices of bone turnover was seen following oophorectomy. Etidronate disodium suppressed this increase, affecting indices
of both resorption and formation. This effect on formation may be an unavoidable consequence of normal resorption-formation
coupling. The ability of etidronate alone to maintain postmenopausal bone mass has yet to be established. However, the suppressive
effect of this diphosphonate on the accelerated bone turnover found after oophorectomy suggests that etidronate may have a
potentially useful role as an inhibitor of resorption in a pulsed regimen. |
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| Keywords: | Etidronate Menopause Bone loss Diphosphonates |
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