Effects of Treatments by Calcium and Sex Hormones on Vertebral Fracturing in Osteoporosis

Lateral radiographs of the thoracic and lumbar spine were takenperiodically in 49 patients with osteoporosis. Thirty patientswere postmenopausal, and 19 nonmenopausal with osteoporosisdue to steroids, male hypogonadism, alcoholism, thyrotoxicosisor unknown cause. Patients were studied before, during and aftertreatment with high calcium alone, or with combined calciumand sex steroids. Calcium was given as effervescent calciumlactate gluconate, and sex hormones as oestradiol valerate,testosterone oenanthate, or methenolone oenanthate. A totalof 964 films covering 409 patient-years were available for measurement.On each vertebra, deformity due to loss of anterior height wasmeasured and assigned to one of four grades. For the time intervalbetween each consecutive pair of films, a patient's vertebralfracture rate score was calculated and expressed per thousandpatient-years. In comparison with the corresponding pretreatment fracture ratescore, both the postmenopausal and the nonmenopausal groupswho had not received sex hormones previously, failed to showsignificant changes (p=0.144; p=0.017) on high calcium aloneduring mean periods of 4.3 and 2.8 years respectively. If thefirst 2 years on high calcium were excluded for the postmenopausalgroup, they still failed to show a reduction in fracture ratescore (observed for a mean period of 5.0 years; p=0.04). When treated with combined calcium and sex hormones, both postmenopausaland nonmenopausal groups showed a lower fracture rate scoreof 20 and 207 respectively when compared with the pretreatmentlevels of 1500 and 1697 (in mean treatment periods of 3.2 and4.4 years; p<0.001 in each case). When given high-dose calciumalone, but after treatment with sex hormones as well, the postmenopausalgroup showed no change in fracture rate score from pretreatment(in a mean of 3.1 years; p=0.069); however the nonmenopausalgroup still showed a significant reduction in fracture ratescore from 1697 to 42 over a mean period of 2.3 years (p=0.001).The postmenopausal group, after stopping all treatment, showeda higher fracture rate score of 1286 (in a mean of 2.6 years)than did those on combined calcium and sex hormones, in whomthe fracture rate score was 20 (in a mean of 3.2 years; p=0.008).A subgroup of 11 patients with osteoporosis of both the menopausaland nonmenopausal types, had data both before (in a mean of5.5 years) and during (for a mean of 2.5 years) treatment withcalcium alone; the fracture rate scores were 1473 and 918 (p=0.247).Data were available for nine patients both before (for meanof 5.5 years) and during (for a mean of 5.5 years) treatmentwith calcium and sex hormones; the fracture rate score fellfrom 1397 to 100 (p=0.001). It is concluded that in groups with both menopausal and nonmenopausalosteoporosis, vertebral fracturing was reduced by treatmentwith combined calcium and sex hormones, but no significant effectfrom calcium alone was shown. In both groups, cessation of therapywas associated with a return to near the pretreatment fracturerate score, strongly suggesting the need for lifelong treatment.