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Alveolar and Postcranial Bone Density in Postmenopausal Women Receiving Hormone/Estrogen Replacement Therapy
A Randomized, Double-blind, Placebo-Controlled Trial
Roberto Civitelli, MD;
Thomas K. Pilgram, PhD;
Mary Dotson, RDH, MPH;
Jane Muckerman, RN, BSN;
Nancy Lewandowski, RN;
Reina Armamento-Villareal, MD;
Naoko Yokoyama-Crothers, BA;
E. Eugenia Kardaris, DDS;
Jay Hauser, DDS;
Sheldon Cohen, DDS;
Charles F. Hildebolt, DDS, PhD
Arch Intern Med. 2002;162:1409-1415.
Background We conducted a 3-year, double-blind, randomized, placebo-controlled
study to determine whether the positive effects of hormone/estrogen replacement
therapy (H/ERT) on postcranial bone density are accompanied by similar positive
effects on oral bone mass.
Methods A total of 135 postmenopausal women (aged 41-70 years) with no evidence
of moderate or severe periodontal disease were randomized to receive daily
oral conjugated estrogen (Premarin; 0.625 mg) alone or in combination with
medroxyprogesterone acetate (Prempro; 0.625 and 2.5 mg, respectively) or placebo.
All subjects received calcium carbonate (1000 mg/d) and cholecalciferol (800
IU/d) supplements. The primary efficacy end points were the changes in alveolar
crest height and alveolar bone density. Alveolar crest height was measured
on bite-wing radiographs, and changes in alveolar bone mass were assessed
by means of digital-subtraction radiography. Postcranial bone density was
measured in the lumbar spine and left proximal femur by means of dual-energy
x-ray absorptiometry.
Results Hormone/estrogen replacement therapy significantly increased alveolar
bone mass compared with placebo (+1.84% vs +0.95% [P = .04]),
and tended to improve alveolar crest height (+4.83% vs +3.46% [P = .34]). Bone mineral density of the proximal femur significantly
increased in the H/ERT compared with the placebo group (total proximal femur,
+3.59% vs +0.22% [P = .001]; neck, +2.05% vs -0.34%
[P = .02]; trochanter, +3.49% vs +0.08% [P<.001]), but not the lumbar spine (+1.01% vs +0.17% [P = .39]). Changes in alveolar bone mass correlated with bone density
changes in the total femur (r = 0.28 [P = .02]) and femoral trochanter (r = 0.25
[P = .04]) in the H/ERT but not in the placebo group.
Conclusions Postcranial and oral bone mass were increased in postmenopausal women
receiving H/ERT. Improvement in oral bone health constitutes an additional
benefit of H/ERT.
From the Division of Bone and Mineral Diseases, Department of Internal
Medicine (Drs Civitelli and Armamento-Villareal and Mss Muckerman and Lewandowski),
the Department of Radiology (Drs Pilgram and Hildebolt and Ms Yokoyama-Crothers),
and the Department of Dentistry (Ms Dotson and Drs Kardaris, Hauser, and Cohen),
Washington University School of Medicine and Barnes-Jewish Hospital, St Louis,
Mo. Dr Civitelli has stock ownership with Wyeth, Madison, NJ.
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