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. 2000 Jan 6;118(1):3-6.
doi: 10.1590/s1516-31802000000100002.

Effect of hormone replacement therapy on the bone mass and urinary excretion of pyridinium cross-links

D P Pardini  1 , A T Sabino, A M Meneses, T Kasamatsu, J G Vieira
Affiliations

Effect of hormone replacement therapy on the bone mass and urinary excretion of pyridinium cross-links

D P Pardini et al. Sao Paulo Med J. .

Abstract
in English, Portuguese

Context: The menopause accelerates bone loss and is associated with an increased bone turnover. Bone formation may be evaluated by several biochemical markers. However, the establishment of an accurate marker for bone resorption has been more difficult to achieve.

Objective: To study the effect of hormone replacement therapy (HRT) on bone mass and on the markers of bone resorption: urinary excretion of pyridinoline and deoxypyridinoline.

Design: Cohort correlational study.

Setting: Academic referral center.

Sample: 53 post-menopausal women, aged 48-58 years.

Main measurements: Urinary pyr and d-pyr were measured in fasting urine samples by spectrofluorometry after high performance liquid chromatography and corrected for creatinine excretion measured before treatment and after 1, 2, 4 and 12 months. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DEXA) before treatment and after 12 months of HRT.

Results: The BMD after HRT was about 4.7% (P < 0.0004); 2% (P < 0.002); and 3% (P < 0. 01) higher than the basal values in lumbar spine, neck and trochanter respectively. There were no significant correlations between pyridinium cross-links and age, weight, menopause duration and BMD. The decrease in pyr and d-pyr was progressive after HRT, reaching 28.9% (P < 0.0002), and 42% (P < 0.0002) respectively after 1 year.

Conclusions: Urinary pyridinoline and deoxypyridinoline excretion decreases early in hormone replacement therapy, reflecting a decrease in the bone resorption rate, and no correlation was observed with the bone mass evaluated by densitometry.

CONTEXTO:: A perda óssea acelerada observada na pós menopausa é atribuída a um incremento do turnover ósseo, com predomínio da reabsorção em decorrência da falência ovariana. Ao contrário da formação tem sido difícil de estabelecer um marcador sensível de reabsorção.

OBJETIVOS:: Avaliar o efeito da terapia de reposicão hormonal (TRH) na densidade e nos marcadores urinários de reabsorção óssea, piridinolina (PIR) e deoxipiridinolina (D-PIR).

TIPO DE ESTUDO:: Estudo coorte de correlação.

LOCAL:: Centro universitário de referência.

PACIENTES:: 53 mulheres menopausadas há 3,6 ± 5 anos, idade mediana de 53 anos.

VARIÁVEIS ESTUDADAS:: A excreção urinária de PIR e D-PIR na urina de jejum ,analisada por HPLC e expressa em pmol /mmol de creatinina ,foi avaliada em condições basais e após 1,2,4 e 12 meses de TRH. Realizaram densitometria óssea (DO) em coluna e fêmur antes e após 12 meses de TRH.

RESULTADOS:: A DO após TRH foi 4.7%(P<0.0004); 2%(P<0.002); and 3%(P<0.01) maior que os valores basais na coluna , colo do fêmur e trocanter respectivamente. Observou-se um decréscimo dos valores de PIR e D-PIR precoce e progressivo, atingindo 28,9% (P<0.0002) e 42% (P<0.0002) após 1ano de TRH respectivamente. Não houve correlação entre os valores de DO e os de PIR E D-PIR.

CONCLUSÕES:: A excreção urinária de PIR e D-PIR constituem um marcador sensível da reabsorção óssea. O decréscimo precoce a torna útil na avaliação da eficácia terapeutica.

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Conflict of interest statement

Conflict of interest: Not declared.

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