Bone mineral density and its correlation with serum estradiol level in postmenopausal women: a cross...

8/13/2019 Bone mineral density and its correlation with serum estradiol level in postmenopausal women: a cross sectional study

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Type of article: Original

Title of the article: Bone mineral density and its correlation with serum estradiol level in

postmenopausal women: a cross sectional study

Authors

1. Dr Pratiksha Gupta, Associate ProfessorDepartment Of Gynaecology and Obstetrics

PGIMSR, ESIC, Basaidarapur, New Delhi, India

2.

Dr Manjari Sinha, Post Graduate Student.

Department Of Gynaecology and Obstetrics


3. Dr Gelabhai R. Jograjiya, Post Graduate Student.Department Of Gynaecology and Obstetrics


Corresponding Author

Dr Pratiksha Gupta

Department Of Gynaecology and Obstetrics

PGIMSR, ESIC, Basaidarapur, New Delhi, India.

Tel no: +919871128703

Fax no: 01123611560

Email id: [email protected]

Running Title

Postmenopausal Bone moneral density and estradiol correlation

Title Page


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Title

Bone mineral density and its correlation with serum estradiol level in postmenopausal

women: a cross sectional study.

Abstract

Objectives: To evaluate BMD in postmenopausal women by dual-energy x-ray

absorptiometry (DEXA) scan. To correlate the possible association of BMD with the serum

estradiol level in postmenopausal women.

Design: This was a cross-sectional study to evaluate BMD and its correlation with serum

estradiol level in postmenopausal women.

Settings: Department Of Gynaecology and Obstetrics, Post Graduate Institute of Medical

Sciences and Research (PGIMSR), ESIC, Basaidarapur, New Delhi-110015, India.

Population: Fifty-three postmenopausal women who fulfilled the inclusion and exclusion

criteria were enrolled in the study.

Methods:Serum estradiol level were measured by ELISA technique on weekly basis using

kits from Biocheck (USA). BMD of lumbar spine, the right femoral neck and distal radius

were determined by DEXA scan using a dexa lunar prodigy system.

Main Outcome Measures:Postmenopausal womens Serum estradiol level and BMD.

Results:BMD of lumbar spine, right femoral neck and distal radius was positively correlated

with serum estradiol level. This correlation was statistically significant (p < 0.0001).

Conclusion: Postmenopausal womens serum estradiol level was directly correlated with

bone mineral density of lumbar spine, right femoral neck and distal radius.

Abstract Page


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Introduction

Menopause is defined as the cessation of menstruation for 12 months in a woman and occurs

on an average at the age of 51 years. It represents permanent failure of ovarian function

secondary to depletion of the follicular pool. The age of menopause in India is around 40-50

years. In postmenopausal period, the ovaries are no longer functional leading to decreased

level of estradiol. [1]The remaining source of estradiol is the adrenals, adipose tissues and

muscle through aromatization of androstenedione. [2] After the age of 30 years, there is

gradual diminution of bone mass which is most clearly seen in women who experience

significant decreases in bone mass. This is associated with lowered estrogen production

several years prior to the onset of menopause. [3]The abrupt decline in serum estradiol levels

after menopause contributes to accelerated bone loss. [4] Osteoporosis is a condition of

diminished bone mass and change in bone architecture up to the fracture threshold without

clinical signs or symptoms. [5]In this disorder, the rate of bone formation is frequently normal

but the rate of bone absorption is increased. Bone loss occurs more frequently in trabecular

bone such as in the vertebrae, femoral neck and distal radius. [6]

Aims and objectives

To evaluate BMD in postmenopausal women by DEXA scan. To correlate the possible

association of BMD with the serum estradiol level in postmenopausal women.

Text


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Material and methods

This a cross-sectional study to evaluate BMD and its correlation with serum estradiol level in

postmenopausal women. The study was approved by the Ethics Committee, and 53

postmenopausal women were included in the study, based on inclusion & exclusion

criteria. The criteria taken in consideration are: Inclusion Criteria were

Postmenopausal women 40 years and above, actively mobile (Requiring no walking

aids), willing to participate in study. Exclusion Criteria were women undergone

hysterectomy or bilateral Oophorectomy (Surgical menopause), acute infection,

diabetes mellitus, diseases of kidney, diseases of liver, malignancies, hormonal

replacement therapy in the last 3 years and chemoradiation. At recruitment, informed

consent was obtained from each woman. Serum estradiol and Serum FSH level were

measured by ELISA technique on weekly basis using kits from Biocheck (USA).

Standard curves were plotted for both the tests using multipoint calibration and

values were calculated from the standard curve. BMD of Lumbar Spine, the right

femoral neck and distal radius were determined by DEXA scan using a dexa lunar

prodigy system. In the DEXA technique, two x-ray energies are used to estimate the

area of mineralized tissue, and the mineral content is divided by the area, which

partially corrects for body size. It produced images of spine, hip or even the whole

body and the computer was able to determine how much bone mineral was present.

In our study WHO guidelines was used for assessment of bone loss.

According to WHO guidelines, bone loss was divided into following categories.

Normal - T Score above -1

Osteopenia - T Score between -1 to -2.5

Osteoporosis - T Score below -2.5

A total of 53 cases further divided into two groups A & B. Group A were cases in

whom serum estradiol level was 5 pg./ml. A total of 20 cases were enrolled in Group A and 33 cases

were enrolled in group B. After measurement of serum estradiol level and BMD by

DEXA scan at lumbar spine, right femoral neck and distal radius, correlations were

calculated. The data thus collected were transferred into a computer based spread

sheet and the statistical analysis carried out. Karl Pearson's correlation coefficient

were calculated.


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Result

BMD of lumbar spine, right femoral neck and distal radius was positively correlated with

serum estradiol level. This correlation were statistically significant P


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There is a paucity of Indian literature regarding serum estradiol level and bone mineral

density in postmenopausal women. Due to a relative paucity of Indian studies in this field,

and its high significance it is important that more studies to be done on this topic. Our study

was therefore an attempt to bring to light the risk of osteopenia and osteoporosis in Indian

postmenopausal women. This will help in counseling these subjects regarding the relevant

lifestyle modifications and hormone replacement therapy.

Limitations:As this was a cross-sectional study, no conclusions can be drawn as regards the

cause-effect relationship between estradiol levels and BMD and longitudinal studies will be

necessary to confirm our conclusions. The sample size was small, hence the results of our

study need to be corroborated by a larger study. It was a single centre study and the results

cannot be extrapolated to the general population, hence the need for community based

studies.

Interpretation: Additional supportive data were reported by Bagur et al. 2004 in

postmenopausal women < 65 years of age, who had estradiol levels of > 10 pg./ml and

higher BMD values in all skeletal sites examined, in comparison with women whose estradiol

levels were < 10 pg./ml.[7] Van Geel et al. 2009 in his study involving 370 postmenopausal

women aged between 55 and 85 years found a significant positive relationship between

serum estradiol levels and BMD values for the lumbar spine (r= 0.201, p


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those with levels between 1025 pg./ml had statistically significant greater mean BMD at

lumbar spine; the differences were 7.2% (p 5 pg. /ml.

Disclosure of interest

There is no conflict of interest financial, personal, political, intellectual or religious interest.

All the authors have contributed equally to qualify for authorship.

Contribution to authorship

All the authors have substantial contribution to conception and design, acquisition of data, or

analysis and interpretation. All the authors contributed equally in drafting the article, revising

it critically for important intellectual content, all have finally approved the version to be

published.


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References1. Sacco SM, Ward WE. Revisiting estrogen: efficacy and safety for postmenopausal

bone health. J Osteoporos 2010;2010:708931. doi: 10.4061/2010/708931.

2. Simpson ER. Aromatization of androgens in women: current concepts and findings.Fertil Steril 2002;77:6-10.

3. Speert H. Obstetrics and gynecology in America: A history. Batimorc: Waverly Press1980.

4. Sanchez-Ramos L, Kaunitz AM, Wears RL, Delke I, Gaudier FL. Misoprostol forcervical ripening and labor induction: a meta-analysis. Obstet Gynecol 1997;89:633-

642.

5. Norman JE, Thong KJ, Baird DT. Uterine contractility and induction of abortion inearly pregnancy by misoprostol and mifepristone. Lancet 1991;338:1233-6.

6. Bishop EH. Elective induction of labor. Obstet Gynecol 1955;5:519- 527.

7. Bagur A, Oliveri B, Mautalen C, Beotti M, Mastaglia S, Yankelevich D, et al. Lowlevel of endogenous estradiol protects bone mineral density in young postmenopausal

women. Climacteric 2004;7:181-8.

8. Van Geel TACM, Geusens PP, Winkens B, Sels JPJE, Dinant GJ. Measures ofbioavailable testosterone and estradiol and their relationships with muscle mass,

muscle strength and bone mineral density in postmenopausal women: a cross-

sectional study. Eur J Endocrinol 2009;160:681-7.

9. Rogers A, Saleh G, Hannon RA, Greenfield D, Eastell A. Circulating estradiol andosteoprotegerin as determinants of bone turnover and bone density in postmenopausal

women. J Clin Endocrinol Metab 2002;87:4470-5.


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10.Zarrabeitia MT, Hernandez JL, Valero C, Ziarrabeitia A, Amado JA, Macias JG, et al.Adiposity, estradiol, and genetic variants of steroid-metabolizing enzymes as

determinants of bone mineral density. Eur J Endocrinol 2007;156:117-22.

11.Murphy S, Khaw KT, Sneyd MJ and Compston JE. Endogenous sex hormones andbone mineral density among community-based postmenopausal women. Postgrad

Med J 1992;68:908 -13.

12.Ettinger B, Pressman A, Sklarin P, Bauer D, Cauley J, Cummings S. Associationsbetween low levels of serum estradiol, bone density, and fractures among elderly

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43.

13.Mawi M. Serum estradiol levels and bone mineral density in postmenopausal women.Univ Med 2010;29:90-95.


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Table: 1 Result of correlation between Serum Estradiol (pg. /ml) and lumbar spine, right

femoral neck and distal radius T-Score in postmenopausal women (n=53)

"Lumbar Spine" "Right Femoral Neck " "Distal Radius "

Number of XY Pairs 53 53 53Pearson r 0.6693 0.6654 0.5932

95% confidence interval 0.4871 to 0.7957 0.4817 to 0.7931 0.3845 to 0.7442

P value (two-tailed) P


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femoral neck and distal radius T-Score in Group A (n=20)

"Lumbar Spine" "Right Femoral Neck " "Distal Radius "

Number of XY Pairs 20 20 20

Pearson r 0.7983 0.8004 0.8405

95% confidence interval 0.5500 to 0.9169 0.5540 to 0.9178 0.6335 to 0.9352



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femoral neck and distal radius T-Score in Group B (n=33)

"Lumbar Spine" "Right Femoral Neck" "Distal Radius "

Number of XY Pairs 33 33 33

Pearson r 0.7917 0.6544 0.6686

95% confidence interval 0.6157 to 0.8925 0.4012 to 0.8147



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Figure Legends

Figure 1

Correlation between Serum Estradiol (pg. /ml) and lumbar spine, right femoral neck and

distal radius T-Score in postmenopausal women.


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Figure 2

Mean and Standard deviation of BMD of lumbar spine, right femoral neck and distal radius

T-score and serum estradiol level of Group

A.


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Figure 3

Correlation between Serum Estradiol (pg. /ml) and lumbar spine, right femoral neck and

distal radius T-Score in group

A.


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Figure 4

Mean and Standard deviation of BMD of lumbar spine, right femoral neck and distal radius

T-score and serum estradiol level of Group

B.


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Figure 5

Correlation between serum estradiol (pg. /ml) and lumbar spine, right femoral neck and distal

radius T-score in Group

B.

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