Effects of Early Estradiol Valerate Administration On Bone Turnover Markers in Surgically Induced Menopausal Women

Background: Compared with natural process, surgically induced menopausal women have a higher bone loss rate. The objectives of this study were to evaluate effects of early treatment with estradiol valerate on the bone turnover markers levels after surgically induced menopause. Methods This prospective study enrolled 48 pre and perimenopausal women who underwent hysterectomy with oophorectomy for benign gynecologic conditions. Two weeks after surgery, all participants were assessed for menopausal hormone therapy (MHT) indications. Estrogen therapy was prescribed for those who had indication and accepted treatment (hormone treatment group). The others who had no MHT indication were allocated to no treatment group. Serum CTX and P1NP levels were measured at preoperative and 12 weeks postoperative. Results The median serum CTX and P1NP at 12 weeks were significantly different between two groups ( p -value < 0.001 and 0.004, respectively). Median serum CTX and P1NP levels of women in the hormone treatment group were 55% and 40% lower than the women in no treatment group, respectively. At 12 weeks after surgery, serum CTX and P1NP levels were significantly elevated among women who did not receive hormone treatment ( p -value < 0.001 and 0.002). In contrast, there were no significant change in the hormone treatment group. Conclusion Surgically induced menopausal women who received early estradiol valerate therapy had significantly lower levels of serum CTX and serum P1NP compared to women who did not receive treatment at 12 weeks after surgeries. This indicated that early estradiol valerate treatment could significantly suppress high bone-remodeling process in women with acute estrogen deprivation conditions. Trial registration: Thai Clinical Trial Registry identification number TCTR20190808004, retrospective registered since 2019-08-08. http://www.thaiclinicaltrials.org/show/TCTR20190808004