THE METABOLIC EFFECTS OF STEROID HORMONES IN OSTEOPOROSIS

Abstract

Osteoporosis is defined as that form of under-mineralization of bone in which the primary defect is a hypo-function of the osteoblasts in laying down bone matrix; 8. etiologic subgroups are listed. The effect of certain steroid hormones (notably estrogens, androgens, and progesterone) has been studied in 11 cases of osteoporosis: 5 cases of the post-menopausal type, 1 case of the senile type, 2 cases of the type seen following orthopedic operations (atrophy of disuse), and 3 cases of the Cushing''s syndrome type. Estrogens in the 2 forms used (estradiol benzoate and diethylstil-bestrol) decreased the Ca and P excretions in the 4 types of osteoporosis studied. a. The fecal as well as the urinary Ca and P excretions were decreased in most instances. b. The effects were usually manifested within 6 days; did not reach maximum until after 30 days; and persisted for 30-50 days after cessation of therapy. c. The synthetic estrogen, diethylstilbestrol, appeared to be as effective as the naturally-occurring estrogen, estradiol. d. The serum P levels, which tend to be high in the post-menopausal group, fell in almost all instances. e. The serum alkaline phosphatase levels, contrary to expectations, did not rise. f. The urinary N excretion showed a poorly-sustained decrease. g. The urinary 17-ketosteroid excretion showed a moderate decrease with estradiol. Androgens in the 2 forms used (testosterone propionate and methyl testosterone) likewise decreased the Ca and P excretions in the 3 types of osteoporosis (post-menopausal, senile, and Cushing''s syndrome). a. As in the case of estrogens, the fecal as well as the urinary Ca and P excretions were decreased; the effect of the therapy on the Ca metabolism was slow in reaching its maximum, and persisted for a long time after cessation of therapy; the serum P levels tended to fall; the serum alkaline phosphatase levels failed to rise except in the 3 cases of Cushing''s syndrome. b. In contrast to estrogens, the decrease in the urinary N excretion was marked and prolonged. c. Methyl testosterone appeared to be as effective as testosterone propionate. Progesterone had no definite effect whether given alone or in combination with estrogen. The effect on the Ca metabolism of estrogen and androgen in combination was greater than that of either alone in the post-menopausal and senile groups. In Cushing''s syndrome estrogen probably does have a beneficial effect on the Ca balance, previous statements to the contrary from this clinic notwithstanding. However, testosterone compounds have a much more striking effect in this condition, as opposed to other types of osteoporosis. The data contain observations on the effect of pregnenolone and dehydroisoandrosterone acetate. A short discussion of certain therapeutic aspects of post-menopausal osteoporosis is included.