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Wednesday, 7 November, 2001, 12:12 GMT
Tests boost HRT 'alternative'
Tibolone increased bone strength
Tibolone increased bone strength
Doctors say that a steroid treatment may offer all the advantages of HRT without some of the possible side-effects.

Tibolone, tested on monkeys, appears to be able to hold off osteoporosis - without increasing the potential risk of heart disease.

The US experts said their work was important because it increases the knowledge available about treatment choices for postmenopausal women.

Tibolone is already considered an alternative to HRT for women concerned about potential breast cancer risks, say the researchers.


Our study is significant because it adds to current knowledge about these choices

Professor Thomas Clarkson, Wake Forest University Baptist Medical Center
Osteoporosis is the weakening of the bones that can lead to breaks, which are difficult to heal.

After the menopause, women are at particular risk of developing the condition because their body has stopped producing the hormone oestrogen, needed for bone health.

Doctors already knew that tibolone increased bone mineral density, a sign of bone strength and alleviated hot flushes and other menopausal symptoms.

There had been fears that its reduction of high-density lipoprotein (HDL) - or "good" cholesterol - could lead to heart disease.

But the US research, carried out by doctors at the Wake Forest University Baptist Medical Center, North Carolina, found although tibolone lowered HDL by half, there was no increase in heart disease.

Thomas Clarkson, professor of comparative medicine at the centre, said: "Our results suggest that tibolone is a cardiovascular-safe treatment for menopausal symptoms as the prevention of osteoporosis."

Comparisons

The team looked at how 150 postmenopausal monkeys reacted to different treatments over two years.

Two different doses of tibolone, an oestrogen drug (Premarin), and a drug combining oestrogen and progestin (PremPro) were given to the animals. Others were given no treatment.

The doses were designed to mirror those women would normally be prescribed.

They were also given a moderately high-fat diet, designed to speed up the development of heart disease.

Bone mineral density increased most in those monkey's receiving the higher dose of tibolone.

They saw a rise of 9.5%, while in the PremPro group bone mineral density rose by 4.5%, and in the Premarin group, it rose by 4.3%.

The team also examined the effect on arteriosclerosis, the build-up of fatty deposits on the walls of the coronary arteries.

While both PremPro and Premarin reduced the condition by 62%, tibolone had no effect.

The researchers found Premarin and PremPro had a "robust" protective effect on the heart, while there was no such protective effect from tibolone.

But they suggest tibolone may be the best of the three for protecting the breast and womb.

The researchers said those monkeys who were given Premarin and PremPro had increased cell growth in those two areas, which can relate to cancer risk.

Professor Clarkson said: "Women who are considering treatment for osteoporosis and menopausal symptoms have several options and must work with their doctors to weigh the benefits versus the risks of each.

"Our study is significant because it adds to current knowledge about these choices."

Questions

A spokeswoman for the National Osteoporosis Society (NOS) said: "This study reiterates previous findings that tibolone is an effective treatment option for osteoporosis as it increases bone mineral density.

"Furthermore, recent studies have raised certain questions concerning HRT and heart disease so the NOS welcomes further studies which will help to clarify these issues."

A spokeswoman for the British Heart Foundation said: "We know HRT has some sort of protection against heart disease.

"This is an interesting piece of research."

The research is published in the Journal of Clinical Endocrinology and Metabolism.

See also:

23 Jul 01 | Health
HRT heart treatment 'caution'
13 Mar 01 | Health
HRT 'may prevent osteoarthritis'
17 Apr 00 | Health
HRT 'reduces heart disease risk'
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