Endocrine Abstracts

The optimal oestrogen dose required to maintain bone mass in young women who develop POF is contentious. We reviewed longitudinal BMD data in 21 women with POF resulting from multi-modality cancer therapy for haematological malignancies. The 21 women were of mean age 30.6 (range 17–45) years at onset of amenorrhoea and weight 64.1+/−11.2 kg. Primary diagnoses were acute myeloid leukaemia (n=12), chronic myeloid leukaemia (n=5), acute lymphocytic leukaemia (n=2), and Hodgkin’s disease (n=2). Twenty patients underwent bone marrow transplant (12 allogeneic, 8 autologous). Thirteen patients received total body irradiation and two mantle irradiation.

Data were analysed according to oestrogen replacement (no E2, HRT, COCP). Longitudinal data were available before starting E2 and whilst taking E2 in three patients. Age at amenorrhoea in patients not receiving E2 (n=6), on HRT (n=12) or the COCP (n=6) were 31.0+/−9.7, 32.5+/−7.6, & 26.0+/−7.4 years and age at initial BMD assessment were 37.0+/−6.0, 35.4+/−5.1, & 31.3+/−7.2 years respectively. Time between baseline BMD and most recent BMD were 50.0+/−24.0, 68.2+/−34.0, & 89.7+/−30.9 months. Baseline BMD at the lumbar spine (LS) showed values (g/cm²) of 1.139+/−0.121, 1.110+/−0.154, & 1.097+/−0.133 (P=0.87) respectively. The change in LS BMD between baseline and most recent scan were 0.012+/−0.074, 0.029+/−0.088, & 0.110+/−0.085 g/cm² (P=0.09). Percentage change in LS BMD were 1.2+/−6.7, 3.4+/−7.9, & 10.7+/−8.9% (P=0.11) respectively. At the femoral neck, baseline BMD was 0.905+/−0.078, 0.855+/−0.166, & 0.894+/−0.080 (P=0.70) and change within the three groups was 0.019+/−0.104, 0.052+/−0.096, & 0.084+/−0.123 g/cm² (P=0.62). The corresponding percentage changes in BMD were 2.4+/−12.5, 8.1+/−13.6, and 9.4+/−14.1% (P=0.63).

These preliminary data suggest young women with POF resulting from cancer therapy retain bone mass whether on oestrogen replacement or not. Although changes between groups failed to reach significance a trend towards greater gains in bone mass was observed in patients on the COCP.