CONCLUSION Estrogen with an osteoblast P4R-acting progestin ( EPT ) in these five published RCT provides Level 1 evidence that MPA caused significantly greater annual percent spinal BMD gains than the same dose of ET .
OBJECTIVE To assess whether progesterone ( P4 ) or osteoblast P4 receptor-acting progestin ( P ) contributed to estrogen ( E ) therapy-related  increased areal bone mineral density ( BMD ) in r and omized controlled trials ( RCT ) with direct r and omization to estrogen ( ET ) or estrogen-progestin ( EPT ) therapy .
Prevention of postmenopausal bone loss with minimal uterine bleeding using low dose continuous estrogen/progestin therapy: a 2-year prospective study.
OBJECTIVE To re-examine the minimal effective dose of conjugated estrogen (CEE)-progestin hormone replacement on postmenopausal bone loss . DESIGN A 2-year , prospect i ve , open label , r and omized study . SETTING Department of Obstetrics and Gynecology of a university hospital . PARTICIPANTS Fifty-two postmenopausal or oophorectomized women . INTERVENTION One of the following regimens was continuously administered for 2 years : ( 1 ) CEE 0.625 mg/day , ( 2 ) CEE 0.625 mg + medroxyprogesterone ( MPA ) 2.5 mg/day , ( 3 ) CEE 0.31 mg + MPA 2.5 mg/day and ( 4 ) control . MEASUREMENTS Lumbar spine and femoral BMD by dual energy X-ray absorptiometry ( DXA ) , a monthly based incidence of bleeding , serum lipids , PTH , calcitonin . A1-p , and osteocalcin . RESULTS Of the 52 patients enrolled in this study , 49 patients completed the 1 year of therapy and 36 completed the 2- year study . The control group showed a significant decrease in lumbar BMD over the 2 years ( P < 0.05 ) . The % changes in lumbar BMD at 2 years of CEE alone , CEE 0.625 + MPA and CEE 0.31 + MPA were 8.52 % ( 95 % confidence intervals ; 4.61 approximately 12.4 % ) , 7.4 % ( 0.60 approximately 14.2 % ) and 3.20 % ( 0.61 approximately 5.84 % ) , respectively , and were significantly higher than pretreatment values . The incidence of bleeding was significantly lower in women taking CEE 0.31 mg + MPA . HDL cholesterol increased in women taking CEE 0.625 mg alone or with MPA . No significant changes in lipid profiles were seen in the control or in the group of women taking CEE 0.31 mg + MPA . CONCLUSIONS Continuous hormone replacement therapy ( HRT ) using 0.31 mg of CEE and 2.5 mg of MPA is effective in increasing lumbar BMD in postmenopausal or oophorectomized women and can be an appropriate option for women with a normal lipid profile or those women wishing to eliminate unscheduled bleeding
CONCLUSION Estrogen with an osteoblast P4R-acting progestin ( EPT ) in these five published RCT provides Level 1 evidence that MPA caused significantly greater annual percent spinal BMD gains than the same dose of ET .
OBJECTIVE To assess whether progesterone ( P4 ) or osteoblast P4 receptor-acting progestin ( P ) contributed to estrogen ( E ) therapy-related  increased areal bone mineral density ( BMD ) in r and omized controlled trials ( RCT ) with direct r and omization to estrogen ( ET ) or estrogen-progestin ( EPT ) therapy .