Chapter 77 Chapter 77 Estrogen and Estrogen Analogs for Prevention and Treatment of Osteoporosis Copyright © 2013 Elsevier Inc. All rights reserved.

FIGURE 77.1 Spine bone mineral density changes for modified intention-to-treat for conjugated equine estrogens (CEEs) and CEEs–medroxyprogesterone acetate (MPA). Adjusted mean percentage changes (SE) in spine BMD are shown for the modified intention-to-treat (A and C) and efficacy-evaluable (B and D) populations for both the CEEs alone (A, B) and CEEs-MPA groups (C, D). Source: Lindsay, R. et al. JAMA 2002;287:2668– 2676, Used with permission [8]. 2

Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 77.2 Changes in bone markers for the Modified Intention-to-Treat (MITT) population for conjugated equine estrogens (CEEs) only and CEEs–medroxyprogesterone acetate (MPA) groups. Adjusted median percentage changes in urinary N-telopeptides of type I collagen (A) and serum osteocalcin (B) for the MITT population over time for the CEEs alone and placebo groups on the left and the CEEs-MPA and placebo groups on the right. Source: Lindsay, R. et al. JAMA 2002;287:2668–2676, used with permission [8]. 3

Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 77.3 Bioavailable E2 levels in three groups of Rochester, MN, men and in post- and premenopausal Rochester women. Source: Khosla S et al. JCEM 2001;86:3555–3561, used with permission [48]. 4

Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 77.4 The ratio of total body bone mineral content to lean body mass plotted against age. Source: reprinted from Jarvinen TL, Kannus P, Sievanen H Estrogen and bonea reproductive and locomotive perspective. J Bone Miner Res 18(11):1921–31. Copyright © John Wiley & Sons. Reprinted with permission [56]. 5

Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 77.5 Risk of breast cancer over 4 years in the placebo and raloxifene groups according to baseline serum estradiol level. Source: Cummings, S. R. et al. JAMA 2002;287:216–220. Used with permission [65]. 6

Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 77.6 Cases per 10,000 women per year in the estrogen therapy treatment and placebo groups in the Womens Health Initiative by age group. Adapted from Gass M, Bassuk S, Manson J. Am J Lifestyle Med 2009;3:29–43. 7

Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 77.7 Cases per 10,000 per year in the estrogen progestin therapy and placebo groups of the Womens Health Initiative study by age. Adapted from Gass M, Bassuk S, Manson J. Am J Lifestyle Med 2009;3:29–43. 8

Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 77.8 Molecular structures of estrodiol and estrogen analogs. 9