Background
: There have been bone mass studies for the treatment of osteoporosis, nonetheless, little attention has been paid to the management of osteopenia. This study was to evaluate the effects of estrogen, alendronate and their combination on bone mineral density and bone metabolism in the postmenopausal women with osteopenia.

Methods : A total of 150 healthy regional patients with osteopenia from Busan were enrolled in prospective randomized clinical trial and randomly assigned to receive conjugated equine estrogen (group I), alendronate (group II), or combination of the two (group III). Assessments included BMD of L2-4 spines and femur neck by DEXA and markers of bone turnover including serum osteocalcin, total alkaline phosphatase and urine Deoxypyridnoline (Dpd). BMD and markers of bone turnover were re-evaluated at 6 and 12 months after the treatment.

Results : BMD of the lumbar spines increased significantly at 12 months after treatment in the three groups (P＜0.05). BMD of the femur neck increased at 12 months after treatment in the three groups, but significantly in group III (P＜0.05). Serum osteocalcin decreased at 12 months after treatment in the three groups, but only significantly in group III. Urine Dpd decreased at 12 months after treatment in three groups, but significantly in group, II and III (P＜0.05). Serum total alkaline phosphatase decreased at 12 months after treatment in only group III (P＜0.05). There was more favorable benefit for group III in BMD of the lumbar spines and serum osteocalcin and urine Dpd at 12 months after treatment compared to group, II and III (P＜0.05).

Conclusion : These results indicated a favorable benefit of conjugated equine estrogen, alendronate, or combination of the two in BMD and important markers of bone turnover. The combined treatment with conjugated equine estrogen and alendronate was more effective in postmenopausal women with osteopenia. Long-term studies are required to confirm these results.

Background
: In postmenopausal women, progesterone should be added to protect the endometrium from hyperplasia or carcinoma induced by the unopposed estrogen. However, the effects of progestogen on bone mineral densities and serum lipoproteins have not been precisely evaluated in Korean postmenopausal women.

Methods : To evaluate the effects of progestogen on bone mineral densities and serum lipoprotein in estrogen replacement therapy, we conducted a 2-year trial of long conjugated equine estrogen(conjugated estrogen 0.625mg/day) with or without cyclic progestogen(MPA 5mg/day for 12 days) in 120 postmenopausal women. In all subjects, bone mineral density was measured in lumbar vertebra(L2-L4) and femur neck using dual energy X-ray absorptiometry(DEXA) and serum lipoprotein was measured from the beginning of the treatment, 12 months, and 24 months later, respectively.

Results : BMD of femur neck in both groups increased but not significantly compared to basal level at 12 months and/or 24 months of treatment. As for BMD of lumbar spine, it increased significantly in both groups. Both groups showed a significant decrease in the levels LDL cholesterol, but there was no statistical significance in serum triglycerides. Conjugated estrogen plus MPA group in contrast to conjugated estrogen only group showed a significant decrease in total cholesterol levels.

Conclusion : These results suggest that the addition of MP of the daily of 5mg for 12 days cyclically in estrogen replacement treatment appear to be effective in postmenopausal women with protection on bone mineral density and maintenance of long-term favorable effects on serum lipoprotein.