| Abstrakt: |
We recently reported that estrogen exerts distinct effects on the GH/IGF‐1 axis that are dependent on the route of delivery, probably reflecting a first‐pass effect on hepatic IGF‐1 production. Oral administration reduces IGF‐1 and increases GH levels; transdermal administration elevates IGF‐1 without changing GH concentrations. Since mesenchymal tissue is a target for GH and IGF‐1 action, we studied changes in the GH/IGF‐1 axis following oral (ethinyl estradiol, 20 μg/day) versus transdermal (Estraderm 100 TTS, Ciba Geigy, 100 μg 17β‐estradiol per day) estrogen delivery and compared corresponding effects on connective and bone tissue metabolism. Mean 24 h GH levels, IGF‐1, markers of fibroblast (procollagen III) and osteoblast (procollagen I, osteocalcin) function, and indices of bone turnover (fasting urinary hydroxyproline and calcium to creatinine ratios, UOHPr/Cr and UCa/Cr) were measured before and after 2 months of either oral or transdermal therapy in two groups of postmenopausal women. Transdermal estrogen administration significantly (p< 0.05) increased IGF‐1, procollagen III, procollagen I, osteocalcin, and UOHPr/Cr. In contrast, oral estrogen administration had a suppressive effect; the levels of IGF‐1 (p= 0.001), procollagen III (p= 0.018), procollagen I (p= 0.002), osteocalcin (p= 0.015), and UOHPr/Cr (p= 0.004) were significantly different from those measured during transdermal administration. Both treatments significantly reduced UCa/Cr (p< 0.015). IGF‐1 changes during estrogen therapy were significantly related (p< 0.05) to changes in procollagen III, procollagen I, osteocalcin, and UOHPr/Cr. Transdermally delivered estrogen stimulates IGF‐1 production, increases osteoblastic function, and stimulates bone and nonbone collagen synthesis. When delivered orally, estrogen reduces IGF‐1 and inhibits osteoblastic function; both routes suppress urinary calcium loss. Estrogen administration confers distinct route‐dependent effects on connective and bone tissue metabolism; the specific effects on fibroblast and osteoblast function suggest IGF‐1 dependency. The divergent effects on indices of bone turnover and connective tissue metabolism suggest that the route of estrogen replacement therapy may have different effects on the integrity of structural tissue in the menopause. |
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