Menopause, Osteopenia
Conditions
Keywords
Genistein, Bone mineral density, digital mammography, safety
Brief summary
BACKGROUND: Recent evidences showed that the phytoestrogen genistein positively affects bone metabolism with no clinically significant adverse effects in a cohort of osteopenic, postmenopausal women. However, there is still a knowledge gap regarding the long-term safety of genistein on the breast, the uterus, the thyroid gland and its efficacy in postmenopausal women. OBJECTIVE: To assess the safety profile of genistein on mammary and thyroid glands and endometrium and cardiovascular apparatus and its effects on bone metabolism after a 3-year therapy with pure, standardized genistein (54 mg/day).
Detailed description
DESIGN: The parent study was a randomized, double-blind, placebo-controlled trial involving 389 osteopenic, postmenopausal women for 24 months. After the 24-month visit, a sub-population (138 patients) accepted to continue the intervention until 36 months, thus generating a follow-up study. SETTING: 3 Italian university medical centers. INTERVENTIONS: Participants received 54 mg of genistein, daily, (n=71) or placebo (n=67). Both intervention and placebo contained calcium and vitamin D3. All patients also received dietary instruction in an isocaloric fat-reduced diet. MEASUREMENTS: Mammographic breast density at baseline and after 24 and 36 months was assessed by visual classification scale and by digitized quantification. BRCA1 and BRCA2 molecular message, sister chromatid exchanges and endometrial thickness were also evaluated at the same time points. Measurements of lumbar spine and femoral neck BMD and QUS t-score were assayed in our patients. Secondary outcomes were serum levels of B-ALP, IGF-I, sRANKL, osteoprotegerin and urinary excretion of CTX, pyridinoline and deoxypyridinoline. Furthermore insulin resistance (HOMA-IR), glucose levels, homocysteine and hot flushes were also evaluated. In addition for thyroid safety TSH, fT3, fT4, thyroid autoantibodies, and mRNA for thyroid and retinoid receptors were evaluated.
Interventions
DIETARY_SUPPLEMENTaglycone genistein
2 capsules per day containing 27 mg of aglycone genistein, calcium carbonate (500 mg) and vitamin D (400 IU), for a 3-year period.
DIETARY_SUPPLEMENTplacebo
2 capsules per day containing calcium carbonate (500 mg) and vitamin D (400 IU), for a 3-year period.
Sponsors
Primus Pharmaceuticals
University of Messina
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
49 Years to 67 Years
Healthy volunteers
No
Inclusion criteria
* Good general health * Have not had a menstrual period in the preceding year * Had not undergone surgically induced menopause * Had a follicle-stimulating hormone level \> 50 IU/liter and a serum 17 beta-estradiol level ≤ 100 pmol/liter * Established osteopenia (-1\<T-score\<-2.5 SD)
Exclusion criteria
* Clinical or laboratory evidence of confounding systemic diseases, such as cardiovascular, hepatic, or renal disorders * Coagulopathy, use of oral or transdermal estrogen, progestin, androgen or other steroids * Biphosphonates, cholesterol-lowering therapy or cardiovascular medications in the preceding six months * Smoking habit of more than two cigarettes per day * Previous treatment with any drug that could affect the skeleton in the preceding year * A family history of estrogen-dependent cancer * BMD at femoral neck \> 0.795 g/cm2; this BMD value corresponds to a T score of -1 standard deviation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Bone Mineral Density | basal and after 1 year |
| Mammographic breast density | basal and after 3 years |
Secondary
| Measure | Time frame |
|---|---|
| Pyridinium cross-links (pyridinoline and deoxypyridinoline) | basal and after 1 year |
| carboxy-terminal cross-linking telopeptide (CTX) | basal and after 1 year |
| Osteoprotegerin and soluble receptor activator of NF-kB ligand (s-RANKL) | basal and after 1 year |
| BRCA1 and BRCA2 mRNA levels | basal and after 3 years |
| Bone-specific alkaline phosphatase (B-ALP) | basal and after 1 year |
| Endometrial thickness | basal and after 3 years |
| Insulin resistance | basal and after 3 years |
| hot flushes | basal and after 3 years |
| Thyroid status | basal and after 3 years |
| Sister Chromatid exchanges | basal and after 3 years |
| Insulin-like growth factor 1 (IGF-1) | basal and after 1 year |
Outcome results
None listed