Estrogen preserves a normal intestinal responsiveness to 1, 25-dihydroxyvitamin D3 in oophorectomized women

Carlo Gennari, Donato Agnusdei, Paolo Nardi, Roberto Civitelli

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Estrogen treatment improves calcium malabsorption induced by surgical or natural menopause, but the mechanisms involved are still under debate, with both increased production of 1, 25-dihydroxyvitamin D3 [1, 25-(OH)2D3] and improved peripheral responsiveness to the steroid having been proposed. To address this issue, we studied the effect of short term administration of 1, 25-(OH)2D3 (1 μg/day for 7 days) on intestinal fractional absorption of 47Ca (47Ca FA) and vertebral bone density, measured by dual photon absorptiometry, in 14 premenopausal women (aged 31–50 yr) before and 6 months after oophorectomy. After surgery, patients were randomly allocated to a 6-month treatment with either conjugated estrogens (0.625 mg/day; n = 7) or placebo (n = 7). Oophorectomy caused a decrease in both basal 47Ca FA (−40.8 ± 23.4%; P = 0.004) and vertebral bone density (−7.21 ± 1.20%; P < 0.001) in the placebo group. Estrogen replacement prevented these changes and increased basal serum 1, 25-(OH)2D3 (+10.3 ± 10.9%; P = 0.047), whereas a detectable but not significant decrease was observed in the control group (−8.8 ± 10.5%; P = 0.07). Assessment of 47Ca FA before and after 1, 25-(OH)2D3 administration revealed a similar degree of responsiveness to the steroid in the estrogen-treated women before and at the end of the study period (45.8 ± 6.9% vs. 42.9%± 14.9% from basal, respectively; P = 0.142), but a blunted response to 1, 25-(OH)2D3 was observed in the placebo group at 6 months (27.9 ± 17.7%) compared to the result obtained before surgery (36.7 ± 9.1%; P = 0.032). Multifactor analysis of variance revealed that the effects of estrogen and 1, 25-(OH)2D3 on 47Ca FA were independent of basal serum 1, 25-(OH)2D3 levels. On the other hand, calcitriol administration increased serum 1, 25-(OH)2D3 to a similar extent before and 6 months after surgery in the placebo group (24.2 ± 18.3% vs. 34.7 ± 16.7% from basal, respectively; P = 0.484) as well as in the estrogen-treated women (34.2 ± 17.2% vs. 26.6 ± 15.45%; P = 0.302). The significant impairment of 1, 25-(OH)2D3 stimulation of 47Ca FA in spite of increased levels of circulating 1, 25-(OH)2D3 in the untreated women is suggestive of an end-organ resistance to the vitamin D metabolite in a hypoestrogenic condition, which can be prevented by hormone replacement, and supports the hypothesis of a vitamin D-independent action of estrogen on intestinal calcium absorption.

Original languageEnglish
Pages (from-to)1288-1293
Number of pages6
JournalJournal of Clinical Endocrinology and Metabolism
Issue number5
StatePublished - Nov 1990

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