PROGESTIN ANTAGONISM OF ESTROGEN STIMULATED 1,25-DIHYDROXYVITAMIN-D LEVELS

Progestins are frequently used in combination with estrogen to prevent or treat postmenopausal osteoporosis. Progestins protect against the undesirable hyperplastic effects of estrogen on the endometrium. The possibility that progestins might antagonize the beneficial effects of estrogen on calcium homeostasis has received little attention. In this study we determined whether the addition of progestin to estrogen would alter the ability of estrogen to raise serum 1,25-dihydroxyvitamin D [1,25-(OH)2D] levels. Women within 5 yr of menopause were treated with three cycles of oral unopposed estrogen [1 or 2 mg/day (3.67 or 7.34-mu-mol/day) 17-beta-estradiol (E2) for 25/30 days of each cycle] followed by three cycles of E2 plus progestin [10 mg/day (29-mu-mol/day) medroxyprogesterone on days 12-251. E2 increased both total and free 1,25-(OH)2D concentrations in a dose-dependent fashion. These levels increased progressively over the three cycles of unopposed estrogen treatment. In contrast the vitamin D binding protein concentration reached maximal levels after one cycle of E2. With the addition of progestin, the levels of total and free 1,25-(OH)2D returned toward baseline although vitamin D binding protein levels remained elevated. PTH levels rose with both doses of E2 as serum calcium levels fell. Progestin did not significantly alter the effects of E2 on PTH or calcium. Our results raise the possibility that progestin may antagonize part of the salubrious effects of estrogen on calcium homeostasis.