Differences Between Oral Tibolone and Estradiol Plus Dydrogesterone in Improving Bone Mineral Density in Peri- and Post-menopausal Women

Background: To retrospectively investigate the efficacy and influencing factors of tibolone and estradiol plus dydrogesterone in improving bone mineral density (BMD) in peri- and post-menopausal women, to provide a basis for clinical management. Methods: Women aged 40–60 years who were undergoing menopausal transition or were post-menopausal, and who attended the menopause clinic at the Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, between January 3, 2011, and May 11, 2020, were included in this study. Participants received tibolone or estradiol plus dydrogesterone for the management of menopause-related symptoms. Demographic characteristics were recorded, and BMD was measured using dual-energy X-ray absorptiometry at baseline and at 1, 2, and 3 years post-treatment to compare the efficacy of the two treatments in improving BMD. Results: The use of estradiol plus dydrogesterone showed an increasing trend in the BMD of the lumbar spine, total hip, and femoral neck after 1 and 2 years of treatment, with a decrease in the third year. Tibolone treatment showed a decreasing trend in BMD after 1, 2, and 3 years, indicating that estradiol plus dydrogesterone is superior to tibolone in improving BMD. After 3 years of tibolone treatment, changes in BMD were correlated with age, height, weight, and body mass index (BMI), whereas after 3 years of estradiol plus dydrogesterone treatment, changes in BMD showed no significant correlation with age, height, weight, and BMI. Conclusions: Both estradiol plus dydrogesterone and tibolone are beneficial for maintaining BMD in peri- and post-menopausal women, with estradiol plus dydrogesterone demonstrating greater advantage over tibolone.