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Effects of Phytoestrogens on Bone Turnover in Postmenopausal Women with a History of Breast Cancer

Department of Obstetrics and Gynecology (E.N., M.M.-H., O.Y., A.T.), Helsinki University Central Hospital, FIN-00029 HUS, Helsinki, Finland; and Department of Obstetrics and Gynecology (E.N.), Jorvi Hospital, FIN-02740 Espoo, Finland

Address all correspondence and requests for reprints to: Dr. Eini Nikander, Department of Obstetrics and Gynecology, Helsinki University Central Hospital, P.O. Box 140, FIN-00029 HUS, Helsinki, Finland. E-mail: eini.nikander{at}pp.fimnet.fi.

High phytoestrogen intake among Asian women has been thought to explain the low risk of bone fractures in these populations. In a randomized placebo-controlled trial we studied the effects of isoflavonoids on urinary output of the N-terminal cross-linked telopeptide of type I collagen, pyridinoline (Pyr), and deoxypyridinoline (Dpyr) (bone resorption markers) and serum levels of bone-specific alkaline phosphatase and N-terminal and C-terminal procollagen type I (bone formation markers). Fifty-five postmenopausal women with a history of breast cancer used phytoestrogens (114 mg of isoflavonoids) or placebo tablets daily for 3 months; the treatment regimens were then crossed over after a 2-month washout period. The markers were measured before and on the last day of each treatment period.

Bone resorption was reduced during phytoestrogen use, as reflected in falls in the urinary output of Pyr (9%; P = 0.001) and Dpyr (5%; P = 0.008). Compared with the placebo group, the fall in Dpyr was significant (P = 0.022) and the falls in Pyr (P = 0.084) and N-terminal cross-linked telopeptide of type I collagen (P = 0.082) showed a trend toward significance. Bone formation markers were not affected by this regimen.

Thus, isoflavonoid-induced inhibition of bone resorption may contribute to the low risk of osteoporosis in Asian women.

This work was supported by grants from research funds of Jorvi Hospital and Helsinki University Central Hospital and the Juho Vainio Foundation.

Abbreviations: BAP, Bone-specific alkaline phosphatase; BMD, bone mineral density; Dpyr, deoxypyridinoline; HRT, hormone replacement therapy; NTx, cross-linked N-terminal telopeptide of type I collagen; PICP, procollagen type I C-terminal propeptide; PINP, procollagen type I N-terminal propeptide; Pyr, pyridinoline.

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