Gorai I, Chaki O, Taguchi Y, Nakayama M, Osada H, Suzuki N, Katagiri N, Misu Y, Minaguchi H
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Calcif Tissue Int. 1999 Jul;65(1):16-22. doi: 10.1007/s002239900651.
A total of 79 Japanese women who were within 5 years of menopause were randomly assigned 1alpha-hydroxyvitamin D3 [1alpha(OH)D3] 1.0 microg/day, conjugated estrogens 0.625 mg/day, a combination of both, or control (no treatment). Lumbar spine and proximal femur bone mineral density (BMD) and biochemical indices were monitored over 2 years. In the 1alpha(OH)D3-treated group, there was a nonsignificant decrease in lumbar spine BMD compared with controls, and no significant loss in the femoral neck compared with controls. In the estrogen-treated group, there was a nonsignificant increase in spine BMD (+2.17% in the first year and +1.71% in the second year), and no loss in femoral neck BMD. The combination of conjugated estrogens +1alpha(OH)D3 was more effective in increasing BMD in the spine (+3. 68% in the first year and +3.63% in the second year) and femur (+2. 56% in the first year and +4.44% in the second year) BMD. There was a significant difference in lumbar spine BMD in both the first and second years between the combination-treated group and the 1alpha(OH)D3-treated and control groups (P < 0.01). Serum osteocalcin (OC) significantly decreased in the combination-treated group (-23.8% in the first year) and the estrogen-treated group (-37. 6% and -41.2% at 6 and 18 months, respectively), and serum alkaline phosphatase (Alp) decreased significantly in the first year in the combination-treated (-31.5%), estrogen-treated (-27.3%), and 1alpha(OH)D3-treated (-7.9%) groups, whereas serum OC increased (+45. 4% in the first year) in women without treatment. The results of this study indicate that early postmenopausal bone loss in the femoral neck is prevented by conjugated estrogens, 1alpha(OH)D3, or both, whereas bone loss in the spine is not prevented by 1alpha(OH)D3. Estrogen proves effective in preventing early postmenopausal bone loss by markedly inhibiting bone turnover. Moreover, a synergistic bone-sparing effect can be expected when estrogen is administered concomitantly with 1alpha(OH)D3 rather than when used alone.
共有79名处于绝经后5年内的日本女性被随机分为四组，分别给予每日1.0微克的1α-羟维生素D3 [1α(OH)D3]、每日0.625毫克的结合雌激素、二者联合用药或对照组（不治疗）。在两年时间里监测腰椎和股骨近端的骨密度（BMD）及生化指标。在1α(OH)D3治疗组中，与对照组相比，腰椎骨密度有不显著的下降，股骨颈与对照组相比无显著丢失。在雌激素治疗组中，脊柱骨密度有不显著的增加（第一年增加2.17%，第二年增加1.71%），股骨颈骨密度无丢失。结合雌激素 + 1α(OH)D3联合用药在增加脊柱（第一年增加3.68%，第二年增加3.63%）和股骨（第一年增加2.56%，第二年增加4.44%）骨密度方面更有效。联合治疗组与1α(OH)D3治疗组和对照组相比，在第一年和第二年腰椎骨密度均有显著差异（P < 0.01）。联合治疗组（第一年下降23.8%）和雌激素治疗组（6个月和18个月时分别下降37.6%和41.2%）血清骨钙素（OC）显著下降，联合治疗组（下降31.5%）、雌激素治疗组（下降27.3%）和1α(OH)D3治疗组（下降7.9%）在第一年血清碱性磷酸酶（Alp）显著下降，而未治疗女性血清OC增加（第一年增加45.4%）。本研究结果表明，结合雌激素、1α(OH)D3或二者均可预防绝经后早期股骨颈骨丢失，而1α(OH)D3不能预防脊柱骨丢失。雌激素通过显著抑制骨转换，在预防绝经后早期骨丢失方面证明是有效的。此外，雌激素与1α(OH)D3联合给药时，比单独使用时预期有协同的保骨作用。
