Ongphiphadhanakul B, Piaseu N, Tung S S, Chailurkit L, Rajatanavin R
Department of Medicine and Research Center, Ramathibodi Hospital, Mahidol University, Rajthevi, Bangkok, Thailand.
Maturitas. 2000 Feb 15;34(2):179-84. doi: 10.1016/s0378-5122(99)00091-2.
Estrogen deficiency is the most common cause of postmenopausal osteoporosis and estrogen replacement is well known to retard postmenopausal bone loss. Calcium supplement alone is generally considered to be insufficient for the prevention of bone loss associated with estrogen deficiency while the role of calcitriol is unclear. In the present study we examined the efficacy different doses of estrogen or calcitriol in the prevention of postmenopausal bone loss in Thais.
The subjects consisted of 146 Thai women no more than 6 years postmenopausal. The subjects were randomly allocated to receive 750 mg supplemental calcium alone, calcium and conjugated equine estrogen (CEE) at 0.3 or 0.625 mg, calcium and calcitriol at 0.25 or 0.5 microg daily. Those receiving CEE also took 5 mg medrogestone for 12 days each month. BMD at L2-4 and femoral neck were measured at baseline 1 year and 2 years after treatments. Data were expressed as mean +/- S.E.
Subjects on supplemental calcium alone had approximately 2.5% decreases in L2-4 (P < 0.05) and femoral BMD (P < 0.01) at 2 years. CEE (0.3 mg) resulted in 3.20 +/- 1.2% increase in vertebral BMD (P < 0.05) while no significant change in BMD was demonstrated at the femoral neck. Likewise, 0.625 mg of CEE induced 5.4 +/- 1.4% increase in vertebral BMD at 2 years (P < 0.001) without change in the femoral BMD. In regard to calcitriol, no significant change in vertebral or femoral BMD was demonstrated with either 0.25 or 0.5 microg calcitriol.
We concluded that calcitriol is effective in the prevention of early postmenopausal bone loss in Thais. It represents an option for the prevention of osteoporosis in postmenopausal women who are contraindicated for estrogen replacement.
雌激素缺乏是绝经后骨质疏松症最常见的病因，雌激素替代疗法能延缓绝经后骨质流失，这是众所周知的。单独补充钙通常被认为不足以预防与雌激素缺乏相关的骨质流失，而骨化三醇的作用尚不清楚。在本研究中，我们检测了不同剂量的雌激素或骨化三醇对泰国绝经后妇女预防骨质流失的疗效。
研究对象为146名绝经不超过6年的泰国女性。这些对象被随机分配，分别单独接受750毫克补充钙、钙与0.3毫克或0.625毫克结合马雌激素（CEE）、钙与0.25微克或0.5微克骨化三醇，每日服用。接受CEE的对象每月还服用12天5毫克甲羟孕酮。在治疗前、治疗1年后和2年后测量第2至4腰椎及股骨颈的骨密度。数据以平均值±标准误表示。
单独补充钙的对象在2年后第2至4腰椎骨密度下降约2.5%（P<0.05），股骨骨密度下降（P<0.01）。CEE（0.3毫克）使椎骨骨密度增加3.20±1.2%（P<0.05），而股骨颈骨密度无显著变化。同样，0.625毫克CEE在2年后使椎骨骨密度增加5.4±1.4%（P<0.001），股骨骨密度无变化。关于骨化三醇，0.25微克或0.5微克骨化三醇均未使椎骨或股骨骨密度发生显著变化。
我们得出结论，骨化三醇对预防泰国绝经后早期骨质流失有效。它为雌激素替代疗法禁忌的绝经后妇女预防骨质疏松症提供了一种选择。
