有多少女性在接受激素替代疗法时会出现骨矿物质密度下降？绝经后雌激素/孕激素干预试验的结果。

How many women lose bone mineral density while taking hormone replacement therapy? Results from the Postmenopausal Estrogen/Progestin Interventions Trial.

作者信息

Greendale G A, Wells B, Marcus R, Barrett-Connor E

机构信息

Division of Geriatrics, University of California, Los Angeles, UCLA School of Medicine, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095-1687, USA.

出版信息

Arch Intern Med. 2000 Nov 13;160(20):3065-71. doi: 10.1001/archinte.160.20.3065.

DOI:10.1001/archinte.160.20.3065

PMID:11074735

Abstract

BACKGROUND

The frequency of bone loss among women using postmenopausal hormone therapy is unknown.

METHODS

We used data from the Postmenopausal Estrogen/Progestin Interventions Trial to address the frequency of bone loss among women using postmenopausal hormone replacement therapy. Of 701 women randomized to active treatment (conjugated equine estrogens alone or in combination with 1 of 3 progestins), 538 (76.7%) were adherent and had replicate bone mineral density (BMD) measures at baseline, 12 months, and 36 months. Of 174 placebo-assigned women, 132 (75.9%) were similarly eligible. Replicate BMD measures were used to calculate within-person measurement errors, which were then used to delineate cut points that defined bone losers with 97.5%, 95.0%, 90.0%, or 75.0% confidence.

RESULTS

At the lumbar spine, during the first 12 months, 1.5% of hormone users lost BMD with 97.5% confidence, corresponding to a decline of -3% per year; during months 12 to 36, only 0.6% of treated women lost spinal BMD to this degree. An annual loss of -1% or more was the criterion for spinal bone loss at the 75.0% confidence level; 5.1% and 8.0% of hormone users met this criterion in the first year and in months 12 to 36, respectively. For the total hip, during the first 12 months, 2.3% of hormone-adherent women lost -3.0% per year or more, the 97.5% confidence definition of loss; 0.4% were so classified during months 12 to 36. To be 75.0% confident of hip BMD loss, a -1.0% per year decline in BMD was required; using this criterion, 14.5% and 11.8% of hormone users lost total hip BMD between 0 to 12 and 12 to 36 months, respectively. Among hormone-adherent women, at the spine and hip, there was virtually no overlap between women classified as bone losers in the first 12 months and those classified as such in the last 24 months. With 95.0% certainty, corresponding to an approximate loss of -2.5% at the spine and hip, 31.3% and 11.7% of placebo-adherent women lost spinal BMD in the first 12 and last 24 months, respectively. Parallel figures for the hip were 32.3% and 7.9%, respectively.

CONCLUSION

Bone loss while taking postmenopausal hormones is rare, and bone loss among untreated women is far from universal.

摘要

背景

使用绝经后激素疗法的女性中骨质流失的频率尚不清楚。

方法

我们利用绝经后雌激素/孕激素干预试验的数据来研究使用绝经后激素替代疗法的女性中骨质流失的频率。在701名随机接受活性治疗（单独使用结合马雌激素或与三种孕激素之一联合使用）的女性中，538名（76.7%）坚持治疗，并在基线、12个月和36个月时进行了重复的骨矿物质密度（BMD）测量。在174名被分配接受安慰剂的女性中，132名（75.9%）同样符合条件。重复的BMD测量用于计算个体内测量误差，然后用于划定定义骨质流失者的切点，置信度分别为97.5%、95.0%、90.0%或75.0%。

结果

在腰椎，在最初的12个月里，1.5%的激素使用者以97.5%的置信度出现BMD丢失，相当于每年下降-3%；在12至36个月期间，只有0.6%的接受治疗的女性脊柱BMD下降到这个程度。每年丢失-1%或更多是75.0%置信水平下脊柱骨质流失的标准；在第一年和12至36个月期间，分别有5.1%和8.0%的激素使用者符合该标准。对于全髋，在最初的12个月里，2.3%坚持使用激素的女性每年丢失-3.0%或更多，这是97.5%置信度下丢失的定义；在12至36个月期间，0.4%的女性被如此分类。要以75.0%的置信度确定髋部BMD丢失，BMD每年需要下降-1.0%；使用该标准，在0至12个月和12至36个月期间，分别有14.5%和11.8%的激素使用者全髋BMD丢失。在坚持使用激素的女性中，在脊柱和髋部，最初12个月被分类为骨质流失者的女性与最后24个月被如此分类的女性之间几乎没有重叠。在95.0%的确定性水平下，相当于脊柱和髋部大约丢失-2.5%，在最初12个月和最后24个月，分别有31.3%和11.7%坚持使用安慰剂的女性脊柱BMD丢失。髋部的相应数字分别为32.3%和7.9%。