Perry W, Wiseman R A
Endocrine Centre, London, UK.
BJOG. 2000 Nov;107(11):1401-6. doi: 10.1111/j.1471-0528.2000.tb11655.x.
To compare trabecular and compact bone response and relationship to oestrogen status using continuous oestradiol valerate 2 mg and norethisterone 0.7 mg daily as hormone replacement and to determine the therapeutic range of 17 beta-oestradiol.
Open label trial.
Independent endocrine clinic
One hundred and thirty-one patients were compared at point of entry and at 36 months.
Postmenopausal women were assessed using a Lunar dual photon and single photon bone scanner, and bone mineral density of the lumbar spine, right hip and left forearm were annually correlated with 17 beta-oestradiol and oestrone levels over three years. Total alkaline phosphatase was compared between improvers and decliners of bone mineral density.
Significant improvement in bone mineral density (P < 0.0001) occurred at all sites except the left forearm, where bone loss was prevented. There was no correlation between oestrogen levels and bone mineral density improvements at hip sites. However, in the lumbar spine larger improvements in bone mineral density occurred in women with 17 beta-oestradiol levels > 185 pmol/L compared with those below, which were statistically significant for those with 17 beta-oestradiol levels > 248 pmol/L. Bone turnover, as quanitifed by total alkaline phosphatase measurements, was suppressed in most patients, but there were no differences in the mean alkaline phosphatase levels between the best improvers and worst decliners for lumbar spine bone mineral density. Improvers had an age mean of 5.21 years greater than decliners (P = 0.01) and a mean duration difference since the menopause of 5 1 years compared with decliners (P = 0.007).
This combined continuous preparation of hormone replacement therapy improves not only trabecular bone but prevents compact bone loss, and the data suggest that the therapeutic range of 17 beta-oestradiol is between 200 pmol/L and 350 pmol/L.
使用每日2毫克戊酸雌二醇和0.7毫克炔诺酮作为激素替代疗法，比较小梁骨和密质骨的反应及其与雌激素状态的关系，并确定17β-雌二醇的治疗范围。
开放标签试验。
独立内分泌诊所
131名患者在入组时和36个月时进行了比较。
使用Lunar双能光子和单能光子骨扫描仪对绝经后女性进行评估，在三年时间里，每年将腰椎、右髋和左前臂的骨矿物质密度与17β-雌二醇和雌酮水平进行关联。比较骨矿物质密度改善者和下降者之间的总碱性磷酸酶水平。
除左前臂外，所有部位的骨矿物质密度均有显著改善（P<0.0001），左前臂的骨质流失得到了预防。髋部部位的雌激素水平与骨矿物质密度改善之间没有相关性。然而，在腰椎，17β-雌二醇水平>185 pmol/L的女性与低于该水平的女性相比，骨矿物质密度有更大改善，对于17β-雌二醇水平>248 pmol/L的女性，这种改善具有统计学意义。通过总碱性磷酸酶测量量化的骨转换在大多数患者中受到抑制，但腰椎骨矿物质密度改善最佳者和下降最差者之间的平均碱性磷酸酶水平没有差异。改善者的平均年龄比下降者大5.21岁（P=0.01），与下降者相比，绝经后的平均时间差为5.1年（P=0.007）。
这种联合持续激素替代疗法不仅改善了小梁骨，还预防了密质骨流失，数据表明17β-雌二醇的治疗范围在200 pmol/L至350 pmol/L之间。
