Doran P M, Riggs B L, Atkinson E J, Khosla S
Endocrine Research Unit, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
J Bone Miner Res. 2001 Nov;16(11):2118-25. doi: 10.1359/jbmr.2001.16.11.2118.
Several lines of evidence implicate estrogen deficiency as a cause of bone loss in elderly men. Thus, in 50 elderly men (mean age +/- SD, 69.1 +/- 6.0 years), we performed a randomized blinded study to assess the effect of 6 months of treatment with 60 mg/day of raloxifene (a selective estrogen receptor modulator [SERM] that has an agonist effect on bone but is not feminizing) versus placebo on bone turnover markers. The mean changes in bone turnover markers, serum sex steroid, or lipid levels with treatment did not differ between groups. However, changes in urinary cross-linked N-telopeptide of type I collagen (NTX) excretion were related directly to the baseline serum estradiol level in the raloxifene (r = 0.57; p = 0.004) but not in the placebo-treated (r = 0.15; p = 0.485) men (p = 0.015 for the difference between groups). Moreover, the men in whom NTX excretion decreased after raloxifene treatment had significantly lower baseline estradiol levels (mean +/- SEM, 22 +/- 2 pg/ml) than the men in whom urinary NTX excretion didn't change or increased after raloxifene therapy (30 +/- 3 pg/ml; p = 0.03), and no such difference was found in the placebo group. Thus, raloxifene has no significant effect on bone turnover markers or lipid levels in elderly men. However, the association noted between baseline estradiol levels and the change in urine NTX excretion in the raloxifene-treated men suggests that a subset of men with low estradiol levels may respond to raloxifene or other SERMs, and further studies are needed to directly test this possibility.
多项证据表明，雌激素缺乏是老年男性骨质流失的一个原因。因此，我们对50名老年男性（平均年龄±标准差，69.1±6.0岁）进行了一项随机双盲研究，以评估每天服用60毫克雷洛昔芬（一种对骨骼具有激动剂作用但不会产生女性化作用的选择性雌激素受体调节剂[SERM]）治疗6个月与安慰剂相比对骨转换标志物的影响。治疗后，两组之间骨转换标志物、血清性激素或脂质水平的平均变化没有差异。然而，雷洛昔芬治疗组中，I型胶原交联N-端肽（NTX）排泄量的变化与基线血清雌二醇水平直接相关（r = 0.57；p = 0.004），而安慰剂治疗组的男性则无此相关性（r = 0.15；p = 0.485）（两组间差异p = 0.015）。此外，雷洛昔芬治疗后NTX排泄量降低的男性，其基线雌二醇水平（平均±标准误，22±2 pg/ml）显著低于雷洛昔芬治疗后尿NTX排泄量未改变或增加的男性（30±3 pg/ml；p = 0.03），而安慰剂组未发现此类差异。因此，雷洛昔芬对老年男性的骨转换标志物或脂质水平没有显著影响。然而，在接受雷洛昔芬治疗的男性中，基线雌二醇水平与尿NTX排泄量变化之间的关联表明，一部分雌二醇水平低的男性可能对雷洛昔芬或其他SERM有反应，需要进一步研究直接验证这种可能性。
