Thijssen Jos H H
Endocrinological Laboratory, University Medical Center Utrecht KE.03.139.2, P.O. Box 85090, 3508 AB Utrecht, The Netherlands.
Maturitas. 2003 Dec 10;46 Suppl 1:S77-87. doi: 10.1016/j.maturitas.2003.09.022.
In view of the fact that fractures are the clinically relevant events, risk factors for fractures are discussed first. Bone mineral density (BMD) appears to be a much less important risk factor for the most severe hip fractures than the risk of falling. No results of experimental studies on hormones and fractures at advanced age are available. An overview of the effects of progestins on bone is given. Effects of progestins on bone have been studied by in vitro experiments using cell lines and by more relevant clinical observations. Prospective studies have been conducted following the use of progestins contained in oral contraceptives, alone or in combination with oestrogens; long-term contraception by injection of depot preparations; so-called "add-back" hormonal therapy attempting to reverse the adverse effects of gonadotropin releasing hormone agonists on bone and after different regimens of hormone replacement therapy (HRT) in postmenopausal women. From the data there are no indications that the various progestins, used in clinical practice, have either a bone-protective or an oestrogen antagonistic activity. Progestins do not add or subtract much of the protective action of oestrogens on the bones.
鉴于骨折是临床相关事件，首先讨论骨折的危险因素。对于最严重的髋部骨折而言，骨矿物质密度（BMD）似乎远不如跌倒风险那样是一个重要的危险因素。目前尚无关于老年激素与骨折的实验研究结果。本文给出了孕激素对骨骼影响的综述。已通过使用细胞系的体外实验以及更具相关性的临床观察来研究孕激素对骨骼的影响。开展了前瞻性研究，这些研究涉及单独使用或与雌激素联合使用口服避孕药中的孕激素；通过注射长效制剂进行长期避孕；所谓的“补充”激素疗法，试图逆转促性腺激素释放激素激动剂对骨骼的不良影响；以及绝经后女性采用不同激素替代疗法（HRT）方案之后的情况。从这些数据来看，没有迹象表明临床实践中使用的各种孕激素具有骨骼保护或雌激素拮抗活性。孕激素对雌激素对骨骼的保护作用增减不多。
