Shintani Masafumi
Department of Obstetrics and Gynecology, Nara Prefectural Mimuro Hospital.
Clin Calcium. 2004 Oct;14(10):105-10.
Hormone replacement therapy (HRT) increases the bone mineral density (BMD) and reduces the risk of vertebral and hip fractures in postmenopausal women. But, long term HRT slightly increases the risk of breast cancer. Raloxifene is a selective estrogen receptor modulator that has estrogen agonist effects in the skeleton and cardiovascular system and estrogen antagonist effects in the uterus and breast. Raloxifene effectively prevents bone loss and significantly, increases lumbar spine, hip, and total body bone mineral density, raloxifene reduces the risk of vertebral fracture. Raloxifene treatment leads to no increase in vaginal bleeding or mastaigia and to greater than 70% reduction in risk for invasive breast cancer. But raloxifene increases the hot flashes in postmenopausal women. In conclusion, HRT is optimal therapy for prevention and treatment of osteoporosis in postmenopausal women with menopausal symptoms, raloxifene is optimal therapy for prevention and treatment of osteoporosis in postmenopausal women without menopausal symptoms.
激素替代疗法（HRT）可增加绝经后女性的骨矿物质密度（BMD），并降低椎骨和髋部骨折的风险。但是，长期使用HRT会略微增加患乳腺癌的风险。雷洛昔芬是一种选择性雌激素受体调节剂，在骨骼和心血管系统中具有雌激素激动剂作用，而在子宫和乳腺中具有雌激素拮抗剂作用。雷洛昔芬可有效预防骨质流失，并显著增加腰椎、髋部和全身的骨矿物质密度，还可降低椎骨骨折的风险。雷洛昔芬治疗不会导致阴道出血或乳房疼痛增加，且可使浸润性乳腺癌的风险降低70%以上。但是雷洛昔芬会增加绝经后女性的潮热症状。总之，对于有绝经症状的绝经后女性，HRT是预防和治疗骨质疏松症的最佳疗法；对于没有绝经症状的绝经后女性，雷洛昔芬是预防和治疗骨质疏松症的最佳疗法。
