Col N F, Bowlby L A, McGarry K
Division of General Internal Medicine, Rhode Island Hospital, Brown University Medical School, Providence, RI 02903, USA.
Minerva Med. 2005 Oct;96(5):331-42.
Osteoporosis is a common disease resulting in millions of potentially preventable fractures each year. Women are disproportionately affected by osteoporosis compared to men, with loss of gonadal functioning and aging being the 2 most important contributing factors to osteoporosis. For many decades, menopausal hormone therapy (HT) has been the mainstay for the prevention and treatment of osteoporosis among menopausal women. While recent randomized trial data have confirmed findings from observational studies concerning HT's protective effect on osteoporosis, they showed that HT increases the risks of breast cancer, venous thromboses, stroke, and coronary heart disease. With a strong body of evidence showing the benefit of HT in preventing osteoporotic fractures, the challenge facing clinicians is not whether HT helps to prevent osteoporotic fractures, but whether HT's fracture-prevention benefits outweigh its risks. With several medications now available having efficacy comparable to HT in preventing fractures, decisions about therapy for osteoporosis or osteopenia should take into consideration bone mineral density, other risk factors for osteoporotic fracture, and a careful examination of the benefits and risks of each treatment option. After a brief discussion of the epidemiology and pathophysiology of osteoporosis, we review the evidence from observational studies and randomized studies examining the impact of menopausal hormone therapy on osteoporosis. We focus on whether there are specific subgroups of women that accrue greater or smaller benefit from HT in terms of osteoporotic fracture reduction. We then expand our perspective to include clinical endpoints other than osteoporosis, presenting a framework for factoring in the many risks and benefits of HT. We conclude that all women should be informed of all alternative treatment options and allowed to make an informed treatment decision according to their personal risks, preferences, values, and willingness to tolerate the risks of treatment.
骨质疏松症是一种常见疾病，每年导致数以百万计本可预防的骨折。与男性相比，女性受骨质疏松症的影响更为严重，性腺功能丧失和衰老 是导致骨质疏松症的两个最重要因素。几十年来，绝经激素治疗（HT）一直是绝经后女性预防和治疗骨质疏松症的主要方法。虽然最近的随机试验数据证实了观察性研究中关于HT对骨质疏松症具有保护作用的结果，但这些数据表明HT会增加患乳腺癌、静脉血栓、中风和冠心病的风险。有大量证据表明HT在预防骨质疏松性骨折方面有益处，临床医生面临的挑战不是HT是否有助于预防骨质疏松性骨折，而是HT预防骨折的益处是否超过其风险。由于现在有几种药物在预防骨折方面的疗效与HT相当，因此关于骨质疏松症或骨质减少症的治疗决策应考虑骨密度、骨质疏松性骨折的其他风险因素，并仔细权衡每种治疗方案的利弊。在简要讨论骨质疏松症的流行病学和病理生理学之后，我们回顾了观察性研究和随机研究中关于绝经激素治疗对骨质疏松症影响的证据。我们关注的是，就减少骨质疏松性骨折而言，是否有特定的女性亚组从HT中获得的益处更大或更小。然后，我们将视角扩展到包括骨质疏松症以外的临床终点，提出一个考虑HT诸多风险和益处的框架。我们的结论是，应该让所有女性了解所有替代治疗方案，并允许她们根据个人风险、偏好、价值观以及耐受治疗风险的意愿做出明智的治疗决定。
