Kim Jung Gu, Ku Seung-Yup, Kim Hoon, Chun Sung Wook, Suh Chang Suk, Choi Young Min
Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Korea.
Menopause. 2009 May-Jun;16(3):534-8. doi: 10.1097/gme.0b013e3181920c77.
The aim of his study was to investigate the relationship between the circulating tumor necrosis factor (TNF) system and bone mineral density (BMD) before and after estrogen plus progestogen therapy (EPT).
Serum levels of TNF-alpha, TNF-beta, soluble TNF receptor (sTNFR) 1, sTNFR2, and bone turnover markers and BMDs at the lumbar spine and proximal femur were measured in 192 postmenopausal Korean women. Among all women, 70 were treated with sequential EPT for 1 year.
BMDs at all skeletal sites and bone turnover markers were not correlated with serum TNF and sTNFR. After adjustment for age, years since menopause, and body mass index, serum TNF-beta levels were significantly lower in osteoporotic women than in normal women, whereas serum levels of TNF-alpha and sTNFR did not differ among normal, osteopenic, and osteoporotic postmenopausal women. After 6 months of EPT, serum TNF-beta levels increased significantly (P < 0.05), whereas serum TNF-alpha, sTNFR1, and sTNFR2 levels were unchanged. The 1-year changes in BMD at the lumbar spine and proximal femur after EPT were not correlated with the basal levels of serum TNF-alpha and sTNFR and their changes 6 months after EPT.
In the circulating TNF system, only serum TNF-beta levels were lower in osteoporotic postmenopausal women compared with normal postmenopausal women and increased after EPT, but changes in circulating TNF and sTNFR after EPT had no association with changes in bone markers and BMD. The circulating TNF system may not be clinically useful for predicting BMD and bone response after EPT.
本研究旨在调查雌激素加孕激素疗法（EPT）前后循环肿瘤坏死因子（TNF）系统与骨密度（BMD）之间的关系。
对192名绝经后韩国女性测量血清肿瘤坏死因子-α（TNF-α）、肿瘤坏死因子-β（TNF-β）、可溶性TNF受体（sTNFR）1、sTNFR2水平以及骨转换标志物，并测量腰椎和股骨近端的骨密度。所有女性中，70名接受序贯EPT治疗1年。
所有骨骼部位的骨密度和骨转换标志物与血清TNF和sTNFR均无相关性。在调整年龄、绝经年限和体重指数后，骨质疏松女性的血清TNF-β水平显著低于正常女性，而正常、骨量减少和骨质疏松的绝经后女性之间血清TNF-α和sTNFR水平无差异。EPT治疗6个月后，血清TNF-β水平显著升高（P<0.05），而血清TNF-α、sTNFR1和sTNFR2水平未改变。EPT治疗后腰椎和股骨近端骨密度的1年变化与血清TNF-α和sTNFR的基础水平及其EPT治疗6个月后的变化无关。
在循环TNF系统中，与正常绝经后女性相比，骨质疏松绝经后女性仅血清TNF-β水平较低，且EPT治疗后升高，但EPT治疗后循环TNF和sTNFR的变化与骨标志物和骨密度的变化无关。循环TNF系统在临床上可能无助于预测EPT治疗后的骨密度和骨反应。
