Menopause Center, Hôpital Paule de Viguier, TSA 70034, 330 avenue de Grande-Bretagne, 31059 Toulouse, France.
Maturitas. 2010 Apr;65(4):348-51. doi: 10.1016/j.maturitas.2009.12.023. Epub 2010 Jan 15.
It is widely recognized that bone mineral density (BMD) is one of the best predictors of osteoporotic fractures. Sex hormone status clearly affects bone either directly or indirectly and a longer estrogen exposure appears to be a major determinant of postmenopausal BMD. Accordingly, several studies have led to the hypothesis that BMD might represent a marker of the accumulated lifetime exposure of estrogen and therefore be used as a predictor factor of the risk of other postmenopausal conditions such as breast cancer or cardiovascular diseases (CVD). With regard to the risk of breast cancer, there is evidence that different surrogate markers of lifetime exposure to estrogen are associated with an increased risk for breast cancer. Most of these markers are the opposite of those for the risk of fracture. Furthermore, several studies have also reported that women with higher BMD have an increased risk of breast cancer compared to women with lower BMD. On the other hand, postmenopausal women with osteoporosis are at increased risk for acute cardiovascular events and mortality independently of age and cardiovascular risk factors. BMD has been shown to inversely correlate with surrogate markers of CVD including aortic calcifications and atherosclerosis. The underlying mechanisms of such a relationship are not fully understood. Several plausible molecular links are serum lipids, pro-inflammatory cytokines or the RANK/RANK ligand/osteoprotegerin system. Interestingly, all of these factors are modulated by estrogens. It could thus be hypothesized that the intensity of postmenopausal estrogen deficiency could be also the common pathogenic factor between atherosclerosis and osteoporosis.
人们普遍认为，骨密度（BMD）是骨质疏松性骨折的最佳预测指标之一。性激素状况显然直接或间接地影响骨骼，而更长时间的雌激素暴露似乎是绝经后 BMD 的主要决定因素。因此，一些研究提出了假设，即 BMD 可能代表雌激素终生暴露的标志物，因此可以用作其他绝经后疾病（如乳腺癌或心血管疾病（CVD））风险的预测因素。关于乳腺癌风险，有证据表明，雌激素终生暴露的不同替代标志物与乳腺癌风险增加相关。这些标志物中的大多数与骨折风险的标志物相反。此外，一些研究还报告称，与 BMD 较低的女性相比，BMD 较高的女性患乳腺癌的风险增加。另一方面，患有骨质疏松症的绝经后妇女发生急性心血管事件和死亡的风险独立于年龄和心血管危险因素增加。BMD 与包括主动脉钙化和动脉粥样硬化在内的 CVD 替代标志物呈负相关。这种关系的潜在机制尚未完全阐明。一些合理的分子联系是血清脂质、促炎细胞因子或 RANK/RANK 配体/骨保护素系统。有趣的是，所有这些因素都受雌激素调节。因此，可以假设绝经后雌激素缺乏的强度也可能是动脉粥样硬化和骨质疏松症之间的共同致病因素。
