Obstetrics and Gynecology Clinic, Obstetrics and Gynecology Department, Fondazione IRCCS Policlinico, Università degli Studi di Milano, Milan, Italy.
J Womens Health (Larchmt). 2010 Sep;19(9):1609-17. doi: 10.1089/jwh.2010.2021.
Several randomized controlled trials (RCTs) have compared the effect of phytoestrogens (PEs) vs. placebos on bone density after menopause, with inconsistent results.
We performed a systematic review to assess the overall effect of PEs on bone mineral density (BMD) in menopausal Western women. We searched for all RCTs comparing PEs with placebos conducted on perimenopausal or postmenopausal Western women, published from January 1990 to February 2010. The main outcome measure was the lumbar spine (LS) BMD.
We identified 17 studies on soy isoflavone (IFs) bone-sparing effects. Some studies did not report a difference between treated and untreated women, whereas others supported a significant role of IFs on slowing bone loss, although these studies suffered from an internal lack of consistency, as a positive effect emerged in some bone districts but not in others. Data on LS BMD were available in 12 studies including 1433 subjects overall. The effect of PEs on BMD (mg/cm(2)) was not statistically significant (mean difference 9.86 mg/cm(2), 95% confidence interval [CI] -2.64-22.36) under a random-effects model. Excluding the genistein study, however, analyses of IF mixtures did not show a bone-sparing effect (0.73, 95% CI -2.79-4.25). No increasing effect emerged when dose and treatment duration were increased.
Our review and meta-analysis suggest that IF mixtures are not effective in decreasing bone loss in perimenopausal and postmenopausal Western women. The role of isolated genistein and individual genetic capacity to metabolize IFs is still open to evaluation.
几项随机对照试验（RCT）比较了植物雌激素（PEs）与安慰剂对绝经后妇女骨密度的影响，但结果不一致。
我们进行了一项系统评价，以评估 PEs 对绝经后西方女性骨矿物质密度（BMD）的总体影响。我们搜索了所有比较 PEs 与安慰剂的 RCT，这些 RCT 是针对围绝经期或绝经后西方女性进行的，发表时间为 1990 年 1 月至 2010 年 2 月。主要观察指标为腰椎（LS）BMD。
我们确定了 17 项关于大豆异黄酮（IFs）骨保护作用的研究。一些研究未报告治疗组与未治疗组妇女之间的差异，而其他研究则支持 IFs 对减缓骨丢失的重要作用，尽管这些研究存在内在的不一致性，因为在一些骨区出现了积极的效果，但在其他骨区则没有。共有 12 项研究报告了 LS BMD 数据，共纳入 1433 例受试者。在随机效应模型下，PEs 对 BMD（mg/cm(2)）的影响无统计学意义（平均差异 9.86 mg/cm(2)，95%置信区间 [CI] -2.64-22.36）。然而，排除金雀异黄素研究后，IF 混合物分析并未显示出骨保护作用（0.73，95%CI -2.79-4.25）。当剂量和治疗持续时间增加时，并未出现增加的效果。
我们的综述和荟萃分析表明，IF 混合物不能有效减少围绝经期和绝经后西方女性的骨丢失。单独金雀异黄素和个体代谢 IFs 的遗传能力的作用仍有待评估。
