卵巢激素抑制联合或不联合雌二醇治疗后的身体成分和骨矿物质密度。
Body composition and bone mineral density after ovarian hormone suppression with or without estradiol treatment.
作者信息
Shea Karen L, Gavin Kathleen M, Melanson Edward L, Gibbons Ellie, Stavros Anne, Wolfe Pamela, Kittelson John M, Vondracek Sheryl F, Schwartz Robert S, Wierman Margaret E, Kohrt Wendy M
机构信息
1Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 2Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 3Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 4Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO.
出版信息
Menopause. 2015 Oct;22(10):1045-52. doi: 10.1097/GME.0000000000000430.
OBJECTIVE
Suppression of ovarian hormones in premenopausal women on gonadotropin-releasing hormone agonist (GnRH(AG)) therapy can cause fat mass (FM) gain and fat-free mass (FFM) loss. Whether this is specifically caused by a decline in serum estradiol (E2) is unknown. This study aims to evaluate the effects of GnRH(AG) with placebo (PL) or E2 add-back therapy on FM, FFM, and bone mineral density (BMD). Our exploratory aim was to evaluate the effects of resistance exercise training on body composition during the drug intervention.
METHODS
Seventy healthy premenopausal women underwent 5 months of GnRH(AG) therapy and were randomized to receive transdermal E2 (GnRH(AG) + E2, n = 35) or PL (GnRH(AG) + PL, n = 35) add-back therapy. As part of our exploratory aim to evaluate whether exercise can minimize the effects of hormone suppression, some women within each drug arm were randomized to undergo a resistance exercise program (GnRH(AG) + E2 + Ex, n = 12; GnRH(AG) + PL + Ex, n = 12).
RESULTS
The groups did not differ in mean (SD) age (36 [8] and 35 [9] y) or mean (SD) body mass index (both 28 [6] kg/m). FFM declined in response to GnRH(AG) + PL (mean, -0.6 kg; 95% CI, -1.0 to -0.3) but not in response to GnRH(AG) + E2 (mean, 0.3 kg; 95% CI, -0.2 to 0.8) or GnRH(AG) + PL + Ex (mean, 0.1 kg; 95% CI, -0.6 to 0.7). Although FM did not change in either group, visceral fat area increased in response to GnRH(AG) + PL but not in response to GnRH(AG) + E2. GnRH(AG) + PL induced a decrease in BMD at the lumbar spine and proximal femur that was prevented by E2. Preliminary data suggest that exercise may have favorable effects on FM, FFM, and hip BMD.
CONCLUSIONS
Suppression of ovarian E2 results in loss of bone and FFM and expansion of abdominal adipose depots. Failure of hormone suppression to increase total FM conflicts with previous studies of the effects of GnRH(AG). Further research is necessary to understand the role of estrogen in energy balance regulation and fat distribution.
目的
促性腺激素释放激素激动剂（GnRH(AG)）治疗会使绝经前女性的卵巢激素受到抑制，进而导致脂肪量（FM）增加和去脂体重（FFM）减少。目前尚不清楚这是否是由血清雌二醇（E2）水平下降所致。本研究旨在评估GnRH(AG)联合安慰剂（PL）或E2补充疗法对FM、FFM和骨密度（BMD）的影响。我们的探索性目标是评估抗阻运动训练在药物干预期间对身体成分的影响。
方法
70名健康的绝经前女性接受了5个月的GnRH(AG)治疗，并被随机分为接受经皮E2（GnRH(AG)+E2，n = 35）或PL（GnRH(AG)+PL，n = 35）补充疗法。作为我们探索性目标的一部分，即评估运动是否能将激素抑制的影响降至最低，每个药物组中的一些女性被随机分配接受抗阻运动计划（GnRH(AG)+E2+Ex，n = 12；GnRH(AG)+PL+Ex，n = 12）。
结果
两组在平均（标准差）年龄（36[8]岁和35[9]岁）或平均（标准差）体重指数（均为28[6]kg/m²）方面无差异。FFM在GnRH(AG)+PL治疗后下降（平均-0.6kg；95%CI，-1.0至-0.3），但在GnRH(AG)+E2治疗后（平均0.3kg；95%CI，-0.2至0.8）或GnRH(AG)+PL+Ex治疗后（平均0.1kg；95%CI，-0.6至0.7）未下降。虽然两组的FM均未改变，但GnRH(AG)+PL治疗后内脏脂肪面积增加，而GnRH(AG)+E2治疗后未增加。GnRH(AG)+PL导致腰椎和股骨近端的BMD下降，而E2可预防这种下降。初步数据表明，运动可能对FM、FFM和髋部BMD有有益影响。
结论
卵巢E2受到抑制会导致骨质流失和FFM减少以及腹部脂肪堆积增加。激素抑制未能增加总FM，这与之前关于GnRH(AG)作用的研究结果相矛盾。有必要进行进一步研究以了解雌激素在能量平衡调节和脂肪分布中的作用。
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