Gennari C, AgnusDei D, Gonnelli S, Nardi P
Institute of Medical Semeiotics, University of Siena, Italy.
Maturitas. 1989 Sep;11(3):187-97. doi: 10.1016/0378-5122(89)90210-7.
In many patients with involutional osteoporosis anabolic steroids may produce a rapid subjective improvement and a pronounced reduction in the frequency of complaints. Animal experiments have demonstrated that anabolic steroids can also have an objective effect on bone tissue. Twenty (20) post-menopausal osteoporotic patients were randomly assigned to 2 different treatment regimens; 10 patients were treated with 50 mg i.m. of nandrolone decanoate (ND) every 3 wk for 12 mth and 10 patients were treated with a placebo. Both groups also received an oral calcium supplement (1 g/day). Bone mineral content (BMC) was measured by dual photon absorptiometry before and after 1, 3, 6 and 12 mth of treatment. Plasma alkaline phosphatase (ALP) and urinary hydroxyproline excretion were measured at the same time. Intestinal calcium absorption was measured by the 47Ca oral test before and after treatment. A transiliac bone biopsy was performed before and after treatment in 4 patients in each group. After 1 yr there was a significant increase in lumbar spine BMC in the group receiving calcium plus ND. A progressive increase in plasma ALP was also observed in the group treated with ND but this was not significant, whereas radiocalcium absorption did increase significantly in this group. Histomorphometric study of bone samples demonstrated a significant increase in trabecular bone volume (TBV) and in active osteoid surface area in the patients treated with ND. Because plasma ALP tends to increase when a small decrease in bone resorption occurs (as measured by urinary hydroxyproline excretion) and the active osteoid surfaces also significant augment, we concluded that ND therapy increases the bone formation rate through inhibition of bone resorption. This interpretation could explain the considerable increase in lumbar spine BMC and the significant increase in TBV observed in patients treated with ND.
在许多患有退行性骨质疏松症的患者中，合成代谢类固醇可使主观症状迅速改善，并显著减少不适症状的发生频率。动物实验表明，合成代谢类固醇对骨组织也有客观影响。20名绝经后骨质疏松症患者被随机分为两种不同的治疗方案；10名患者每3周肌肉注射50mg癸酸诺龙（ND），共治疗12个月，另外10名患者接受安慰剂治疗。两组患者均口服补钙剂（每日1g）。在治疗1、3、6和12个月前后，通过双能光子吸收法测量骨矿物质含量（BMC）。同时测量血浆碱性磷酸酶（ALP）和尿羟脯氨酸排泄量。治疗前后通过47Ca口服试验测量肠道钙吸收。每组4名患者在治疗前后进行髂骨活检。1年后，接受钙剂加ND治疗的组腰椎BMC显著增加。接受ND治疗的组血浆ALP也有逐渐升高，但不显著，而该组放射性钙吸收确实显著增加。对骨样本的组织形态计量学研究表明，接受ND治疗的患者小梁骨体积（TBV）和活跃类骨质表面积显著增加。由于当骨吸收略有减少（通过尿羟脯氨酸排泄量测量）时血浆ALP往往会升高，且活跃类骨质表面也显著增加，我们得出结论，ND治疗通过抑制骨吸收来提高骨形成率。这一解释可以说明接受ND治疗的患者腰椎BMC的显著增加以及TBV的显著增加。
