Steiniche T, Hasling C, Charles P, Eriksen E F, Mosekilde L, Melsen F
Dept. of Endocrinology, Aarhus Amtssygehus, Denmark.
Bone. 1989;10(5):313-20. doi: 10.1016/8756-3282(89)90126-9.
Thirty-seven patients with postmenopausal crush fracture osteoporosis were randomized to oral cyclic estrogen/gestagen (n = 20) or oral calcium (2000 mg elemental calcium per day) (n = 17). Fourteen in each group completed 1 year of treatment. Iliac crest bone biopsies were obtained after intravital double labeling with tetracycline before and after treatment in 10 patients on estrogen/gestagen and 11 patients on calcium. In the estrogen/gestagen group the activation frequency in trabecular bone decreased from 0.52 + 0.11 (SEM) year-1 to 0.27 + 0.08 year-1 (p less than 0.01). No significant changes were found in resorption or formation periods. The osteoid surfaces and the mineralizing surfaces decreased (p less than 0.05), whereas the decrease in eroded surfaces was insignificant. Furthermore, no significant changes were observed in final resorption depth, wall thickness or bone balance per remodeling cycle. Serum alkaline phosphatase and renal hydroxyproline excretion decreased during treatment (p less than 0.002), whereas the lumbar bone mineral content (BMC) increased (p less than 0.01). In the calcium group the extent and thickness of osteoid surfaces decreased (p less than 0.05) without significant changes in activation frequency. Serum alkaline phosphatase and renal hydroxyproline excretion decreased during treatment (p less than 0.02). No significant changes were observed in lumbar BMC or the other histomorphometric parameters. The study supports that the positive effect of estrogen/gestagen on BMC can be explained by a reduction in the activation frequency of new remodeling cycles leading to a decreased remodeling space and an increase in mean bone age. There is no evidence of a positive balance per remodeling cycle.(ABSTRACT TRUNCATED AT 250 WORDS)
37例绝经后压缩性骨折骨质疏松症患者被随机分为口服周期性雌激素/孕激素组（n = 20）或口服钙剂组（每天2000mg元素钙）（n = 17）。每组各有14例患者完成了1年的治疗。对10例接受雌激素/孕激素治疗的患者和11例接受钙剂治疗的患者，在治疗前后用四环素进行体内双标记后获取髂嵴骨活检标本。在雌激素/孕激素组，小梁骨的激活频率从0.52±0.11（SEM）年-1降至0.27±0.08年-1（p<0.01）。吸收期或形成期未发现显著变化。类骨质表面和矿化表面减少（p<0.05），而侵蚀表面的减少不显著。此外，每个重塑周期的最终吸收深度、壁厚度或骨平衡未观察到显著变化。治疗期间血清碱性磷酸酶和尿羟脯氨酸排泄减少（p<0.002），而腰椎骨矿物质含量（BMC）增加（p<0.01）。在钙剂组，类骨质表面的范围和厚度减少（p<0.05），激活频率无显著变化。治疗期间血清碱性磷酸酶和尿羟脯氨酸排泄减少（p<0.02）。腰椎BMC或其他组织形态计量学参数未观察到显著变化。该研究支持雌激素/孕激素对BMC的积极作用可通过减少新重塑周期的激活频率来解释，这导致重塑空间减小和平均骨龄增加。没有证据表明每个重塑周期存在正平衡。（摘要截短至250字）
