Reproductive Medicine Division, Departments of Obstetrics and Gynecology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama IV Rd. Pathum Wan, Pathum Wan District, Bangkok, 10330, Thailand.
Gender, Sexual and Climacteric Medicine Division, Departments of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
BMC Womens Health. 2021 Oct 13;21(1):363. doi: 10.1186/s12905-021-01508-w.
Compared with a natural process, surgically induced menopausal women have a higher bone loss rate. This study aims to evaluate early treatment with estradiol valerate on bone turnover markers after surgically induced menopause.
This prospective study included 41 pre and perimenopausal women who underwent hysterectomy with oophorectomy for benign gynecologic conditions. Two weeks after the operation, all participants were assessed for menopausal hormone therapy (MHT) indications. Estrogen therapy was prescribed for those who had indications and accepted treatment (hormone treatment group). The others who had no MHT indication were allocated to the no-treatment group. Serum CTX and P1NP levels at preoperative and 12 weeks postoperative were measured and set as the primary outcome. Within the same group, serum CTX and P1NP before and after surgical menopause were analyzed using Wilcoxon signed-rank test. ANCOVA was used to compare serum CTX and P1NP at 12 weeks after surgical menopause between the two groups. Spearman's rank correlation coefficient analysis analyzed the correlation between age and baseline bone turnover markers. A p-value of < 0.05 was considered statistically significant.
At 12 weeks after surgery, there were no significant differences in serum CTX and P1NP levels in the hormone treatment group compared to baseline. In contrast, serum CTX and P1NP levels were significantly elevated among women who did not receive hormone treatment (p-value < 0.001 and 0.002, respectively). Serum CTX and P1NP at 12 weeks were significantly different between the two groups (p-value < 0.001 and 0.004, respectively).
Early estrogen administration with oral estradiol valerate could significantly suppress the high bone remodeling in surgically induced menopausal women. Trial registration Thai Clinical Trial Registry identification number TCTR20190808004, retrospective registered since 2019-08-08. http://www.thaiclinicaltrials.org/show/TCTR20190808004 .
与自然进程相比，手术诱导绝经的女性骨丢失率更高。本研究旨在评估手术后早期应用戊酸雌二醇对手术诱导绝经后骨转换标志物的影响。
这是一项前瞻性研究，纳入了 41 名因良性妇科疾病接受子宫切除术加卵巢切除术的绝经前和围绝经期女性。术后 2 周，所有患者均接受绝经激素治疗（MHT）适应证评估。有适应证且接受治疗的患者给予雌激素治疗（激素治疗组）。无 MHT 适应证的患者分配至未治疗组。测量术前和术后 12 周的血清 CTX 和 P1NP 水平，并将其作为主要结局。同一组内，采用 Wilcoxon 符号秩检验分析手术绝经前后血清 CTX 和 P1NP 的变化。采用协方差分析比较两组术后 12 周血清 CTX 和 P1NP 的差异。采用 Spearman 秩相关系数分析年龄与基线骨转换标志物的相关性。p 值<0.05 为差异有统计学意义。
术后 12 周，激素治疗组血清 CTX 和 P1NP 水平与基线相比无显著差异。而未接受激素治疗的女性血清 CTX 和 P1NP 水平显著升高（p 值分别为<0.001 和 0.002）。两组间术后 12 周血清 CTX 和 P1NP 水平差异有统计学意义（p 值分别为<0.001 和 0.004）。
早期口服戊酸雌二醇可显著抑制手术诱导绝经女性的高骨重塑。
泰国临床试验注册中心注册号 TCTR20190808004，于 2019 年 8 月 8 日注册，网址为 http://www.thaiclinicaltrials.org/show/TCTR20190808004。
