From the Department of Internal Medicine, Section of Endocrinology.
School of Public Health, Yale University, New Haven, CT.
Menopause. 2022 Oct 1;29(10):1200-1203. doi: 10.1097/GME.0000000000002045. Epub 2022 Aug 20.
The aim of this study was to examine the effect of either conjugated equine estrogen or transdermal estradiol on vitamin D metabolism in postmenopausal women.
Twenty-five women from the Kronos Early Estrogen Prevention Study who were randomized to conjugated equine estrogen 0.45 mg/d and 20 women who were treated with transdermal estradiol 50 mg/d (patch replaced weekly) were analyzed in the present study. All participants received micronized progesterone for 12 days per month.
There was no significant treatment effect on serum total 25-hydroxyvitamin D over 48 months in either study group, and there were no significant differences between treatment arms. In contrast, at 12 months, directly measured free 25-hydroxyvitamin D was significantly higher in the transdermal estradiol group than in the conjugated equine estrogen group. Directly measured free 25-hydroxyvitamin D subsequently increased significantly from 12 to 48 months in both treatment arms. Calculated free 25-hydroxyvitamin D was also significantly higher in the transdermal estradiol group at 36 months. Vitamin D-binding protein decreased significantly in both treatment groups from 12 to 48 months, but at 48 months, least square mean values were no different based on treatment assignment.
Directly measured free 25-hydroxyvitamin D levels, but not serum total 25-hydroxyvitamin D levels, are different within the first 12 months of estrogen replacement depending on the preparation. However, this difference is transient, in that there were no differences at 36 or 48 months. These findings suggest that there may be a short-term benefit to prescribing transdermal estradiol for women who are either vitamin D deficient or vitamin D insufficient.
本研究旨在探讨马结合雌激素或经皮雌二醇对绝经后妇女维生素 D 代谢的影响。
本研究分析了 Kronos 早期雌激素预防研究中随机分配至马结合雌激素 0.45mg/d 组的 25 名女性和经皮雌二醇 50mg/d（每周更换贴片）组的 20 名女性。所有参与者每月接受 12 天的微粒化孕酮治疗。
在任何研究组中，48 个月内血清总 25-羟维生素 D 均无显著治疗效果，且治疗组之间无显著差异。相比之下，在 12 个月时，经皮雌二醇组的直接测量游离 25-羟维生素 D 明显高于马结合雌激素组。直接测量的游离 25-羟维生素 D 随后在两个治疗组中从 12 个月显著增加至 48 个月。在 36 个月时，经皮雌二醇组的计算游离 25-羟维生素 D 也明显更高。从 12 个月到 48 个月，两个治疗组的维生素 D 结合蛋白均显著下降，但在 48 个月时，基于治疗分配，最小二乘均值无差异。
直接测量的游离 25-羟维生素 D 水平，而不是血清总 25-羟维生素 D 水平，在雌激素替代治疗的最初 12 个月内根据制剂不同而不同。然而，这种差异是短暂的，因为在 36 或 48 个月时没有差异。这些发现表明，对于维生素 D 缺乏或不足的女性，开处方经皮雌二醇可能有短期获益。
