Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Curr Opin Obstet Gynecol. 2023 Apr 1;35(2):141-149. doi: 10.1097/GCO.0000000000000858. Epub 2023 Feb 1.
The purpose of this review is to summarize the evidence on the benefits of menopausal hormone therapy (MHT) for the maintenance of skeletal health, prevention of osteoporosis and related fractures in peri and postmenopausal women.
We will review the impact of estrogen on skeletal health as well as the physiology of bone loss during the perimenopause and postmenopause. We will then elucidate the data that include estrogen alone and combination of MHT to demonstrate that in the absence of contraindication, MHT should be considered as an option for the maintenance of skeletal health both when concomitant menopausal symptoms are present and when not.
It has been well established that estrogens maintain bone mineral density (BMD) and reduce fracture risk at all sites. However, the most extensively studied form of estrogen with established fracture prevention is oral doses of synthetic estrogens. Due to the reduced risk profile, lower doses of bioidentical oral or transdermal estrogens are often preferred in clinical practice. We will highlight the current data on improvement in BMD and fracture risk reduction, including differences in formulation, dose, and route of delivery, to support a provider in the clinical decision-making process.
本综述旨在总结绝经激素治疗（MHT）对维持绝经后妇女骨骼健康、预防骨质疏松症及其相关骨折的益处的证据。
我们将回顾雌激素对骨骼健康的影响以及绝经前后骨丢失的生理学。然后，我们将阐明包括单独使用雌激素和 MHT 联合治疗的数据，以证明在没有禁忌症的情况下，MHT 应该被视为维持骨骼健康的一种选择，无论是在伴有绝经相关症状还是不伴有症状的情况下。
已经证实雌激素可以维持骨密度（BMD）并降低所有部位的骨折风险。然而，研究最广泛的具有明确骨折预防作用的雌激素形式是口服合成雌激素。由于风险状况降低，在临床实践中，通常更喜欢使用生物等效的口服或经皮雌激素的较低剂量。我们将重点介绍关于改善 BMD 和降低骨折风险的最新数据，包括配方、剂量和给药途径的差异，以支持提供者在临床决策过程中的决策。
