Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Unit for Human Reproduction, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Hormones (Athens). 2024 Jun;23(2):339-344. doi: 10.1007/s42000-024-00526-1. Epub 2024 Jan 18.
Menopausal hormone therapy (MHT) has consistently shown a bone protective effect by reducing the risk of vertebral, non-vertebral, and hip fractures in postmenopausal women regardless of baseline fracture risk. However, the optimal sequential treatment after MHT discontinuation has not been determined. This systematic review aimed to obtain the best evidence regarding the effect of antiresorptive or osteoanabolic treatment on bone mineral density (BMD) and/or fracture risk following MHT.
A comprehensive search was conducted in the PubMed, Scopus, and Cochrane databases up to October 31, 2023. Randomized-controlled trials (RCTs) and observational studies conducted in postmenopausal women were included.
After the exclusion of duplicates, 717 studies were identified. Two were eligible for qualitative analysis, one RCT and one retrospective cohort study. The RCT showed that alendronate 10 mg/day for 12 months further increased lumbar spine (LS) BMD by 2.3% following MHT and maintained femoral neck (FN) BMD in postmenopausal women (n = 144). It also decreased bone anabolic and resorption markers by 47 and 36%, respectively. In the retrospective study (n = 34), raloxifene 60 mg/day increased both LS and FN BMD at 12 months by 3 and 2.9%, respectively. No fractures were reported.
Antiresorptive therapy with either a bisphosphonate (i.e., alendronate) or raloxifene could be considered a sequential antiosteoporosis therapy after MHT withdrawal since they have been shown in studies to further increase BMD. However, no safe conclusions can be drawn from the existing literature.
无论基线骨折风险如何，绝经激素治疗（MHT）都通过降低绝经后妇女椎骨、非椎骨和髋部骨折的风险，始终表现出对骨骼的保护作用。然而，MHT 停药后的最佳序贯治疗尚未确定。本系统评价旨在获得关于抗吸收或成骨治疗对 MHT 后骨密度（BMD）和/或骨折风险影响的最佳证据。
在 2023 年 10 月 31 日之前，在 PubMed、Scopus 和 Cochrane 数据库中进行了全面检索。纳入了在绝经后妇女中进行的随机对照试验（RCT）和观察性研究。
在排除重复项后，共确定了 717 项研究。其中有 2 项研究符合定性分析的条件，1 项 RCT 和 1 项回顾性队列研究。该 RCT 显示，阿仑膦酸钠 10mg/天，共 12 个月，在 MHT 后进一步使腰椎（LS）BMD 增加 2.3%，并维持绝经后妇女的股骨颈（FN）BMD（n=144）。它还分别使骨合成和吸收标志物降低了 47%和 36%。在回顾性研究中（n=34），雷洛昔芬 60mg/天使 LS 和 FN 在 12 个月时的 BMD 分别增加 3%和 2.9%。没有报告骨折。
抗吸收治疗，无论是使用双磷酸盐（即阿仑膦酸钠）还是雷洛昔芬，都可以被认为是 MHT 停药后的序贯抗骨质疏松治疗，因为研究表明它们可以进一步增加 BMD。然而，现有文献无法得出安全的结论。
