Naveh-Many T, Epstein E, Silver J
Nephrology Services, Hadassah University Hospital, Hebrew University Hadassah Medical School, Jerusalem, Israel.
Curr Opin Nephrol Hypertens. 1995 Jul;4(4):319-23. doi: 10.1097/00041552-199507000-00006.
Postmenopausal oestrogen deficiency is associated with the development of osteoporosis. Oestrogen therapy prevents further bone loss but does not have an anabolic effect. The only treatment with an anabolic effect on bone is intermittent parathyroid hormone treatment. Oestrogens have a direct action on the parathyroid to increase parathyroid hormone gene expression and parathyroid hormone secretion. They exert this effect at doses that are too low to cause the uterotrophic effect of oestradiol. Osteoporotic patients have a decreased parathyroid hormone secretory response to changes in serum calcium, supporting the experimental data that oestrogens have a direct effect on the parathyroid. The value of parathyroid hormone treatment is limited by the need for parenteral therapy. The ability of oestrogens to increase parathyroid hormone secretion suggests that the intermittent administration of oestrogen analogues, at doses that exert no effects on breast tissue and the uterus, would be the optimal treatment for osteoporosis.
绝经后雌激素缺乏与骨质疏松症的发生有关。雌激素疗法可防止进一步的骨质流失，但没有合成代谢作用。对骨骼具有合成代谢作用的唯一治疗方法是间歇性甲状旁腺激素治疗。雌激素对甲状旁腺有直接作用，可增加甲状旁腺激素基因表达和甲状旁腺激素分泌。它们在剂量过低以至于不会引起雌二醇子宫营养作用的情况下发挥这种作用。骨质疏松症患者对血清钙变化的甲状旁腺激素分泌反应降低，这支持了雌激素对甲状旁腺有直接作用的实验数据。甲状旁腺激素治疗的价值受到需要肠胃外治疗的限制。雌激素增加甲状旁腺激素分泌的能力表明，以对乳腺组织和子宫无影响的剂量间歇性给予雌激素类似物将是骨质疏松症的最佳治疗方法。
