甲状旁腺激素用于预防雌激素缺乏引起的骨质流失。

Parathyroid hormone for the prevention of bone loss induced by estrogen deficiency.

作者信息

Finkelstein J S, Klibanski A, Schaefer E H, Hornstein M D, Schiff I, Neer R M

机构信息

Endocrine Unit, Massachusetts General Hospital, Boston 02114.

出版信息

N Engl J Med. 1994 Dec 15;331(24):1618-23. doi: 10.1056/NEJM199412153312404.

DOI:10.1056/NEJM199412153312404

PMID:7969342

Abstract

BACKGROUND

Analogues of gonadotropin-releasing hormone (GnRH) are often given to induce hypogonadism in women who have estrogen-dependent disorders such as endometriosis and uterine leiomyomas. Because estrogen deficiency causes bone loss, concern about premature osteoporosis has prevented long-term therapy with GnRH analogues. We conducted a study to determine whether parathyroid hormone could prevent bone loss in women receiving therapy with GnRH analogues.

METHODS

We administered human parathyroid hormone (40 micrograms subcutaneously daily) to 20 of 40 women with endometriosis who were being treated with nafarelin (200 micrograms intranasally twice daily) for six months; the remaining 20 women received only nafarelin. Cortical and trabecular bone density and biochemical markers of bone turnover were measured every three months during the six-month study period.

RESULTS

Serum estradiol concentrations fell to postmenopausal values in 36 of the 40 women. In the women who received nafarelin alone, the mean (+/- SE) bone density in the lumbar spine decreased by 2.8 +/- 0.5 percent (P < 0.001) when measured in the anteroposterior projection and by 3.5 +/- 0.8 percent (P < 0.001) when measured in the lateral projection. In contrast, bone density in the lumbar spine did not change when measured in the anteroposterior projection and increased by 3.4 +/- 1.2 percent when measured in the lateral projection (P = 0.01) in the women who also received parathyroid hormone. Bone density at the femoral neck decreased slightly and similarly in both groups. Radial bone density did not change in either group. Serum alkaline phosphatase and osteocalcin concentrations and urinary hydroxyproline and pyridinoline excretion increased (P < 0.001) in the women who received nafarelin plus parathyroid hormone.

CONCLUSIONS

Parathyroid hormone can prevent bone loss in the lumbar spine in young women with estrogen deficiency caused by treatment with GnRH analogues.

摘要

背景

促性腺激素释放激素（GnRH）类似物常用于诱导患有雌激素依赖性疾病（如子宫内膜异位症和子宫肌瘤）的女性出现性腺功能减退。由于雌激素缺乏会导致骨质流失，对过早发生骨质疏松症的担忧使得GnRH类似物无法长期使用。我们进行了一项研究，以确定甲状旁腺激素是否能预防接受GnRH类似物治疗的女性骨质流失。

方法

40名患有子宫内膜异位症且正在接受那法瑞林（每日两次经鼻给予200微克）治疗的女性中，20名接受人甲状旁腺激素（每日皮下注射40微克）治疗六个月；其余20名女性仅接受那法瑞林治疗。在为期六个月的研究期间，每三个月测量一次皮质骨和小梁骨密度以及骨转换的生化标志物。

结果

40名女性中有36名的血清雌二醇浓度降至绝经后水平。仅接受那法瑞林治疗的女性，腰椎前后位测量时平均（±标准误）骨密度下降2.8±0.5%（P<0.001），侧位测量时下降3.5±0.8%（P<0.001）。相比之下，同时接受甲状旁腺激素治疗的女性，腰椎前后位测量时骨密度无变化，侧位测量时增加3.4±1.2%（P=0.01）。两组女性的股骨颈骨密度均略有下降且相似。两组桡骨骨密度均无变化。接受那法瑞林加甲状旁腺激素治疗的女性血清碱性磷酸酶和骨钙素浓度以及尿羟脯氨酸和吡啶啉排泄量增加（P<0.001）。