Insua A, Negri A, Zanchetta J R
Instituto de Investigaciones Metabólicas, Buenos Aires, Argentina.
Medicina (B Aires). 1995;55(5 Pt 1):408-14.
Estrogen treatment prevents early postmenopausal bone loss. The aim of this study was to evaluate the effects of estrogen-progestogen therapy on bone mass in elderly osteopenic postmenopausal women. Fifteen women with a mean age of 58 +/- 6 (mean +/- SD) years and 12 +/- 7 (5-31) years from menopause were evaluated. Bone mineral density (BMD) was assessed by dual X-ray absoptiometry (DXA) with 1.7% variation coefficient at lumbar spine (L2-4) and 1.9% at femur neck. Measurements were done at both sites before and after a 12 month treatment. At the beginning of the study lumbar spine BMD (LS BMD) was low: < 0.9 grs/cm2; z-score: -1.4 +/- 0.17 (mean +/- SEM). Treatment consisted in transdermal 17 beta estradiol (50 micrograms/day) (n = 10) or an equivalent natural estrogen oral dose (n = 5). Variable doses of medroxiprogesterone acetate were added on an individualized basis to women with an intact uterus (n = 12). Calcium intake was increased up to a median of 1200 mg/day (800-1600). After a one year treatment LS BMD was increased by 8.4 +/- 1.1% (mean +/- SEM) (95% CI: 6-10.8), from 0.748 +/- 0.02 to 0.810 +/- 0.02 gr/cm2 (p < 0.0001). A less marked gain in femur neck bone mineral density (FN BMD) was also noticed: 3.9 +/- 1.5% (95% CI: 0.6-7.2); 0.671 +/- 0.02 vs 0.697 +/- 0.02 gr/cm2 (p < 0.05). Patients treated with transdermal and oral routes showed similar results. Percentage variations in LS BMD and FN BMD were positively correlated (r: 0.53; p < 0.05). Six patients were treated for 2 years; LS BMD continued to rise, the additional gain being 5.1 +/- 2.2% (p < 0.05), while a non significant increase in FN BMD was observed (7.5 +/- 3.5%; p = 0.06). In the early postmenopausal period, hormonal replacement therapy (HRT) produces either a stabilization or a slight increase (2-4%) in BMD. In contrast, a significant augmentation of bone mass (especially at the spine) seems to occur in osteopenic women when THR is administered in the late postmenopausal period. This suggests that HRT could be used for the prevention as well as for the treatment of postmenopausal osteoporosis. Further studies should be done to evaluate whether HRT reduces the incidence of osteoporotic fractures in elderly osteopenic women.
雌激素治疗可预防绝经后早期骨质流失。本研究的目的是评估雌激素 - 孕激素疗法对老年骨质疏松性绝经后女性骨量的影响。对15名平均年龄为58±6（平均±标准差）岁、绝经12±7（5 - 31）年的女性进行了评估。采用双能X线吸收法（DXA）评估骨矿物质密度（BMD），腰椎（L2 - 4）的变异系数为1.7%，股骨颈为1.9%。在12个月治疗前后对两个部位进行测量。研究开始时腰椎骨密度（LS BMD）较低：<0.9克/平方厘米；z值：-1.4±0.17（平均±标准误）。治疗方法为经皮给予17β - 雌二醇（50微克/天）（n = 10）或等效的天然雌激素口服剂量（n = 5）。对有完整子宫的女性（n = 12）根据个体情况添加不同剂量的醋酸甲羟孕酮。钙摄入量增加至中位数为1200毫克/天（800 - 1600）。经过一年治疗，LS BMD增加了8.4±1.1%（平均±标准误）（95%置信区间：6 - 10.8），从0.748±0.02增加到0.810±0.02克/平方厘米（p < 0.0001）。股骨颈骨矿物质密度（FN BMD）也有较不明显的增加：3.9±1.5%（95%置信区间：0.6 - 7.2）；从0.671±0.02增加到0.697±0.02克/平方厘米（p < 0.05）。经皮和口服途径治疗的患者结果相似。LS BMD和FN BMD的百分比变化呈正相关（r：0.53；p < 0.05）。6名患者接受了2年治疗；LS BMD持续上升，额外增加了5.1±2.2%（p < 0.05），而FN BMD的增加不显著（7.5±3.5%；p = 0.06）。在绝经后早期，激素替代疗法（HRT）可使BMD稳定或略有增加（2 - 4%）。相比之下，在绝经后期给予HRT时，骨质疏松女性的骨量似乎会显著增加（尤其是在脊柱）。这表明HRT可用于预防和治疗绝经后骨质疏松症。应进行进一步研究以评估HRT是否能降低老年骨质疏松女性骨质疏松性骨折的发生率。
