Effects of Combined Estrogen and Effervescent Fluocalcic Therapy on the Bone Mineral Density and Bone Metabolism of Surgical Menopause Women with Osteopenia
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective: To evaluate the effects of estrogen therapy and fluocalcic on the bone mineral density and bone metabolism in surgically menopausal osteopenic women. Methods: This prospective randomized clinical trial examined the effects of conjugated equine estrogen and fluocalcic in combination and separately, on bone mass density (BMD) and biochemical markers of bone turnover in 200 women with low bone mass. Treatment included 1 mg estradiol (Group I, n=50), 2 mg estradiol (Group II, n=50), 1mg estradiol plus fluocalcic (Group III, n=50), and 2mg estradiol plus fluocalcic (Group IV, n=50) for 12 months. Bone density measurements were performed at 6 and 12 months at the lumbar spine and femur neck. Biochemical markers of bone turnover were also measured every 6 months. Results: The BMD of the lumbar spine increased significantly during the treatment in Group III and Group IV (P<0.05), while the BMD of the femur neck increased slightly, but not significantly, during treatment in all groups. In addition, urinary deoxypyridinoline decreased significantly in Group III and Group IV at 12 months of treatment (P<0.005). On the other hand, serum osteocalcin and total alkaline phosphatase decreased slightly, but not significantly, in all groups during the treatment. Conclusion: The combined treatment with estradiol and fluocalcic is more effective in surgically menopausal women with osteopenia because it decreases bone biochemical markers and increases BMD.
Abstract
Objective: To evaluate the effects of estrogen therapy and fluocalcic on the bone mineral density and bone metabolism in surgically menopausal osteopenic women. Methods: This prospective randomized clinical trial examined the effects of conjugated equine estrogen and fluocalcic in combination and separately, on bone mass density (BMD) and biochemical markers of bone turnover in 200 women with low bone mass. Treatment included 1 mg estradiol (Group I, n=50), 2 mg estradiol (Group II, n=50), 1mg estradiol plus fluocalcic (Group III, n=50), and 2mg estradiol plus fluocalcic (Group IV, n=50) for 12 months. Bone density measurements were performed at 6 and 12 months at the lumbar spine and femur neck. Biochemical markers of bone turnover were also measured every 6 months. Results: The BMD of the lumbar spine increased significantly during the treatment in Group III and Group IV (P<0.05), while the BMD of the femur neck increased slightly, but not significantly, during treatment in all groups. In addition, urinary deoxypyridinoline decreased significantly in Group III and Group IV at 12 months of treatment (P<0.005). On the other hand, serum osteocalcin and total alkaline phosphatase decreased slightly, but not significantly, in all groups during the treatment. Conclusion: The combined treatment with estradiol and fluocalcic is more effective in surgically menopausal women with osteopenia because it decreases bone biochemical markers and increases BMD.
참고문헌 (40)
- Min BK, "A study on menopause in Korean women", Kor J Obstet Gynecol, 28, pp.966~972 (1985)
- Michaelsson K, "Hormone replacement therapy and risk of hip fracture: population based case-control study", BMJ, 20, pp.1853~1863 (1998)
- Kanis JA, "Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease", Osteoporosis Int, 7, pp.390~406 (1997)
- Lee CJ, "The Effects of Hormone Replacement Therapy on Serum Osteocalcin, Serum Calcium, Serum Alkaline Phosphatase, and Urine Calcium of Postmenopausal Women", Korean J Obstet Gynecol, 40, pp.2733~2740 (1997)
- Kim HY, "Impacts of Added Progestogen on the Bone Mineral Densities and Bone Metabolism of Postmenopausal women undergoing Estrogen Replacement Therapy", Korean J Obstet Gynecol, 41, pp.564~575 (1998)
- Yang HI, "Long term effects on oral progestogen (medroxyprogesterone acetate) on the bone mineral densities and the level of serum lipid metabolism during estrogen replacement therapy in postmenopausal women", J Korean Acad Fam Med, 20, pp.1000~1011 (1999)
- Ettinger B, "Associations between low levels of serum estradiol. bone density, and fractures among elderly women: the study of osteoporotic fractures", J Clin Endocrinol Metab, 83, pp.2239~2243 (1998)
- Cummings SR, "Monitoring osteoporosis therapy with bone densitometry: misleading changes and regression to the mean. Fracture Intervention Trial Research Group", JAMA, 283, pp.1318~1321 (2000)
- Grodstein F, "A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease", Ann Intern Med, 133, pp.933~941 (2000)
- Heikkinen J, "Long term continuous combined hormone replacement therapy in the prevention of postmenopausal bone loss: A comparison of high-and low-dose estrogen-progestin regimens", Osteoporos Int, 11, pp.929~937 (2000)
- Farley JR, "Fluoride directly stimulates proliferation and alkaline phosphatase activity of born forming cells", Science, 222, pp.330~332 (1983)
- Chung HY, "Serum Fluoride Level in Normal Adult Women and Changes in Serum Fluoride Level after Disodium Monofluorophosphate Administration", J Korean Soc Endocrinol, 12, pp.565~570 (1997)
- Corden RS, "Follicular status at menopause", Human Reprod, 2, pp.617~623 (1987)
- Emans SJ, "Estrogen deficiency in adolescents and young adults: impact on bone mineral content and effects of estrogen replacement therapy", Obstet Gynecol, 76, pp.585~592 (1990)
- Riggs BL, "Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis", N Engl J Med, 322, pp.802~809 (1990)
- Melton LJ, "Perspective how many women have osteoporosis", J Bone Miner Res, 7, pp.1005~1010 (1992)
- Borderie D, "Biochemical markers as predictors of bone mineral density changes after GnRH agonist treatment", Calcif Tissue Int, 6, pp.21~25 (1998)
- Weinstein MC, "Cost-effectiveness of hormone replacement therapy in the menopause", Obstet Gynecol Surv, 38, pp.445~455 (1983)
- Kim HY, "The effects of 1alphahydroxyvitamin D3 on the Bone Mineral Density and Bone Metabolism in Postmenopausal Women", Korean J Obstet Gynecol, 41, pp.829~838 (1998)
- Lindsay R, "The minimum effective dose of estrogen for prevention of postmenopausal bone loss", Obstet Gynecol, 63, pp.759~763 (1984)
- Ettinger B, "Menopausal bone loss can be prevented by low dose estrogen with calcium supplement", J Comput Assist Tomogr, 9, pp.633~639 (1985)
- Gallagher JC, "Effect of progestin therapy on cortical and trabecular bone: Comparsion with estrogen", Am J Med, 90, pp.171~178 (1991)
- MacLennan AH, "Oral oestrogen replacement therapy versus placebo for hot flushes. In: Menstrual Disorders Module of the Cochrane Database of Systematic Reviews" (2000), Cochrane Library Update Software
- Webber CE, "Effects of 2 tears of hormoen replacement upon bone mass, serum lipid and lipoprotein", Maturis, 19, pp.13~23 (1994)
- Mizunuma H, "Prevention of postmenopausal bone loss with minimal uterine bleeding using low dose continuous estrogen", progestin therapy: a 2-year prospective study, 1997, pp.27, 69~76
- Recker RR, "Effect of low-dose continuous estrogen and progesterone therapy with calcium and vitamin D on bone in elderly women", Ann Intern Med, 130, pp.897~904 (1999)
- Lau KW, "Inhibition of phosphotyrosine dephosphorylation leads to increased phosphotyrosine phosphorylation of MAP kinase, MAP kinase activity, and human bone cell proliferation", Bone, 16(Suppl 1), pp.96~100 (1995)
- Resch H, "Pharmacokinetic profile of a new fluoride preparation: Sustained-release monofluorophoshate", Calcif Tissue int, 54, pp.7~11 (1994)
- Baylink DJ, "Serum fluoride levels In; Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism", pp.262~263 (1998), Raven Press 3
- Resch H, "Pharmacokinetic profile of a new fluoride preparation: Sustained-release monofluorophoshate", Calcif Tissue Int, 54, pp.7~11 (1994)
- Pak CY, "Treatment of postmenopausal osteoporosis with slow-release sodium fluoride. Final report of a randomized controlled trial", Ann Intern Med, 123, pp.401~408 (1995)
- Reginster JY, "The effect of sodium monofluorophosphate plus calcium on vertebral fracture rate in postmenopausal women with moderate osteoporosis. A randomized, controlled trial", Ann Intern Med, 129, pp.1~8 (1998)
- Meunier PJ, "Fluoride salts are no better at preventing new vertebral fractures than calcium-vitamin D in postmenopausal osteoporosis: the FAVO study", Osteoporos Int, 8, pp.4~12 (1998)
- Ringe JD, "Monofluorophosphate combined with hormone replacement therapy in postmenopausal osteoporosis. An open-label pilot efficacy and safety study", Rheumatol Int, 22, pp.27~32 (2002)
- Alexandersen P, "Monofluorophosphate combined with hormone replacement therapy induces a synergistic effect on bone mass by dissociating bone formation and resorption in postmenopausal women: a randomized study", J Clin Endocrinol Metab, 84, pp.3013~3020 (1999)
- Black D, "Quantitative analysis of the pyridinium crosslinks of collagne in urine using on paired reverse D phase highperformace liquid chromatography", Anal Biochem, 169, pp.197~204 (1998)
- Slovik DM, "Clinical evaluation of bone turnover by serum osteocalcin measurement in a hospital setting", J Clin Endocrinol Metabl, 59, pp.228~236 (1994)
- Crilly RG, "Rise in plasma alkaline phosphatase at the menopause", Clin Sci (Lond), 58, pp.341~342 (1980)
- Adriana BCM, "Monitoring Alendronate therapy for Osteoporosis", J Bone Miner Res, 14, pp.602~608 (1999)
- Hong JR, "Changes of markers of bone turnover after 6-month treatment with HRT and Fluocalcic in postmenopausal osteoporotic women", Kosin Medical Journal, 18, pp.11~16 (2003)
