한국 폐경 여성에서 기저 골밀도 및 1차년도 호르몬치료에 대한 골반응성에 따른 2차년도 호르몬치료에 대한 골반응성 연구
The Bone Response to Second Year Hormone Therapy according to the Basal Bone Mineral Density and the Bone Response to First Year Hormone Therapy in Korean Postmenopausal Women
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목적: 한국 폐경 여성에서 기저 골밀도 및 호르몬치료 후 1년에서의 골반응도에 따른 호르몬치료 후 2차년도에 골반응도를 알아보고자 하였다. 방법: 1년간 주기적 에스트로겐-프로게스토겐 병합요법을 시행 받은 자연폐경 여성 550명을 대상으로 하였는데, 이 중 318명이 2차년도까지 호르몬치료를 완료하였다. 이중에너지엑스레이흡수계측기(DXA)를 이용하여 요추, 대퇴골경부 및 대퇴골전자의 골밀도를 치료 전, 치료 1년 및 2년에 각각 측정하였다. 결과: 골밀도를 측정한 세 부위 모두에서 호르몬치료 후1 년째 골밀도 감소가 클수록 2차년도에 골밀도 증가가 높은 양상을 보였다. 호르몬치료 중 1년간 골밀도가 3% 이상 감소한 경우를 비반응군으로 정의하였을 때, 호르몬 치료 전 골다공증 여성에서 정상 골밀도 여성보다 호르몬치료 후 비반응군 비율이 낮았는데 2차년도에서는 차이가 없었다. 2년간 연속비반응군은 요추 1.9%, 대퇴골경부 2.8%, 대퇴골전자 2.8%로 전체 골부위로 보았을 때는 6.9%였다. 연속비반응군에서 반응군에 비해 모든 부위에서의 기저 골밀도 및 호르몬 치료 후 1년 후 대퇴골 전자에서 골밀도가 높았으나 연속비반응군과 반응군간 호르몬치료 전과 1년 후 골량 상태의 차이(즉 정상골밀도, 골감소증 및 골다공증 분포비)는 없었다. 결론: 호르몬치료 전 골밀도가 높을수록 호르몬치료 1년째 골반응도가 나쁘나 호르몬치료 2차년도에서는 골반응도가 좋아진다. 그러므로 호르몬치료 후 1년에서 골밀도의 감소를 보인다는 이유만으로 치료 방법을 변경하지는 말아야 한다.
Abstract
Objectives: To investigate bone responses to the second year of hormone therapy(HT) according to basal bone mineral density(BMD) and responses to the first year HT in postmenopausal Korean women. Methods: A total of 550 postmenopausal women received sequential combined estrogen-progestogen therapy for 1 year, and 318 for more than 1 year. BMD of the lumbar spine(LS), femoral neck(FN) and trochanter(FT) were measured by dual energy X-ray absorptiometry(DXA) before HT, and at 1 and 2 years after HT. Results: Women with a greater loss of BMD during the first year of HT were more likely to gain BMD during the second year at any of the three skeletal sites. The proportion of non-responders(women with >3% bone loss per year) to HT was significantly lower in women with osteoporosis before HT compared to those with normal basal BMD during the first year of treatment, but not during the second year. The frequency of consecutive non-responders to HT was 1.9% in the LS, 2.8% FN, 2.8% FT, and 6.9% among the total group. The basal BMD at all sites and 1 -year BMD at the FT were higher in the consecutive non-responder group than in the responder group. However, there were no differences in the status of the basal and 1 -year bone mass(namely the proportion of normal BMD, osteopenia, and osteoporosis) between the two groups. Conclusion: The higher the basal BMD was, the worse the bone response to 1 -year of HT was. However, the 2 -year HT group showed improvement. HT treatment should not be changed solely on the basis of first year BMD loss.
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