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한국 폐경 여성에서 2년간 호르몬 요법이 골밀도에 미치는 영향

The Effect of Hormone Replacement Therapy on Bone Mineral Density in Korean Postmenopausal Women for 2 Years

김미향|정지영|정혁|오지영|정민형|양승오|김흥열|오한진
대한골다공증학회 (THE KOREAN SOCIETY OF OSTEOPOROSIS)|2009.04|OSTEOPOROSIS (The Journal of Korean Society of Osteoporosis)|제7권 제1호|pp. 35-42

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참고문헌

키워드

골다공증Osteoporosis골밀도Bone mineral densityEstrogenHormone therapy호르몬 치료에스트로젠프로제스테론Progesterone
주제분류기타의약학

초록

목적: 호르몬 요법이 한국의 폐경 여성의 골밀도에 미치는 효과를 측정하고자 한다. 방법: 2003년에서 2008년까지 195명의 호르몬 요법을 시행한 실험군과 203명의 대조군에서 1) 에스트로젠과 주기적인 프로제스테론을 사용한 군, 2) 에스트로젠과 지속적인 프로제스테론을 사용한 군, 3) 에스트로젠만 사용한 군, 4) 치료를 하지 않은 군으로 구분하였다. 요추 2-4번과 대퇴골의 골밀도를 dual energy X-ray absorptiometry를 이용하여 기저치와 치료 중 6, 12, 24개월 간격으로 측정하였다. 결과 분석을 위해 연령 및 체질량지수를 보정하였다. 결과치는 평균±표준오차로 표시하였다. 결과: 대조군과 비교하여 호르몬 요법을 시행한 군에서 요추와 대퇴골의 골밀도 결과는 의미 있게 향상되었다. 호르몬 요법에 의한 골밀도 변화는 기저치의 골밀도와 음성적으로 상관관계를 보였다. 호르몬 치료를 시행한 3군 모두에서는 12개월에 측정한 대퇴골의 골밀도를 제외한 요추 및 대퇴골의 골밀도는 통계적인 차이를 보이지 않았다. 결론: 본 연구는 호르몬 치료가 장기간 동안 골밀도의 감소를 예방한다는 것을 확인시켜 주었다. 또한 본 연구에서는 에스트로젠 단독 투여와 에스트로젠과 프로제스테론을 동시에 투여하는 것이 골밀도의 변화에 큰 차이가 없음을 보여주었다. 기저 골밀도 수치가 호르몬 치료에 대한 반응에 영향을 미치고 낮은 골밀도를 보인 환자에서 의미 있는 반응이 관찰될 것이라는 의견은 호르몬 치료가 필요한 환자를 선별하는데 도움이 될 것이다.

Abstract

Objectives: To evaluate the effects of hormone therapy(HT) on BMD in Korean postmenopausal women. Methods: From 2003 to 2008, a total of 195 HT group and 203 control group recruited. Treatment were (1) estrogen with cyclic addition of progesterone; (2) estrogen with continuous addition of progesterone; (3) estrogen only; and (4) no treatment. Lumbar(L2-L4) and femur bone mineral densities(BMD) were determined by dual energy X-ray absorptiometry at baseline, after 6, 12, and 24 month of treatment. In these analyses, we adjusted for age and body mass index. Data were expressed as mean±SEM. Results: Compared with control, BMDs at both lumbar spine and femur neck at 24 month were significantly higher in women under HT. BMD change with HT was negatively correlated with baseline BMD. There were no significant differences in both spine and femur BMDs among the 3 active treatment groups except in femur BMD at 12 month. Conclusion: This study confirms the long-term preventive effect of HT on BMD loss. This study suggests no difference in BMD response between estrogen alone and addition of combined estrogen-progesterone therapy. The notions that basal bone density affect the response to HT and that a significant response is obtained in the patient with low BMD should provied useful decision-making information for the identification of candidates for HT.

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