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호르몬 요법이 뼈에 미치는 영향

The Effect of Hormone Therapy on Bone

정민형
대한골다공증학회 (THE KOREAN SOCIETY OF OSTEOPOROSIS)|2008.12|OSTEOPOROSIS (The Journal of Korean Society of Osteoporosis)|제6권 제2호|pp. 71-78

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참고문헌

키워드

골다공증Osteoporosis뼈BoneHormone therapy호르몬 치료성호르몬Sex steroid
주제분류기타의약학

초록

성호르몬은 성인에서 뼈의 발달과 유지에 필수적이며 폐경기에 동반되는 에스트로젠의 부족은 폐경기 여성에서 골다공증을 유발하는 주요 원인이다. 골다공증은 매우 흔한 질환으로 매년 수백만 명에게 예방 가능한 골절을 유발한다. 특히 여성에서는 남성에 비해 노화 및 성호르몬의 감소에 의해 골다공증이 발생할 가능성이 높다. 수십 년 동안 폐경기 호르몬 치료는 폐경기 여성에서 골다공증을 예방하고 치료하는 주요한 방법이었으나 더불어 유방암, 정맥 색전증, 뇌졸중, 관상동맥질환을 유발하기도 하였다. 최근에는 호르몬 치료이외의 골다공증 치료 약제들이 사용 가능해졌고 골다공증 치료를 시작하기 전 골농도, 골다공증에 의한 골절을 유발할 수 있는 다른 위험 인자 등을 고려하고 각각의 치료 방법의 장단점을 감안해 선택하고 있다. 본 저자는 여기에 최근의 골다공증 치료에 대한 여러 연구 논문의 결과를 밝혀 환자 개인적인 위험인자, 선호도, 환자의 치료 의지 등을 고려하여 치료 방법을 선택할 때 도움이 되고자 한다.

Abstract

Sex steroids are essential for skeletal development and the maintenance of bone health throughout adult life, and estrogen deficiency at menopause is a major pathogenetic factor in the development of osteoporosis in postmenopausal women. Osteoporosis is a common disease resulting in millions of potentially preventable fractures each year. Women are disproportionately affected by osteoporosis compared to men, with loss of gonadal functioning and aging being the two most important contributing factors to osteoporosis. For many decades, menopausal hormone therapy(HT) has been the mainstay for the prevention and treatment of osteoporosis among menopausal women. While recent randomized trial data have confirmed findings from observational studies concerning HT's protective effect on osteoporosis, they showed that HT increases the risks of breast cancer, venous thromboses, stroke, and coronary heart disease. With a strong body of evidence showing the benefit of HT in preventing osteoporotic fractures, the challenge facing clinicians is not whether HT helps to prevent osteoporotic fractures, but whether HT's fracture-prevention benefits outweigh its risks. With several medications now available having efficacy comparable to HT in preventing fractures, decisions about therapy for osteoporosis or osteopenia should take into consideration of bone mineral density, other risk factors for osteoporotic fracture, and a careful examination of the benefits and risks of each treatment option. After a brief discussion of the epidemiology and pathophysiology of osteoporosis, I review the evidence from observational studies and randomized studies examining the impact of menopausal hormone therapy on osteoporosis. I conclude that all women should be informed of all alternative treatment options and allowed to make an informed treatment decision according to their personal risks, preferences, values, and willingness to tolerate the risks of treatment.

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