호르몬 요법과 골다공증
Hormone Therapy and Osteoporosis
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During the perimenopause, both the quantity and quality of bone decline rapidly, resulting in a dramatic increase in the risk of fracture in postmenopausal women. Data from the large Women's Health Initiative (WHI), in which women with an intact uterus(mean age: 63 years) were randomly assigned to estrogen plus progestin, showed that HT increased total hip BMD and reduced the risk of fractures at the hip, vertebrae, and wrist. Similarly, the estrogen-alone component of the WHI, which involved women(mean age: 64 years) with prior hysterectomy, demonstrated a reduced rate of hip fracture. It is never too early in the menopause to evaluate women for bone loss and advise them on steps to take to prevent the declines in bone mass and quality that increase the risk of future osteoporosis and fracture. Postmenopausal women should therefore be screened for osteoporosis risk factors and have their BMD levels tested, if warranted, in accordance with current guidelines. Use of BMD assists physicians in diagnosing osteoporosis and in monitoring treatment effects. Low-dose hormone therapy and ultralow-dose hormone therapy can provide an effective protection against the postmenopausal decrease of BMD. Estrogen depletion after menopause become involved with postmenopausal bone loss, therefore ET(estrogen therapy) and EPT(estrogen-progestogen therapy) have been considered as first-line therapy for postmenopausal osteopenia and osteoporosis.
Abstract
During the perimenopause, both the quantity and quality of bone decline rapidly, resulting in a dramatic increase in the risk of fracture in postmenopausal women. Data from the large Women's Health Initiative (WHI), in which women with an intact uterus(mean age: 63 years) were randomly assigned to estrogen plus progestin, showed that HT increased total hip BMD and reduced the risk of fractures at the hip, vertebrae, and wrist. Similarly, the estrogen-alone component of the WHI, which involved women(mean age: 64 years) with prior hysterectomy, demonstrated a reduced rate of hip fracture. It is never too early in the menopause to evaluate women for bone loss and advise them on steps to take to prevent the declines in bone mass and quality that increase the risk of future osteoporosis and fracture. Postmenopausal women should therefore be screened for osteoporosis risk factors and have their BMD levels tested, if warranted, in accordance with current guidelines. Use of BMD assists physicians in diagnosing osteoporosis and in monitoring treatment effects. Low-dose hormone therapy and ultralow-dose hormone therapy can provide an effective protection against the postmenopausal decrease of BMD. Estrogen depletion after menopause become involved with postmenopausal bone loss, therefore ET(estrogen therapy) and EPT(estrogen-progestogen therapy) have been considered as first-line therapy for postmenopausal osteopenia and osteoporosis.
참고문헌 (23)
- "Physician's Guide to Prevention and Treatment of Osteoporosis"[URL]
- Writing Group for the Women's Health Initiative Investigators, "Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women. Principal Results From the Women's Health Initiative Randomized Controlled Trial", JAMA, 288, pp.321~333 (2002)
- Hersh AL, "National use of postmenopausal hormone therapy: annual trends and response to recent evidence", JAMA, 291, pp.47~53 (2004)
- Ettinger B, "Effect of the Women's Health Initiative on women's decisions to discontinue postmenopausal hormone therapy", Obstet Gynecol, 102, pp.1225~1232 (2003)
- Cauley JA, "Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial", JAMA, 290, pp.1729~1738 (2003)
- Anderson GL, "Effect of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial", JAMA, 291, pp.2212~2220 (2004)
- 김우선, "호르몬 대치요법이 60세 이상의 폐경 후 여성 골밀도에 미치는 영향", 대한폐경회지, 13, pp.114~122 (2007)
- Gambacciani M, "Ultra low-dose hormone replacement therapy and bone protection in postmenopausal women", Maturitas, 59, pp.2~6 (2008)
- Dane C, "Comparison of the effects of raloxifene and low-dose hormone replacement therapy on bone mineral density and bone turnover in the treatment of postmenopausal osteoporosis", Gynecol Endocrinol, 23, pp.398~403 (2007)
- Al-Azzawi F, "Bone mineral density in postmenopausal women treated with a vaginal ring delivering systemic doses of estradiol acetate", Menopause, 12, pp.331~339 (2005)
- Hohenhaus MH, "Hormone Therapy for the prevention of bone loss in menopausal women with osteopenia: is it a viable option", Drugs, 67, pp.2311~2221 (2007)
- Taniguchi R, "Hormone replacement Up-to-date. effect of estrogen therapy (ET) and estrogen-progestogen therapy (EPT) on the bone metabolism", Clin Calcium, 17, pp.1342~1348 (2007)
- Gass M, "Preventing osteoporosisrelated fractures: An overview", Am J Med, 119, pp.3S~11S (2006)
- Greenspan SL, "Significant differential effects of alendronate, estrogen, or combination therapy on the rate of bone loss after discontinuation of treatment of postmenopausal osteoporosis:a randomized, double-blind, placebo-controlled trial", Ann Intern Med, 137, pp.875~883 (2002)
- Gallagher JC, "Effect of discontinuation of estrogen, calcitriol, and the combination of both on bone density and bone markers", J Clin Endocrinol Metab, 87, pp.4914~4923 (2002)
- Yates J, "Rapid loss of hip fracture protection after estrogen cessation: evidence from the national osteoporosis risk assessment", Obstet Gynecol, 103, pp.440~446 (2004)
- Barrett-Connor E, "Recency and duration of postmenopausal hormone therapy: effects on bone mineral density and fracture risk in the National Osteoporosis Risk Assessment (NORA)study", Menopause, 10, pp.412~419 (2003)
- The Board of Trustees of The North Menopause Society, "Position Statement. Management of osteoporosis in postmenopausal women: 2006 position statement of The North American Menopause Society", Menopause, 13, pp.340~367 (2006)
- Genazzani AR, "Position Statement. Menopause and aging, quality of life and sexuality", Climacteric, 10, pp.88~96 (2007)
- Skouby SO, "Climacteric medicine: European Menopause and Andropause Society (EMAS) 2004", 2005 position statements on peri- and postmenopausal hormone replacement therapy, 2005, pp.51, 8~14
- "Physician’s Guide to Prevention and Treatment of Osteoporosis"[URL]
- North American Menopause Society, "Management of postmenopausal osteoporosis position statement of the North American Menopause Society", Menopause, 9, pp.84~101 (2002)
- Hodgson SF, "American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis 2001 edition, with selected updates for 2003", Endocr Pract, 9, pp.544~564 (2003)