小剂量雌激素对绝经后骨质疏松症的治疗

目的:探讨减半剂量雌激素联合孕激素和钙剂对绝经后骨质疏松症的防治作用。方法:138例绝经2年以上因骨痛就诊的妇女。①测定用药前血性激素,血、尿骨代谢生化,并与20例未绝经的正常妇女相比较;②绝经者随机分为3组(每组46例),A组给予倍美力0.625mg+安宫黄体酮2mg+钙尔奇D1g/d,B组给予倍美力0.3mg+安宫黄体酮2mg+钙尔奇D1g/d,C组给予安慰剂+钙尔奇D1g/d,均连续用药2年。在用药前、用药后6个月、12个月、24个月分别测定血骨钙素(BGP)、碱性磷酸酶(BAP)、I型羧基末端终肽(CICP)、比林二酚(Pyd)、尿钙(Ca)、肌酐(Cr)、IL-6;行双光子(DEXA)测定骨密度(BMD),并超声测定子宫内膜及钼靶摄片了解乳房情况。结果:①与未绝经组比,绝经后血清E2、BGP、BMD值下降(P<0.05),血FSH、LH,尿Pyd/Cr、Ca/Cr比值增高(P<0.05)。②3组对象用药后3个月,骨痛均有不同程度改善;A组和B组用药后1年骨密度有明显提高,而C组在1年后骨密度呈下降趋势。3组对象治疗过程中均未发现子宫内膜的异常增厚。用药6个月时骨代谢生化指标及血清IL-6水平就有显著下降。结论:绝经后妇女中,小剂量雌、孕激素加钙剂能防治骨质疏松症的发生。

Treatment of Postmenopause Osteoporosis Women with Low Dose Estrogen

Objective:To study the effects of prevention and treatment in postmenopausal osteoporosis with low dose hormone replacement therapy.Methods:Sixty-nine postmenopausal women were divided into three groups(n=46 per group):Group A to receive daily oral conjugated estroge(Premarin 0.625 mg)in combination with medroxyprogesterone acetate and calcium carbonate(1 g/d);group B to receive daily oral conjugated estrogen(Premarin 0.3 mg)in combination with medroxyprogesterone acetate and calcium carbonate(1g/d);group C to receive placebo and calcium carbonate(1g/d)for two years.We observed bone mineral density.biochemical markers and LI-6,We also followed up endometrium thickness and breast.Examinations were scheduled to be performed pre-therapy and after 6,12,18,24 months of therapy.Results:Bone mineral density of group Aand B increased significantly one year after treatment.Bone mineral density of group C decreased in one year No endometrial hyperplasia was observed in any of the three groups.The biochemical markers decreased at 6 months and remained low thereafter.We also observed a similar decrease in serum levels of IL-6.Conclusion:Lower-dose HRT are effective in long-tem prevention of postmenopausal osteoporosis.and prevents endometrium hyperplasia and decrease the vaginal bleeding rate.