Menopausal hormone therapy and osteoporosis in midlife and postmenopausal women

doi:10.7504/fk2014040105

Abstract

Abstract:

Abstract:Osteoporosis is prevalent in midlife and postmenopausal women. It is clear that estrogen is a potent inhibitor of bone resorption. Estrogen deficiency after menopause may lead to a rapidly bone loss,therefore,the risk of osteoporosis is much higher in postmenopausal women than in men. Menopausal hormone therapy prevents from bone loss,maintain bone mass and reduce the risk of osteoporosis-related fractures. Menopausal hormone therapy is also the most effective treatment for vasomotor symptoms associated with menopause,as well as may decrease the risk of coronary heart disease and all cause mortality in women younger than 60 years of age and within 10 years of menopause. The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age,time since menopause and the risk of venous thromboembolism (VTE),stroke,ischemic heart disease and breast cancer.

Key words: osteoporosis, menopausal hormone therapy, fracture

摘要：

骨质疏松症是中老年妇女的常见病。雌激素有明确抑制骨吸收的作用。绝经后由于雌激素的缺乏，导致骨量的快速丢失，使中、老年女性患骨质疏松症的危险大大高于男性。绝经后激素治疗能有效阻止骨丢失，维持骨量，降低骨折危险。特别提倡在60岁以前或绝经10年内开始使用激素治疗。此期间启用激素治疗，除对骨骼的保护作用外，还可以明显缓解绝经症状及降低冠心病风险，获益最多，风险最小。选择绝经激素治疗，是基于生活质量、健康优先原则和个人危险因素而做的个人决策。

关键词: 骨质疏松症, 绝经激素治疗, 骨折

CLC Number:

R711

XU Ling. Menopausal hormone therapy and osteoporosis in midlife and postmenopausal women[J]. Acta Metallurgica Sinica, DOI: 10.7504/fk2014040105.

徐苓. 激素补充治疗与中老年女性骨质疏松症[J]. 中国实用妇科与产科杂志, DOI: 10.7504/fk2014040105.

References

[1］ Kanis JA，Oden A,Mc Closkey EV,et al.A systematic review of hip fracture incidence and probability of fracture worldwide[J]. Osteoporos Int,2012,23(9):2239-2256.

[2］ Dhanwal DK,Dennison EM,Harvey NC,et al.Epidemiology of hip fracture: Worldwide geographic variation［J］.Indian J Orthop,2011,45(1):15-22. 

[3］ Kanis JA,Melton L III,Christiansen C,et al. The diagnosis of osteoporosis[J]. J Bone Miner Res,1994,8:1137-1141.

[4］中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊治指南（2011年）[J].中华骨质疏松和骨矿盐疾病杂志,2011,4(1):2-17.

[5］ Kanis JA,Mc Closkey EV,Johansson H,et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women[J].Osteoporos Int,2013,24(17):23-57.

[6］ Bartl R,Frisch B. Osteoporosis: Diagnosis,Prevention,Therapy[M]. 2nd ed. Berlin,Heidelberg: Springer-Verlag,2009:119-124.

[7］ Santen RJ,Allred DC,Ardoin SP,et al. Endocrine Society. Postmenopausal hormone therapy: an Endocrine Society scientific statement[J]. J Clin Endocrinol Metab,2010,95 (7 Suppl 1):s1-s66. 

[8］路军丽,林守清,张李松,等.戊酸雌二醇与甲羟孕酮联合应用预防绝经近期低骨量妇女骨丢失的作用[J].中华医学杂志,2001,82（23）:1593-1598.

[9］ Udell JA,Fischer MA,Brookhart MA,et al. Effect of the Women's Health Initiative on Osteoporosis Therapy and Expenditure in Medicaid[J].J Bone Miner Res,2006,21(5) :765-771.

[10］ Cummings SR,Ettinger B,Delmas PD,et al. The effects of tibolone in older postmenopausal women[J]. N Engl J Med,2008,359(7):697-708.

[11］ Writing Group for Women's Health Initiative Investigators. 2002 Risks and benefits of estrogen plus progestinin healthy postmenopausal women: principal results from the women's health initiative randomized controlled trial[J].JAMA,2002,288: 321-333.

[12］ Villiiers TJD,Gass MLS,Haines CJ,et al. Global Consensus Statement on Menopausal Hormone Therapy[J]. Climacteric,2013,16: 203-204.

[13］ Villiiers TJD,Pines A,Panay N et al. Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health[J]. Climacteric,2013,16: 316-337.

[14］中华医学会妇产科分会绝经学组.绝经期管理与激素补充治疗临床应用指南（2012版）[J].中华妇产科杂志,2013,48（10）:795-799.

[1]	ZHANG Yao，MA Ying. Menopausal hormone therapy and gynecological malignancy. [J]. Acta Metallurgica Sinica, 2020, 36(3): 217-221.
[2]	PENG Hong-fa，YAN Xiao-nan. Menopausal hormone therapy and osteoporosis. [J]. Acta Metallurgica Sinica, 2020, 36(3): 230-233.
[3]	SHU Kuan-yong，DENG Wei-ping. Menopausal hormone therapy and menopausal symptoms. [J]. Acta Metallurgica Sinica, 2020, 36(3): 206-209.
[4]	LIANG Cheng，HE Jing. Cesarean section of breech presentation - the prevention of newborn fracture. [J]. Acta Metallurgica Sinica, 2019, 35(2): 151-153.
[5]	LEI Xiao-min，TAN Xin-sha. Effects of premature ovarian insufficiency on bone metabolism [J]. Acta Metallurgica Sinica, 2018, 34(3): 245-248.
[6]	GONG Li-li ，ZHANG Shao-fen，YU Qi,CHEN Rong,RUAN Xiang-yan，LIU Hong-wei，HU Li-na.. Efficacy of Estradiol Hemihydrate Patches used in 124 postmenopausal women. [J]. Acta Metallurgica Sinica, 2015, 31(6): 556-558.
[7]	. 原发性骨质疏松的共同特点为在骨代谢过程中,骨吸收和骨形成之间出现失衡，病因复杂，发病机制与遗传、内分泌紊乱、营养不均衡和废用等有关。现综述如下。 1 遗传因素家系和双胞胎研究表明骨质疏松有很强的遗传倾向。遗传因素在骨量和骨强度的获得上起重要作用。基因的多态性与骨代谢的差异有着密切的关系，并且是由多个候选基因而非单一基因共同影响的。近年来有关基因研究较多并得到人们关注的候选基因主要有维生素D受体(vitamin D receptor,VDR)基因、雌激素受体(estrogen receptor,ER)基因、Ⅰ型胶原基因及一些生长因子基因。 1. [J]. Acta Metallurgica Sinica, 2014, 30(5): 379-382.
[8]	YU Qi. More attention should be paid to menopause related osteoporosis. YU Qi [J]. Acta Metallurgica Sinica, 2014, 30(5): 321-322.
[9]	JIANG Jian-fa,SUN Ai-jun. Epidemiology,classification and diagnosis of osteoporosis in middle-aged women [J]. Acta Metallurgica Sinica, 2014, 30(5): 323-326.
[10]	ZOU Shi-En,ZHANG Shao-Fen. Phytoestrogens and osteoporosis of middle-aged and elderly women [J]. Acta Metallurgica Sinica, 2014, 30(5): 329-333.
[11]	HUANG Qi-ren. Calcium,Vitamin D and osteoporosis [J]. Acta Metallurgica Sinica, 2014, 30(5): 336-340.
[12]	TAN Yong. TCM prevention and treatment strategies of middle-aged women with osteoporosisTCM prevention and treatment strategies of middle-aged women with osteoporosis [J]. Acta Metallurgica Sinica, 2014, 30(5): 340-343.
[13]	ZOU Jun. Exercise in the treatment and prevention of osteoporosis in elderly women [J]. Acta Metallurgica Sinica, 2014, 30(5): 343-347.
[14]	MA Ying. The other treatments for osteoporosis in middle-aged and elderly women [J]. Acta Metallurgica Sinica, 2014, 30(5): 347-351.
[15]	. [J]. Acta Metallurgica Sinica, 2014, 30(5): 379-382.