Hormone Replacement Therapy Versus the Combined Oral Contraceptive Pill in Premature Ovarian Failure: A Randomized Controlled Trial of the Effects on Bone Mineral Density
Hormone Replacement Therapy Versus the Combined Oral Contraceptive Pill in Premature Ovarian Failure: A Randomized Controlled Trial of the Effects on Bone Mineral Density
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DOI：
10.1210/jc.2015-4063
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发表时间：
2016-09-01
影响因子：
5.8
通讯作者：
Rymer, Janice
中科院分区：
文献类型：
--
作者：
Cartwright, Beth;Robinson, Jillian;Rymer, Janice
背景：卵巢早衰（POF）的妇女面临多年的雌激素缺乏。主要后果之一是骨质流失。雌激素替代的最佳形式是未知的，管理是没有证据的。两个广泛的选择是联合激素替代疗法（HRT）或联合口服避孕药（COCP）。目的：比较HRT和COCP对自发性POF妇女骨密度和骨转换的影响，并观察不治疗的效果。设计：为期两年的开放随机试验，比较HRT和COCP，并对使用相同方案的妇女进行非随机观察。设置：伦敦教学医院。参与者：共59名年龄在18-44岁的自发性POF妇女，30名妇女选择接受治疗并随机分组，29名妇女拒绝治疗。干预：随机分组为HRT（Nuvelle）或COCP（Microgynon 30）。主要结果测量：主要结果是腰椎骨密度的变化。总髋关节和股骨颈骨密度和骨转换标记物的变化也assessed.Results：共36名妇女（61%）完成了试验（无治疗52%; HRT 60%; COCP 80%）。与COCP相比，HRT治疗2年后腰椎骨密度增加（+0.050 g/cm（2）; 95%置信区间0.007-0.092; P = .025）。两个治疗组的骨转换标志物显示相似的降低。在没有治疗组，骨密度下降，在所有网站和骨转换标志物保持相对不变。结论：结果表明，HRT是上级COCP在增加骨密度在腰椎自发性POF的妇女。样本量小和高脱落率的局限性意味着需要进一步的研究来证实这些发现。然而，任何一种治疗都明显上级不治疗。
Context: Women with premature ovarian failure (POF) face many years of estrogen deficiency. One of the major consequences is bone loss. The optimal form of estrogen replacement is unknown and management is not evidence based. The 2 broad options are combined hormone replacement therapy (HRT) or the combined oral contraceptive pill (COCP).Objectives: To compare the effects of HRT and COCP on bone density and turnover in women with spontaneous POF and to observe the effects of no treatment.Design: Two-year open randomized trial comparing HRT and COCP and nonrandomized observation of women declining treatment using the same protocol.Setting: London teaching hospital.Participants: A total of 59 women with spontaneous POF aged 18-44, 30 women elected to take treatment and were randomized, and 29 declined treatment.Intervention: Randomization was to HRT (Nuvelle) or COCP (Microgynon 30).Main Outcome Measures: The primary outcome was change in lumbar spine bone mineral density. Changes in total hip and femoral neck bone density and bone turnover markers were also assessed.Results: A total of 36 women (61%) completed the trial (no treatment 52%; HRT 60%; COCP 80%). In comparison with COCP, treatment with HRT increased bone density at the lumbar spine at 2 years (+0.050 g/cm(2); 95% confidence interval 0.007-0.092; P = .025). Bone turnover markers showed similar reductions in the 2 treatment groups. In the no treatment group, bone density dropped at all sites and bone turnover markers remained relatively unchanged.Conclusions: The results suggest that HRT is superior to COCP in increasing bone density at the lumbar spine in women with spontaneous POF. The limitations of a small sample size and high drop-out rate mean that further research is required to confirm the findings. However, either treatment is clearly superior to no treatment.