Effect of discontinuation of estrogen, calcitriol, and the combination of both on bone density and bone markers
Effect of discontinuation of estrogen, calcitriol, and the combination of both on bone density and bone markers
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DOI：
10.1210/jc.2002-020727
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发表时间：
2002-11-01
影响因子：
5.8
通讯作者：
Detter, JR
中科院分区：
文献类型：
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作者：
Gallagher, JC;Rapuri, PB;Detter, JR
在一项为期 5 年的随机前瞻性研究中，我们检查了雌激素替代疗法/激素替代疗法 (ERT/HRT)、骨化三醇、ERTJMT 和骨化三醇或安慰剂 3 年的治疗效果，以及停止治疗 2 年以上对骨矿物质密度 (BMD)、促钙激素、骨重塑标志物和钙吸收的影响 489 名老年妇女。该研究的治疗阶段是双盲的。停止治疗2年后，所有3个治疗组均出现快速骨质流失，且BMD下降大部分发生在第一年。ERT/HRT组中，脊柱BMD在第3年增加5.5%，第4年下降3.2%，第5年下降0.7%；股骨颈 BMD 第 3 年增加 3.7%，第 4 年减少 2.5%，第 5 年减少 0.4%；全身 BMD 第 3 年增加 2.1%，第 4 年减少 1.4%，第 5 年减少 0.6%。在联合组中，脊柱 BMD 第 3 年增加 7.1%，第 4 年减少 4.3%，第 5 年减少 0.3%；股骨颈 BMD 第 3 年增加 4.5%，第 4 年减少 3.0%，第 5 年减少 0.01%；全身BMD第3年增加2.2%，第4年减少1.5%，第5年减少0.6%。在骨化三醇组中，脊柱BMD第3年增加1.8%，第4年减少1.8%，第5年没有变化；股骨颈 BMD 第 3 年增加 0.2%，第 4 年减少 0.2%，第 5 年减少 0.6%；第 3 年总体 BMD 下降 0.4%，第 4 年下降 0.6%，第 5 年下降 0.4%。与安慰剂相比，所有治疗组在第 5 年的总体 BMD 均显着升高；与安慰剂组相比，只有联合组的脊柱 BMD (3.4% P < 0.001) 和总髋部 BMD (2.4%；P < 0.01.) 显着更高。与基线相比，第 5 年时，联合组中只有脊柱 BMD 显着升高（2.6%；P < 0.001）。停止治疗后，骨化三醇组中钙吸收的增加和血清 PTH 水平的降低得到逆转，激素测试组中骨标志物的降低也得到逆转。这些结果表明，老年女性停止 ERT/HRT 和/或骨化三醇治疗会导致治疗中获得的 BMD 大部分下降；然而，在联合治疗组中，对脊柱骨密度有统计学上显着的残余影响。
In a 5-yr randomized prospective study we examined the treatment effect of estrogen replacement therapy/hormone replacement therapy (ERT/HRT), calcitriol, ERTJMT and calcitriol, or placebo for 3 yr and the effect of discontinuation of therapy for 2 more yr on bone mineral density (BMD), calciotropic hormones, markers of bone remodeling, and calcium absorption in 489 elderly women. The treatment phase of the study was double-blinded. After discontinuing therapy for 2 yr, there was rapid bone loss in all 3 treatment groups, and most of the decrease in BMD occurred in the first year.In the ERT/HRT group, spine BMD increased 5.5% in yr 3, decreased 3.2% in yr 4, and decreased 0.7% in yr 5; femoral neck BMD increased 3.7% in yr 3, decreased 2.5% in yr 4, and decreased 0.4% in yr 5; total body BMD increased 2.1% in yr 3, decreased 1.4% in yr 4, and decreased 0.6% in yr 5. In the combination group, spine BMD increased 7.1% in yr 3, decreased 4.3% in yr 4, and decreased 0.3% in yr 5; femoral neck BMD increased 4.5% in yr 3, decreased 3.0% in yr 4, and decreased 0.01% in yr 5; total body BMD increased 2.2% in yr 3, decreased 1.5% in yr 4, and decreased 0.6% in yr 5. In the calcitriol group, spine BMD increased 1.8% in yr 3, decreased 1.8% in yr 4, and showed no change in yr 5; femoral neck BMD increased 0.2% in yr 3, decreased 0.2% in yr 4, and decreased 0.6%, in yr 5; total body BMD decreased 0.4% in yr 3, decreased 0.6% in yr 4, and decreased 0.4% in yr 5. Compared with placebo, all treated groups at yr 5 had significantly higher total body BMD; only the combination group had significantly higher spine BMD (3.4% P < 0.001) and total hip BMD (2.4%; P < 0.01.) compared with the placebo group. Compared with baseline, only spine BMD in the combination group was significantly higher (2.6%; P < 0.001) at yr 5.The increase in calcium absorption and the decrease in serum PTH levels in the calcitriol groups were reversed after discontinuation of treatment, and the decrease in bone markers was reversed in the hormone-tested groups. These results suggest that discontinuation of ERT/HRT and/or calcitriol therapy in elderly women leads to a decrease in much of the BMD gained on treatment; however, in the combination group there was a statistically significant residual effect on spine BMD.