Journal of Menopausal Medicine

The Korean Society of Menopause (대한폐경학회)
권호 표지

Comparison of the Effects of Hormone Replacement Therapy on Bone Mineral Density, Lipid Profiles, and Biochemical Markers of Bone Metabolism

폐경 여성에서 호르몬 치료에 따른 골밀도, 혈중 지질 농도 및 생화학적 골표지자 변화의 비교

  • NamKung, Jeong (Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine) ;
  • Kim, Jang-Heub (Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine) ;
  • Jo, Hyun-Hee (Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine) ;
  • Oh, Eun-Kyeong (Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine) ;
  • Cheon, Keun-Young (Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine) ;
  • Kwon, Dong-Jin (Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine) ;
  • Lew, Young-Ok (Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine) ;
  • Kim, Eun-Jung (Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine) ;
  • Hwang, Seong-Jin (Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine) ;
  • Song, Jae-Yen (Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine) ;
  • Kim, Min-Joung (Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine) ;
  • Kim, Mee-Ran (Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine)
  • 남궁정 (가톨릭대학교 의과대학 산부인과학교실) ;
  • 김장흡 (가톨릭대학교 의과대학 산부인과학교실) ;
  • 조현희 (가톨릭대학교 의과대학 산부인과학교실) ;
  • 오은경 (가톨릭대학교 의과대학 산부인과학교실) ;
  • 천근영 (가톨릭대학교 의과대학 산부인과학교실) ;
  • 권동진 (가톨릭대학교 의과대학 산부인과학교실) ;
  • 유영옥 (가톨릭대학교 의과대학 산부인과학교실) ;
  • 김은중 (가톨릭대학교 의과대학 산부인과학교실) ;
  • 황성진 (가톨릭대학교 의과대학 산부인과학교실) ;
  • 송재연 (가톨릭대학교 의과대학 산부인과학교실) ;
  • 김민정 (가톨릭대학교 의과대학 산부인과학교실) ;
  • 김미란 (가톨릭대학교 의과대학 산부인과학교실)
  • Published : 2010.08.31
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Abstract

Objectives: To assess the effects of hormone replacement therapy on bone mineral density (BMD), biochemical markers of bone turnover, and lipid profiles in postmenopausal women. Methods: We retrospectively reviewed the medical records of 199 postmenopausal women who had received care at the Department of Obstetrics and Gynecology of Catholic University Seoul St. Mary's Hospital between January 1994 and December 2008. The patients were divided into the following three groups: group 1 received combined estrogen and progesterone therapy (n = 91); group 2 received estrogen only (n = 65); and group 3 received tibolone (n = 43). We compared the changes in biochemical markers of bone turnover, lipid profiles, and BMD during therapy. Results: The BMD of the lumbar spine increased in groups 1 and 3 by 2.0% and 1.2%, respectively, and the BMD of the total femur increased in groups 1 and 2 by 2.3% and 0.5% from the initial values after 3 years, respectively. However, the BMD of the femoral neck and total femur decreased significantly in group 3 by 4.8% and 1.9%, respectively, 3 years after treatment initiation (P < 0.05). Serum osteocalcin and urinary deoxypyridinoline decreased in all groups 1 year after treatment. In groups 1 and 3, the total cholesterol level decreased and the triglycerides level increased. However, there were no definite changes in the total cholesterol and triglycerides levels in group 2. The high density lipoprotein cholesterol (HDL)-cholesterol level increased in groups 1 and 2, but decreased in group 3. As a result, the BMD of the lumbar spine increased and the total cholesterol level decreased in the combined therapy and tibolone groups. Tibolone had no beneficial effect on the BMD of the femoral neck. Conclusion: Our results suggest that each therapy has different effects on BMD, biochemical markers of bone metabolism, and lipid profiles. A prospective study involving a larger group, and considering multiple factors, will be required to obtain more clinically meaningful conclusions.

연구목적: 폐경 여성에서 에스트로겐, 에스트로겐-프로게스테론 병합, 티볼론 사용 시의 골밀도, 생화학적 골표지자 및 혈청 지질 농도 변화를 보고자 하였다. 연구재료 및 방법: 1994년 1월부터 2008년 12월까지 가톨릭대학교 서울성모병원 (구(舊) 강남성모병원) 산부인과 외래를 방문한 폐경 여성 199명을 대상으로 의무기록을 바탕으로 후향적으로 연구하였다. 모든 환자는 평균 3년 이상 호르몬 치료를 시행하였으며 치료 1군 (91명)은 에스트로겐과 프로게스테론을 병합 투여한 군, 치료 2군 (65명)은 에스트로겐 단독 투여한 군, 치료 3군 (43명)은 티볼론을 투여한 군으로 나누어 분류하였다. 호르몬 치료를 시작하기 전, 치료 후 매 1년마다 골밀도 및 혈청 지질 농도 (혈중 총 콜레스테롤, 저밀도 지단백, 고밀도 지단백, 중성지방), 생화학적 골표지자 (biochemical markers of bone turnover)의 농도를 측정하였다. 결 과: 치료 3년 후 1군과 3군에서 척추 골밀도는 각각 2.0%, 1.2% 증가하였다. 그러나 치료 3군에서 대퇴골 전체 및 경부 골밀도가 각각 1.9%, 4.8% 통계적으로 유의하게 감소하였다 (P < 0.05). 모든 군에서 치료 1년 후 혈중 osteocalcin과 요중 deoxypyridinoline은 감소하였다. 치료 2년 후 1군과 3군에서 총 콜레스테롤은 감소하고 중성 지방은 증가하였으며, 2군에서는 총 콜레스테롤의 큰 변화는 없었으나 중성지방은 감소하였다. 고밀도 지단백은 1군과 2군에서 모두 증가하였으나 3군에서는 감소하였다. 결과적으로 에스트로겐과 프로게스테론 병합 요법군과 티볼론군에서 척추 골밀도 증가와 총 콜레스테롤 감소 효과를 나타내었으나, 티볼론의 경우 대퇴골 골밀도에는 유익하지 않은 것으로 나타났고, 고밀도 지단백이 감소되는 결과를 보였다. 결론: 폐경 후 여성에서 에스트로겐과 프로게스테론 병합, 에스트로겐 단독 및 티볼론 사용시의 골밀도 및 혈청지질 농도 변화가 각각 다르게 나타났으나, 좀 더 대규모의 전향적인 연구가 필요하다.

Keywords

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