Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis?

被引:102
作者
Rozenberg, S. [1 ]
Al-Daghri, N. [2 ]
Aubertin-Leheudre, M. [3 ]
Brandi, M. -L. [4 ,5 ]
Cano, A. [6 ,7 ]
Collins, P. [8 ,9 ]
Cooper, C. [10 ,11 ,12 ,13 ]
Genazzani, A. R. [14 ]
Hillard, T. [15 ]
Kanis, J. A. [16 ,17 ]
Kaufman, J. -M. [18 ]
Lambrinoudaki, I. [19 ]
Laslop, A. [20 ]
McCloskey, E. [21 ]
Palacios, S. [22 ]
Prieto-Alhambra, D. [23 ]
Reginster, J. -Y. [24 ,25 ]
Rizzoli, R. [26 ,27 ]
Rosano, G. [28 ]
Tremollieres, F. [29 ,30 ]
Harvey, N. C. [10 ,11 ,12 ]
机构
[1] Vrije Univ, Univ Libre Bruxelles, CHU St Pierre, Dept Obstet & Gynecol, Brussels, Belgium
[2] King Saud Univ, Coll Sci, Chair Biomarkers Chron Dis, Dept Biochem, Riyadh, Saudi Arabia
[3] Univ Quebec, CRIUGM, Fac Sci, Dept Phys Act Sci, Montreal, PQ, Canada
[4] Univ Florence, Dept Biochem Expt & Clin Sci, Florence, Italy
[5] Univ Hosp Florence, Unit Bone & Mineral Dis, Florence, Italy
[6] Univ Valencia, Dept Obstet & Gynecol, Valencia, Spain
[7] INCLIVA Hlth Res Inst, Valencia, Spain
[8] Imperial Coll London, Natl Heart & Lung Inst, London, England
[9] Royal Brompton Hosp, Royal Brompton Campus,Sydney St, London, England
[10] Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England
[11] Univ Southampton, NIHR Southampton Biomed Res Ctr, Tremona Rd, Southampton, Hants, England
[12] Univ Hosp Southampton NHS Fdn Trust, Tremona Rd, Southampton, Hants, England
[13] Univ Oxford, NIHR Oxford Biomed Res Ctr, Oxford, England
[14] Univ Pisa, Dept Clin & Expt Med, Div Obstet & Gynecol, Pisa, Italy
[15] Poole Hosp NHS Trust, Dept Obstet & Gynaecol, Poole, Dorset, England
[16] Australian Catholic Univ, Mary McKillop Inst Hlth Res, Melbourne, Vic, Australia
[17] Univ Sheffield, Ctr Metab Bone Dis, Sch Med, Sheffield, S Yorkshire, England
[18] Ghent Univ Hosp, Dept Endocrinol, Ghent, Belgium
[19] Natl & Kapodistrian Univ Athens, Dept Obstet & Gynecol 2, Sch Med, Menopause Unit, Athens, Greece
[20] Fed Off Safety Hlth Care, Sci Off, Vienna, Austria
[21] Univ Sheffield, Dept Oncol & Metab, Mellanby Ctr Bone Res, Ctr Integrated Res Musculoskeletal Ageing, Sheffield, S Yorkshire, England
[22] Palacios Inst Womens Hlth, Madrid, Spain
[23] Univ Oxford, Nuffield Dept Orthopaed Rheumatol & Musculoskelet, Ctr Stat Med, Oxford, England
[24] Univ Liege, Div Publ Hlth Epidemiol & Hlth Econ, WHO Collaborating Ctr Publ Hlth Aspects Musculosk, Liege, Belgium
[25] King Saud Univ, Dept Biochem, Chair Biomarkers Chron Dis, Coll Sci, Riyadh, Saudi Arabia
[26] Geneva Univ Hosp, Div Bone Dis, Geneva, Switzerland
[27] Fac Med, Geneva, Switzerland
[28] IRCCS San Raffaele, Rome, Italy
[29] Univ Hosp Toulouse, Hop Paule Viguier, Menopause Ctr, Toulouse, France
[30] INSERM, U1048 I2MC Equipe 9, Toulouse, France
关键词
Cardiovascular; Epidemiology; Hormone therapy; Menopause; Osteoporosis; Safety; ESTROGEN PLUS PROGESTIN; CORONARY-HEART-DISEASE; REPLACEMENT THERAPY; COST-EFFECTIVENESS; HEALTH OUTCOMES; HIP FRACTURE; WOMEN; RISK; ATHEROSCLEROSIS; PREVENTION;
D O I
10.1007/s00198-020-05497-8
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We provide an evidence base and guidance for the use of menopausal hormone therapy (MHT) for the maintenance of skeletal health and prevention of future fractures in recently menopausal women. Despite controversy over associated side effects, which has limited its use in recent decades, the potential role for MHT soon after menopause in the management of postmenopausal osteoporosis is increasingly recognized. We present a narrative review of the benefits versus risks of using MHT in the management of postmenopausal osteoporosis. Current literature suggests robust anti-fracture efficacy of MHT in patients unselected for low BMD, regardless of concomitant use with progestogens, but with limited evidence of persisting skeletal benefits following cessation of therapy. Side effects include cardiovascular events, thromboembolic disease, stroke and breast cancer, but the benefit-risk profile differs according to the use of opposed versus unopposed oestrogens, type of oestrogen/progestogen, dose and route of delivery and, for cardiovascular events, timing of MHT use. Overall, the benefit-risk profile supports MHT treatment in women who have recently (< 10 years) become menopausal, who have menopausal symptoms and who are less than 60 years old, with a low baseline risk for adverse events. MHT should be considered as an option for the maintenance of skeletal health in women, specifically as an additional benefit in the context of treatment of menopausal symptoms, when commenced at the menopause, or shortly thereafter, in the context of a personalized benefit-risk evaluation.
引用
收藏
页码:2271 / 2286
页数:16
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