臨床婦人科産科70巻11号

2016年11月発行

今月の臨床 骨粗鬆症の最新トピックス─ガイドラインの大幅改訂を迎えて 治療

エストロゲン製剤

著者： 松下宏¹ 若槻明彦¹

所属機関： ¹愛知医科大学医学部産婦人科学講座

ページ範囲：P.1030 - P.1035

●エストロゲンは骨吸収を抑制し，BMDを増加させる．

●エストロゲン製剤は高い骨折予防効果をもつ．

●CEEの骨折抑制効果は骨量減少女性や健常女性でも認められ，また60歳以下の女性で高い．

参考文献

1）Reifenstein EC, et al : The metabolic effects of steroid hormones in osteoporosis. J Clin Invest 26 : 24─56, 1947

2）Rossouw JE, et al : Risks and benefits of estrogen plus progestin in healthy postmenopausal women : principal results from the Women's Health Initiative randomized controlled trial. JAMA 288 : 321─333, 2002

3）Reid IR : Menopause. Primer on the metabolic bone disease and disorders of mineral metabolism, 8th ed（Rosen CJ, et al eds）. pp165─169. John Wiley＆Sons, Hoboken, NJ, 2013

4）加藤茂明 : 核受容体を介した女性ホルモンの分子作用機序．O.li.v.e. 3 : 58─62, 2013

5）Eghbali-Fatourechi G, et al : Role of RANK ligand in mediating increased bone resorption in early postmenopausal women. J Clin Invest 111 : 1221─1230, 2003

6）Bell NH : RANK ligand and the regulation of skeletal remodeling. J Clin Invest 111 : 1120─1122, 2003

7）Pacifici R : T cells : critical bone regulators in health and disease. Bone 47 : 461─471, 2010

8）The Writing Group for the PEPI : Effects of hormone therapy on bone mineral density : results from the postmenopausal estrogen/progestin interventions（PEPI） trial. JAMA 276 : 1389─1396, 1996

9）Dören M, et al : Effects of specific post-menopausal hormone therapies on bone mineral density in post-menopausal women : a meta-analysis. Hum Reprod 18 : 1737─1746, 2003

10）Torgerson DJ, et al : Hormone replacement therapy and prevention of nonvertebral fractures : a meta-analysis of randomized trials. JAMA 285 : 2891─2897, 2001

11）Siris ES, et al : Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 164 : 1108─1112, 2004

12）Stevenson JC : HRT, osteoporosis and regulatory authorities Quis custodiet ipsos custodes? Hum Reprod 21 : 1668─1671, 2006

13）折茂　肇 : 女性ホルモン薬．骨粗鬆症の予防と治療ガイドライン2015年版（骨粗鬆症の予防と治療ガイドライン作成委員会 編）．pp88─89，ライフサイエンス出版，2015

14）Lindsay R, et al : Effect of lower doses of conjugated equine estrogens with and without medroxyprogesterone acetate on bone in early postmenopausal women. JAMA 287 : 2668─2676, 2002

15）Mizunuma H, et al : Dose effects of oral estradiol on bone mineral density in Japanese women with osteoporosis. Climacteric 13 : 72─83, 2010

16）Anderson GL, et al : Effects of conjugated equine estrogen in postmenopausal women with hysterectomy : the Women's Health Initiative randomized controlled trial. JAMA 291 : 1701─1712, 2004

17）Fournier A, et al : Unequal risks for breast cancer associated with different hormone replacement therapies : results from the E3N cohort study. Breast Cancer Res Treat 107 : 103─111, 2008

18）Opatrny L, et al : Hormone replacement therapy use and variations in the risk of breast cancer. BJOG 115 : 169─175, 2008

19）Corrao G, et al : Menopause hormone replacement therapy and cancer risk : an Italian record linkage investigation. Ann Oncol 19 : 150─155, 2008

20）Canonico M, et al : Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women : systematic review and meta-analysis. BMJ 31 : 1227─1231, 2008

21）Jick H, et al : Risk of hospital admission for idiopathic venous thromboembolism among users of postmenopausal oestrogens. Lancet 348 : 981─983, 1996

22）Rossouw JE, et al : Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 297 : 1465─1477, 2007

23）De Villiers TJ, et al : Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric 16 : 316─337, 2013