Postmenopozal Kadınlarda Hormon Tedavisi, Raloksifen ve Tibolonun Osteoporoz ile Meme ve Endometrium Üzerindeki Etkilerinin İncelenmesi

Abstract

Amaç: Postmenopozal osteoporozlu kadınlarda üç farklı ilacın osteoporoz üzerindeki etkinliği ile tedavi sürecinde meme ve endometriyumdaki değişimlerin incelenmesi amaçlanmıştır. Yöntem: Çalışmamıza Dicle Üniversitesi Tıp Fakültesi Aile Hekimliği Polikliniğine 01 Ocak 2006-31 Aralık 2007 tarihleri arasında başvuran postmenopozal dönemde osteoporoz veya osteopenisi bulunan 72 kadından takip sürecini tamamlayan 31 hasta retrospektif kohort olarak incelendi. Çalışmada, açık ve kapalı uçlu sorular ile hazırlanmış anket yüzyüze görüşme tekniği ile uygulandı. Hastaların tedavi modaliteleri Kadın Doğum ve Fizik Tedavi uzman konsültasyonları ile yürütülmüştür. İlk taramadan 12 ay sonra olgular yeniden değerlendirilerek, hastalarda kemik mineral yoğunlukları (KMY) ile endometriyum ve meme dokusundaki değişiklikler incelendi. Bulgular: 31 hastanın beşi (%16) hormon replasman tedavisi (HT), dokuzu (%29) raloksifen (RLX), 17’si (%55) Tibolon (TIB) aldı. Hastaların yaş ortalamaları, 54.7±8.1; ortalama menopoz yaşları 44.2±6.0 yıldır. Tedavi öncesi 31 hastanın 17’si (%55) osteopenik, 14’ü (%45) osteoporotikti. Tedavi sonrası ise altı (%19) hastanın DEXA sonuçları normal sınırlar içine geriledi. Tedavi öncesi ve sonrası L2-4 T skorları karşılaştırıldığında, her üç tedavinin de istatistiksel olarak anlamlı düzeyde etkin iyileşme gösterdiği saptanmıştır (p=0.001). Tedavi öncesi ve sonrasında çalışmamızda endometrium kalınlığı (EK) ve meme dokusunda anlamlı bir farklılık saptanmamıştır (p>0.05). Sonuç: Her üç osteoporoz tedavisi KMY’de istatistiksel olarak anlamlı iyileşme göstermiştir. Her üç ilaç tedavisinin de endometrium ve meme dokusunda anlamlı bir değişiklik oluşturmadığı saptanmıştır. Ancak çalışmamızın sonuçlarının bir yıllık bir periyodu kapsaması nedeniyle, uzun süreli izlem çalışmalarına gereksinim olduğu düşünülmektedir

Keywords

• Menopoz, osteoporoz, meme, endometriyum

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