Amaç:Yaşlı osteoporozlu kişilerde özellikle de postmenopozal kadınlarda kemik kırık riski daha yüksektir.Raloksifen postmenopozal osteoporozun önlenmesinde ve tedavisinde kullanılan selektif östrojen reseptörmodülatörüdür. Kalsitonin kemik rezorpsiyonunu inhibe eder ve osteoporozlu bireylerde kullanım için önerilir.Bu çalışma postmenopozal osteoporozda raloksifen ve kalsitonin tedavilerinin etkilerini araştırmak ve kemikmineral yoğunluğu (KMY) değerlerini kıyaslamak için planlandı.Yöntem:Bu amaçla çalışmaya 44 postmenopozal osteoporozlu (raloksifen grubu: 22, kalsitonin grubu: 22) hastaalındı. Hastalar rastgele olarak iki gruba ayrıldı. Hastalarda lomber omurganın ve sol femur proksimalininKMY'u dual energy X-ray absorptiometry kullanılarak tedavi öncesi ve tedavinin birinci yılı sonunda olmaküzere iki kez ölçüldü. Birinci gruba günde 60 mg raloksifen verilirken, ikinci gruba kalsitonin 200 IU/ gün nazalolarak verildi.Bulgular:Bu tedaviler sonrası lomber omurgada raloksifenle (p=0.011) ve kalsitoninle (p=0.008) istatistikselolarak belirgin bir düzelme saptanırken, femur KMYölçümlerinde her iki grupta birinci yılın sonunda anlamlı biriyileşme saptanmadı (p>0.05). Gruplar arası kıyaslamalarda ise KMY iyileşmesi açısından bir farklılıkbulunmadı (p>0.05).Sonuç: Postmenopozal osteoporozlu hastalarda raloksifen ve kalsitonin tedavileri bir yılın sonunda trabekülerkemikte belirgin olarak iyileşme sağlarken kortikal kemikte değişiklik gözlenmedi
1. NIH Consensus Development Panel on Osteoporosis
Prevention, Diagnosis, and Therapy. Osteoporosis
prevention, diagnosis, and therapy. JAMA 2001;285:
785-95.
2. Kanis JA. Assessment of fracture risk and its
application to screening for postmenopausal
osteoporosis: synopsis of a WHO report. WHO Study
Group. Osteoporos Int 1994;4:368-81.
3. Siris ES, Miller PD, Barrett-Connor E, Faulkner KG,
Wehren LE, Abbott TA, Berger ML, Santora AC,
Sherwood LM. Identification and fracture outcomes of
undiagnosed low bone mineral density in
postmenopausal women: results from the National
Osteoporosis Risk Assessment. JAMA 2001;286:
2815-22.
4. Lindsay R, Cosman F. The pharmacology of estrogens
in osteoporosis. In: Bilezikian JP,Raisz LG, Rodan GA,
editors. Principles of bone biology.Academic Pres, San
Diego, 1996:10638.
5. Fleisch H. Bisphosphonates: mechanisms of action and
clinical use. In: Bilezikian JP, Raisz LG, Rodan GA,
editors. Principles of bone biology.Academic Pres, San
Diego, 1996:103752.
6. Azria M, Avioli L. Calcitonin. In: Bilezikian JP, Raisz
LG, Rodan GA, editors. Principles of bone biology.
Academic Pres, San Diego, 1996:108398.
7. Fogelman I, Ribot C, Smith R, Ethgen D, Sod E,
Reginster JY. Risedronate reverses bone loss in
postmenopausal women with low bone mass: results
from a multinational, double-blind, placebocontrolled
trial. BMD-MN Study Group. J Clin Endocrinol Metab
2000;85:1895900.
8. Rosen CJ, Chesnut CH III, Mallinak NJ. The predictive
value of biochemical markers of bone turnover for bone
mineral density in early postmenopausal women
treated with hormone replacement or calcium
supplementation. J Clin Endocrinol Metab
1997;82:190410.
9. Delmas PD. Treatment of postmenopausal
osteoporosis. Lancet 2002: 8;359:2018-26.
10. Love RR, Mazess RB, Barden HS, Epstein S,
Newcomb PA, Jordan VC, Carbone PP, DeMets DL.
Effects of tamoxifen on bone mineral density in
postmenopausal women with breast cancer. N Engl J
Med 1992;326 85256.
11. Grey AB, Stapleton JP, Evans MC, Tatnell MA, Ames
RW, Reid IR. The effect of the antiestrogen tamoxifen
on bone mineral density in normal late postmenopausal
women.Am J Med 1995;99 63641.
12. Delmas PD, Balena R, Confravreux E, Hardouin C,
Hardy P, Bremond A. Bisphosphonate risedronate
prevents bone loss in women with artificial menopause
due to chemotherapy of breast cancer: a doubleblind,
placebo-controlled study. J Clin Oncol 1997;15 95562.
13. Fisher B, Costantino JP, Redmond CK, Fisher ER,
Wickerham DL, Cronin WM. Endometrial cancer in
tamoxifen-treated breast cancer patients: findings from
the National Surgical Adjuvant Breast and Bowel
Project (NSABP) B-14. J Natl Cancer Inst
1994;86 52737.
14. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK,
Nickelsen T, Genant HK, Christiansen C, Delmas PD,
Zanchetta JR, Stakkestad J, Gluer CC, Krueger K,
Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P,
Cummings SR. Reduction of vertebral fracture risk in
postmenopausal women with osteoporosis treated with
raloxifene: results from a 3-year randomized clinical
trial. Multiple Outcomes of Raloxifene Evaluation
(MORE) Investigators. JAMA1999;282(7):637-45.
15. Chesnut CH 3rd, Silverman S, Andriano K, Genant H,
Gimona A, Harris S, Kiel D, LeBoff M, Maricic M,
Miller P, Moniz C, Peacock M, Richardson P, Watts N,
Baylink D. A randomized trial of nasal spray salmon
calcitonin in postmenopausal women with established
osteoporosis: the prevent recurrence of osteoporotic
fractures study. PROOF Study Group. Am J Med
2000;109 26776.
16. Reginster JY, Deroisy R, Lecart MP, Sarlet N, Zegels B,
Jupsin I, de Longueville M, Franchimont P et al. A
double-blind, placebocontrolled, dose-finding trial of
intermittent nasal salmon calcitonin for prevention of
postmenopausal lumbar spine bone loss. Am J Med1995;98 45258.
17. Overgaard K, Riis BJ, Christiansen C, Hansen MA.
Effect of salcatonin given intranasally on early
postmenopausal bone loss. BMJ 1989;299 47779.
18. Overgaard K, Hansen MA, Jensen SB, Christiansen C.
Effect of salcatonin given intranasally on bone mass
and fracture rates in established osteoporosis: a doseresponse study. BMJ 1992;305 55661
One Year Results of Raloxifene and Calcitonin Treatments in Postmenopausal Osteoporosis
Year 2006,
Volume: 7 Issue: 1, 15 - 18, 01.04.2006
Objective: The risk of bone fractures is higher in osteoporotic elderly people, particularly in postmenopausal women. Raloxifene is the only selective estrogen receptor modulator that has been approved for the prevention and treatment of postmenopausal osteoporosis. Calcitonin inhibits bone resorption and is recommended for use in women with osteoporosis. This study was performed to investigate the effects of raloxifene and calcitonin treatments in postmenopausal osteoporosis by comparison of the respective bone mineral density (BMD) values. Materials and methods: Forty four women with postmenopausal osteoporosis (raloxifene: 22 , calcitonin :22) were enrolled in this study. Patients were divided into two groups randomly. BMD was measured twice in the lumbar spine and left proximal femur before treatment and at the end of one year by using dual energy X-ray absorptiometry. Raloxifene was administered at a dose of 60 mg/day to the first group; calcitonin was given 200IU per day as a nasal spray. Results: Although statistically significant improvement was found in the lumbar spine with raloxifene (p=0.011) and calcitonin (p=0.008) treatments, no improvement was determined in femur BMD (p>0.05) level at end of the first year. Statistical difference was not observed between two groups (p>0.05). Conclusion: While significant improvement was produced in trabecular bone with raloxifen and calcitonin treatments at the end of one year, no change was observed in cortical bone by the two treatments.
1. NIH Consensus Development Panel on Osteoporosis
Prevention, Diagnosis, and Therapy. Osteoporosis
prevention, diagnosis, and therapy. JAMA 2001;285:
785-95.
2. Kanis JA. Assessment of fracture risk and its
application to screening for postmenopausal
osteoporosis: synopsis of a WHO report. WHO Study
Group. Osteoporos Int 1994;4:368-81.
3. Siris ES, Miller PD, Barrett-Connor E, Faulkner KG,
Wehren LE, Abbott TA, Berger ML, Santora AC,
Sherwood LM. Identification and fracture outcomes of
undiagnosed low bone mineral density in
postmenopausal women: results from the National
Osteoporosis Risk Assessment. JAMA 2001;286:
2815-22.
4. Lindsay R, Cosman F. The pharmacology of estrogens
in osteoporosis. In: Bilezikian JP,Raisz LG, Rodan GA,
editors. Principles of bone biology.Academic Pres, San
Diego, 1996:10638.
5. Fleisch H. Bisphosphonates: mechanisms of action and
clinical use. In: Bilezikian JP, Raisz LG, Rodan GA,
editors. Principles of bone biology.Academic Pres, San
Diego, 1996:103752.
6. Azria M, Avioli L. Calcitonin. In: Bilezikian JP, Raisz
LG, Rodan GA, editors. Principles of bone biology.
Academic Pres, San Diego, 1996:108398.
7. Fogelman I, Ribot C, Smith R, Ethgen D, Sod E,
Reginster JY. Risedronate reverses bone loss in
postmenopausal women with low bone mass: results
from a multinational, double-blind, placebocontrolled
trial. BMD-MN Study Group. J Clin Endocrinol Metab
2000;85:1895900.
8. Rosen CJ, Chesnut CH III, Mallinak NJ. The predictive
value of biochemical markers of bone turnover for bone
mineral density in early postmenopausal women
treated with hormone replacement or calcium
supplementation. J Clin Endocrinol Metab
1997;82:190410.
9. Delmas PD. Treatment of postmenopausal
osteoporosis. Lancet 2002: 8;359:2018-26.
10. Love RR, Mazess RB, Barden HS, Epstein S,
Newcomb PA, Jordan VC, Carbone PP, DeMets DL.
Effects of tamoxifen on bone mineral density in
postmenopausal women with breast cancer. N Engl J
Med 1992;326 85256.
11. Grey AB, Stapleton JP, Evans MC, Tatnell MA, Ames
RW, Reid IR. The effect of the antiestrogen tamoxifen
on bone mineral density in normal late postmenopausal
women.Am J Med 1995;99 63641.
12. Delmas PD, Balena R, Confravreux E, Hardouin C,
Hardy P, Bremond A. Bisphosphonate risedronate
prevents bone loss in women with artificial menopause
due to chemotherapy of breast cancer: a doubleblind,
placebo-controlled study. J Clin Oncol 1997;15 95562.
13. Fisher B, Costantino JP, Redmond CK, Fisher ER,
Wickerham DL, Cronin WM. Endometrial cancer in
tamoxifen-treated breast cancer patients: findings from
the National Surgical Adjuvant Breast and Bowel
Project (NSABP) B-14. J Natl Cancer Inst
1994;86 52737.
14. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK,
Nickelsen T, Genant HK, Christiansen C, Delmas PD,
Zanchetta JR, Stakkestad J, Gluer CC, Krueger K,
Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P,
Cummings SR. Reduction of vertebral fracture risk in
postmenopausal women with osteoporosis treated with
raloxifene: results from a 3-year randomized clinical
trial. Multiple Outcomes of Raloxifene Evaluation
(MORE) Investigators. JAMA1999;282(7):637-45.
15. Chesnut CH 3rd, Silverman S, Andriano K, Genant H,
Gimona A, Harris S, Kiel D, LeBoff M, Maricic M,
Miller P, Moniz C, Peacock M, Richardson P, Watts N,
Baylink D. A randomized trial of nasal spray salmon
calcitonin in postmenopausal women with established
osteoporosis: the prevent recurrence of osteoporotic
fractures study. PROOF Study Group. Am J Med
2000;109 26776.
16. Reginster JY, Deroisy R, Lecart MP, Sarlet N, Zegels B,
Jupsin I, de Longueville M, Franchimont P et al. A
double-blind, placebocontrolled, dose-finding trial of
intermittent nasal salmon calcitonin for prevention of
postmenopausal lumbar spine bone loss. Am J Med1995;98 45258.
17. Overgaard K, Riis BJ, Christiansen C, Hansen MA.
Effect of salcatonin given intranasally on early
postmenopausal bone loss. BMJ 1989;299 47779.
18. Overgaard K, Hansen MA, Jensen SB, Christiansen C.
Effect of salcatonin given intranasally on bone mass
and fracture rates in established osteoporosis: a doseresponse study. BMJ 1992;305 55661
Gürer G, Şendur ÖF, Aydeniz A, Aydemir AH (April 1, 2006) One Year Results of Raloxifene and Calcitonin Treatments in Postmenopausal Osteoporosis. Meandros Medical And Dental Journal 7 1 15–18.