POSTMENOPOZAL OSTEOPOROZDA RALOKSİFEN VE KALSİTONİN TEDAVİLERİNİN BİR YILLIK SONUÇLARI

Year 2006, Volume: 7 Issue: 1, 15 - 18, 01.04.2006

Gülcan Gürer Ömer Faruk Şendur Ali Aydeniz Ali Hakan Aydemir

Abstract

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

Keywords

Postmenopozal osteoporoz, kalsitonin, raloksifen

One Year Results of Raloxifene and Calcitonin Treatments in Postmenopausal Osteoporosis

Abstract

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.

Keywords

Postmenopausal osteoporosis, calcitonin, raloxifene

References

• 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 dose￾response study. BMJ 1992;305 55661