应用雌激素防治绝经后骨质疏松症的问题

Prevention of postmenopausal osteoporosis with HRT or ERT

绝经后骨质疏松症的主要病因是雌激素降低,补充雌激素可以预防骨质疏松症的发生,从而减少骨折的发生率。绝经早期应用雌激素效果最好,而且安全,同时还可以治疗绝经症状,预防及治疗泌尿生殖器官萎缩及由此引起的痛苦,提高中、老年妇女的生活质量。长期应用雌激素主要应注意乳腺癌、血栓栓塞性疾病与中风的发生。子宫未切除者,雌激素与孕激素并用可以预防子宫内膜癌。应用前进行风险与受益评估,具有风险因素者不宜使用,当受益超过风险时有应用价值,应用最小的有效剂量,可以减少雌激素的副反应,应用时应定期随访以评估利弊。

Estrogen is decreased after menopause, which is the main pathogenesis of postmenopausal osteoporosis. Estrogen replacement therapy （ERT） may prevent it and therefore decrease the fracture rate. ERT is the most effective and safe therapy during the early postmenopansal period, since it not only prevents bone loss, but also improves postmenopausal symptoms, treats and prevents atropy of urogenital organs, increases their quality of llfe. Breast cancer, thromboembolic disease and stroke should be concerned during long term use of estrogen. Estrogen combining with progestin （HRT） may prevent endometfium carcinoma. Benefits and risks should be evaluated before ERT or HRT, it should＇nt be used in those women who have some risk factors of breast cancer, thromboembolic disease and stroke. The effective and lower dosage must be used when using estrogen in order to reduce the side effects. Following-up should be given periodically during ERT or HRT.