Effects of menopausal hormone therapy on bone and body composition

Zusammenfassung

Die Wechseljahre sind durch tiefgreifende klinische und hormonelle Veränderungen gekennzeichnet. Ein Östrogenmangel führt zu einem beschleunigten Knochenverlust und erhöhtem Frakturrisiko. Parallel dazu deuten Verlaufs-Studien auf einen Anstieg der Adipositas mit einer Neigung zu mehr zentralem Fett sowie einen Verlust an Muskelmasse hin. Die post-menopausale Hormontherapie (MHT), die derzeit auf die symptomatische Linderung von Hitzewallungen und andere klimakterische Symptome beschränkt ist, hat sich als wirksam erwiesen, um die Knochendichte zu erhalten. Jüngste Daten der OsteoLaus-Kohorte, einer bevölkerungsbasierten Studie mit postmenopausalen Frauen im Alter von 50–80 Jahren, deuten darauf hin, dass zusätzlich ein günstiger Effekt auf die Mikroarchitektur der Knochen vermittelt wird. Darüber hinaus haben Frauen unter MHT, weniger androides und viszerales Fett, entsprechend der verfügbaren Daten aus anderen Studien. Die Physiopathologie dieses Zusammenhangs ist nicht vollständig geklärt und kann Änderungen des Energieverbrauchs durch Östrogene betreffen. Im Gegenteil scheint die Wirkung der MHT auf die Magermasse begrenzter zu sein und könnte mit spezifischen Arten MHT oder dem zeitlichen Einsatz der MHT in Verbindung gebracht werden. Interessanterweise ist die Entwicklung nach dem MHT-Entzug in verschiedenen Geweben nicht identisch, wobei der Verlust des Nutzens für das Fettgewebe schneller eintritt. In Anbetracht des erneuten Interesses von MHT, zumindest für Frauen in der frühen Postmenopause, können diese Daten bei der Erwägung einer MHT wertvoll sein.

Abstract

Menopause is characterized by profound clinical and hormonal changes. Estrogen deficiency leads to accelerated bone loss and increased risk of fracture. In parallel, longitudinal studies suggest a gain of adiposity with propensity for more central fat, as well as a loss of lean mass. Menopausal hormone therapy (MHT), currently limited for symptomatic relief of hot flushes and other climacteric symptoms, has shown proved efficacy to preserve bone mineral density. Recent data of the OsteoLaus cohort, a population-based study of postmenopausal women aged 50–80 years, indicate that additional bone benefits are mediated by a favorable effect on bone microarchitecture. In addition, women on MHT exhibit less an droid and visceral fat, in accordance with the review of the available evidence from other studies. The physiopathology of this link is not utterly elucidated and may implicate changes of energy expenditure by estrogens. On the contrary, the effect of MHT for lean mass seem to be more limited and may be associated with specific types of MHT or a particular timing of administration. Interestingly, the evolution after MHT withdrawal is not identical across different tissues with more rapid loss of the adipose benefits.In view of the renewed interest of MHT at least for early post-menopausal women, these data can be valuable assets when considering such treatment.

Schlüsselwörter

Postmenopausale Hormontherapie - Knochendichte - trabekulärer Knochenwert (TBS) - viszerales Fettgewebe - OsteoLaus

Key words

menopausal hormone therapy - bone mineral density - trabecular bone score - visceral adipose tissue - OsteoLaus

• References

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