Knochenstoffwechsel, Knochendichte und Östrogenspiegel in der Perimenopause: eine prospektive 2-Jahres-Untersuchung

Zusammenfassung

Der Knochenstoffwechsel und die trabekuläre Knochendichte von 69 prä-, peri- und früh-postmenopausalen Frauen wurden prospektiv untersucht. Marker des Knochenabbaus (BAP = Bonespecific alkalic Phosphatase, knochenspezifische alkalische Phosphatase; OC4 = Osteocalcin) und des Knochenaufbaus (PYD = Pyridinolin, DPD = Desoxypyridnolin, NTX = N-terminales Telopeptid crosslinked Kollagen Typ I, CTX = C-terminales Telopeptid crosslinked Kollagen Typ I) wurden in Serum und Urin zu 5 Zeitpunkten bestimmt (0, 3, 6, 12 und 24 Monaten). Knochendichtemessungen wurden zu Beginn und nach 24 Monaten durchgeführt. Die Ergebnisse der 40 Frauen ohne Hormoneinnahme, die alle Untersuchungen wahrgenommen hatten, wurden bezüglich des Menopausenstatus und der Veränderungen der Messgrößen im Verlauf der 2 Jahre miteinander verglichen. Während die trabekuläre Knochendichte zu Studienbeginn bei den früh postmenopausalen Frauen am niedrigsten war, zeigten die perimenopausalen Frauen den deutlichsten Knochendichteverlust im Studienzeitraum (- 10,6 %). Die Knochenstoffwechselmarker waren in der postmenopausalen Gruppe am höchsten. In der perimenopausalen Gruppe kam es im Verlauf zum Anstieg von OC, PYD und CTX. Perimenopausale Frauen zeigten die höchsten Östrogenwerte.

Abstract

Bone metabolism and trabecular bone density were studied prospectively in 69 pre-, peri- and early postmenopausal women. Markers of bone resorption (OC = osteocalcin, BAP = bonespecific alkalic phosphatase) and bone formation (PYD = pyridinolin, DPD = desoxypyridnolin, NTX = N-terminal telopeptide crosslinked collagen type I, CTX = C-terminal telopeptide crosslinked collagen type I) in serum and urine were followed over a course of two years with five points of examination (0, 3, 6, 12 and 24 months). Bone density was measured at 0 and 24 months. The results of 40 hormonally untreated women who completed all examinations were compared regarding menopausal status and changes over the 2-year-period. While baseline tracecular bone density was lowest in early postmenoapusal women, perimenopausal women showed greatest bone loss (- 10,6 %) during the two year study period. Bone metabolism markers were highest in the postmenopausal group. Perimenopause was associated with a gradual rise in OC, PYD and CTX. Perimenopausal women showed the highest serum estradiol at 0 and 12 months with values exceeding those of premenopausal women. Whether the increased perimenopausal bone loss could be related to the increase in anovulatory cycles during the perimenopausal transition is subject to ongoing investigation.

Schlüsselwörter

Perimenopause - Menopause - Knochenstoffwechsel - Knochendichte - Östrogen

Key words

perimenopause - menopause - bone density - bone metabolism - estrogen

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