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Erschienen in: Journal für Gynäkologische Endokrinologie/Schweiz 3/2019

26.08.2019 | Prävention

Der Einfluss der Gestagene auf die Knochengesundheit

verfasst von: Dr. med. Maki Kashiwagi, Vanadin Seifert-Klauss

Erschienen in: Journal für Gynäkologische Endokrinologie/Schweiz | Ausgabe 3/2019

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Zusammenfassung

Progesteron und synthetische Gestagene verfügen neben der Fähigkeit zur Endometriumtransformation über eine Reihe weiterer nichtgenomischer und genomischer Wirkmechanismen, die in ihrer Vielzahl noch Gegenstand aktueller Forschung sind. Während Medroxyprogesteronacetat in hoher Dosis (Depotgestagene) mit einer Verminderung des Knochenaufbaus assoziiert ist, wirken in niedriger Dosis (tägliche Gabe) Gestagene unterschiedlich stark auch zusätzlich zum antiresorptiven Östrogen positiv – vor allem anabol – auf den Knochen. Bereits in der Perimenopause und damit vor dem Östrogendefizit der Meno‑/Postmenopause kommt es zu einem markanten Knochendichteverlust. Vom gesamten menopausalen trabekulären Verlust verlieren manche Frauen 50 % in der Perimenopause. Mehrere Untersuchungen weisen hierbei auf eine Assoziation mit gestörten Lutealphasen und damit verbundenem relativem Progesteronmangel hin. Bei klimakterischen Beschwerden könnte somit der sequenzielle Einsatz von Progesteron oder gezielt ausgewählten synthetischen Gestagenen zusammen mit Östrogenen einen zusätzlichen Beitrag zur Osteoporoseprävention leisten.
Literatur
1.
Zurück zum Zitat Stute P et al (2014) Gynaecologists’ awareness of bone healthcare in Switzerland. Swiss Med Wkly 144:w13931 PubMed Stute P et al (2014) Gynaecologists’ awareness of bone healthcare in Switzerland. Swiss Med Wkly 144:w13931 PubMed
2.
Zurück zum Zitat Bonnick SL (2008) Monitoring changes in bone density. Womens Health (Lond) 4:89–97 CrossRef Bonnick SL (2008) Monitoring changes in bone density. Womens Health (Lond) 4:89–97 CrossRef
3.
Zurück zum Zitat International Society For Clinical Densitometrist Official Position 2015 International Society For Clinical Densitometrist Official Position 2015
4.
Zurück zum Zitat Cauley JA et al (2003) Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA 290(13):1729–1738 CrossRefPubMed Cauley JA et al (2003) Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA 290(13):1729–1738 CrossRefPubMed
5.
Zurück zum Zitat Lindsay R et al (2005) Bone response to treatment with lower doses of conjugated estrogens with and without medroxyprogesterone acetate in early postmenopausal women. Osteoporos Int 16(4):372–379 CrossRefPubMed Lindsay R et al (2005) Bone response to treatment with lower doses of conjugated estrogens with and without medroxyprogesterone acetate in early postmenopausal women. Osteoporos Int 16(4):372–379 CrossRefPubMed
6.
Zurück zum Zitat Torgerson DJ, Bell-Syer SE (2001) Hormone replacement therapy and prevention of nonvertebral fractures: a meta-analysis of randomized trials. JAMA 285(22):2891–2897 CrossRefPubMed Torgerson DJ, Bell-Syer SE (2001) Hormone replacement therapy and prevention of nonvertebral fractures: a meta-analysis of randomized trials. JAMA 285(22):2891–2897 CrossRefPubMed
7.
Zurück zum Zitat Torgerson DJ, Bell-Syer SE (2001) Hormone replacement therapy and prevention of vertebral fractures: a meta-analysis of randomised trials. Bmc Musculoskelet Disord 2:7 CrossRefPubMedPubMedCentral Torgerson DJ, Bell-Syer SE (2001) Hormone replacement therapy and prevention of vertebral fractures: a meta-analysis of randomised trials. Bmc Musculoskelet Disord 2:7 CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Baber RJ et al (2016) 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 19(2):109–150 CrossRefPubMed Baber RJ et al (2016) 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 19(2):109–150 CrossRefPubMed
9.
Zurück zum Zitat Stanczyk FZ et al (2013) Progestogens used in postmenopausal hormone therapy: differences in their pharmacological properties, intracellular actions, and clinical effects. Endocr Rev 34(2):171–208 CrossRefPubMed Stanczyk FZ et al (2013) Progestogens used in postmenopausal hormone therapy: differences in their pharmacological properties, intracellular actions, and clinical effects. Endocr Rev 34(2):171–208 CrossRefPubMed
10.
Zurück zum Zitat Gellersen B, Fernandes MS, Brosens JJ (2009) Non-genomic progesterone actions in female reproduction. Hum Reprod Update 15(1):119–138 CrossRefPubMed Gellersen B, Fernandes MS, Brosens JJ (2009) Non-genomic progesterone actions in female reproduction. Hum Reprod Update 15(1):119–138 CrossRefPubMed
11.
Zurück zum Zitat Taraborrelli S (2015) Physiology, production and action of progesterone. Acta Obstet Gynecol Scand 94(Suppl 161):8–16 CrossRefPubMed Taraborrelli S (2015) Physiology, production and action of progesterone. Acta Obstet Gynecol Scand 94(Suppl 161):8–16 CrossRefPubMed
12.
Zurück zum Zitat Seifert-Klauss V et al (2012) Progesterone and bone: a closer link than previously realized. Climacteric 15(Suppl 1):26–31 CrossRefPubMed Seifert-Klauss V et al (2012) Progesterone and bone: a closer link than previously realized. Climacteric 15(Suppl 1):26–31 CrossRefPubMed
13.
Zurück zum Zitat Ishida Y (2008) Effect of progestins with different glucocorticoid activity on bone metabolism. Clin Endocrinol (oxf) 68(3):423–428 Ishida Y (2008) Effect of progestins with different glucocorticoid activity on bone metabolism. Clin Endocrinol (oxf) 68(3):423–428
14.
Zurück zum Zitat Enriquez J et al (2017) The synthetic progestin, gestodene, affects functional biomarkers in neonatal rat osteoblasts through an estrogen receptor-related mechanism of action. Endocr Res 42(4):269–280 CrossRefPubMed Enriquez J et al (2017) The synthetic progestin, gestodene, affects functional biomarkers in neonatal rat osteoblasts through an estrogen receptor-related mechanism of action. Endocr Res 42(4):269–280 CrossRefPubMed
15.
Zurück zum Zitat Lemus AE et al (2009) Bioconversion of norethisterone, a progesterone receptor agonist into estrogen receptor agonists in osteoblastic cells. J Endocrinol 200(2):199–206 CrossRefPubMed Lemus AE et al (2009) Bioconversion of norethisterone, a progesterone receptor agonist into estrogen receptor agonists in osteoblastic cells. J Endocrinol 200(2):199–206 CrossRefPubMed
16.
Zurück zum Zitat Curtis KM, Martins SL (2006) Progestogen-only contraception and bone mineral density: a systematic review. Contraception 73(5):470–487 CrossRefPubMed Curtis KM, Martins SL (2006) Progestogen-only contraception and bone mineral density: a systematic review. Contraception 73(5):470–487 CrossRefPubMed
17.
Zurück zum Zitat Scholes D et al (2002) Injectable hormone contraception and bone density: results from a prospective study. Epidemiology 13(5):581–587 CrossRefPubMed Scholes D et al (2002) Injectable hormone contraception and bone density: results from a prospective study. Epidemiology 13(5):581–587 CrossRefPubMed
18.
Zurück zum Zitat Kaunitz AM, Arias R, McClung M (2008) Bone density recovery after depot medroxyprogesterone acetate injectable contraception use. Contraception 77(2):67–76 CrossRefPubMed Kaunitz AM, Arias R, McClung M (2008) Bone density recovery after depot medroxyprogesterone acetate injectable contraception use. Contraception 77(2):67–76 CrossRefPubMed
19.
Zurück zum Zitat Costa ML et al (2012) Progestin-only contraception prevents bone loss in postpartum breastfeeding women. Contraception 85(4):374–380 CrossRefPubMed Costa ML et al (2012) Progestin-only contraception prevents bone loss in postpartum breastfeeding women. Contraception 85(4):374–380 CrossRefPubMed
20.
Zurück zum Zitat Lanza LL et al (2013) Use of depot medroxyprogesterone acetate contraception and incidence of bone fracture. Obstet Gynecol 121(3):593–600 CrossRefPubMed Lanza LL et al (2013) Use of depot medroxyprogesterone acetate contraception and incidence of bone fracture. Obstet Gynecol 121(3):593–600 CrossRefPubMed
21.
Zurück zum Zitat Meier C et al (2010) Use of depot medroxyprogesterone acetate and fracture risk. J Clin Endocrinol Metab 95(11):4909–4916 CrossRefPubMed Meier C et al (2010) Use of depot medroxyprogesterone acetate and fracture risk. J Clin Endocrinol Metab 95(11):4909–4916 CrossRefPubMed
22.
Zurück zum Zitat Orr-Walker BJ et al (1998) The effect of past use of the injectable contraceptive depot medroxyprogesterone acetate on bone mineral density in normal post-menopausal women. Clin Endocrinol (oxf) 49(5):615–618 CrossRef Orr-Walker BJ et al (1998) The effect of past use of the injectable contraceptive depot medroxyprogesterone acetate on bone mineral density in normal post-menopausal women. Clin Endocrinol (oxf) 49(5):615–618 CrossRef
24.
Zurück zum Zitat Thijssen JH (2003) Overview on the effects of progestins on bone. Maturitas 46(Suppl 1):77–87 CrossRef Thijssen JH (2003) Overview on the effects of progestins on bone. Maturitas 46(Suppl 1):77–87 CrossRef
25.
Zurück zum Zitat Horowitz M et al (1993) Effects of norethisterone on bone related biochemical variables and forearm bone mineral in post-menopausal osteoporosis. Clin Endocrinol (oxf) 39(6):649–655 CrossRef Horowitz M et al (1993) Effects of norethisterone on bone related biochemical variables and forearm bone mineral in post-menopausal osteoporosis. Clin Endocrinol (oxf) 39(6):649–655 CrossRef
26.
Zurück zum Zitat Kuhnz W et al (1997) In vivo conversion of norethisterone and norethisterone acetate to ethinyl etradiol in postmenopausal women. Contraception 56(6):379–385 CrossRefPubMed Kuhnz W et al (1997) In vivo conversion of norethisterone and norethisterone acetate to ethinyl etradiol in postmenopausal women. Contraception 56(6):379–385 CrossRefPubMed
27.
Zurück zum Zitat Lindsay R et al (2002) Effect of lower doses of conjugated equine estrogens with and without medroxyprogesterone acetate on bone in early postmenopausal women. JAMA 287(20):2668–2676 CrossRefPubMed Lindsay R et al (2002) Effect of lower doses of conjugated equine estrogens with and without medroxyprogesterone acetate on bone in early postmenopausal women. JAMA 287(20):2668–2676 CrossRefPubMed
28.
Zurück zum Zitat Liu JH, Muse KN (2005) The effects of progestins on bone density and bone metabolism in postmenopausal women: a randomized controlled trial. Am J Obstet Gynecol 192(4):1316–1323 (discussion 1323–4) CrossRefPubMed Liu JH, Muse KN (2005) The effects of progestins on bone density and bone metabolism in postmenopausal women: a randomized controlled trial. Am J Obstet Gynecol 192(4):1316–1323 (discussion 1323–4) CrossRefPubMed
29.
Zurück zum Zitat Prior JC et al (2006) Unsuccessful attempt to demonstrate progesterone’s bone formation actions. Am J Obstet Gynecol 194(5):1502–1503 (author reply 1503–4) CrossRefPubMed Prior JC et al (2006) Unsuccessful attempt to demonstrate progesterone’s bone formation actions. Am J Obstet Gynecol 194(5):1502–1503 (author reply 1503–4) CrossRefPubMed
30.
Zurück zum Zitat Prior JC et al (2017) Estrogen-progestin therapy causes a greater increase in spinal bone mineral density than estrogen therapy—a systematic review and meta-analysis of controlled trials with direct randomization. J Musculoskelet Neuronal Interact 17(3):146–154 PubMedPubMedCentral Prior JC et al (2017) Estrogen-progestin therapy causes a greater increase in spinal bone mineral density than estrogen therapy—a systematic review and meta-analysis of controlled trials with direct randomization. J Musculoskelet Neuronal Interact 17(3):146–154 PubMedPubMedCentral
31.
Zurück zum Zitat Greendale GA et al (2012) Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women’s Health Across the Nation (SWAN). J Bone Miner Res 27(1):111–118 CrossRefPubMedPubMedCentral Greendale GA et al (2012) Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women’s Health Across the Nation (SWAN). J Bone Miner Res 27(1):111–118 CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Seifert-Klauss V et al (2012) Bone loss in premenopausal, perimenopausal and postmenopausal women: results of a prospective observational study over 9 years. Climacteric 15(5):433–440 CrossRefPubMed Seifert-Klauss V et al (2012) Bone loss in premenopausal, perimenopausal and postmenopausal women: results of a prospective observational study over 9 years. Climacteric 15(5):433–440 CrossRefPubMed
33.
Zurück zum Zitat Prior JC et al (2013) The endocrinology of Perimenopause—new definition and understanding of hormonal and bone changes. Current topics in menopause, S 54–83 Prior JC et al (2013) The endocrinology of Perimenopause—new definition and understanding of hormonal and bone changes. Current topics in menopause, S 54–83
34.
Zurück zum Zitat Prior JC et al (1990) Spinal bone loss and ovulatory disturbances. N Engl J Med 323(18):1221–1227 CrossRefPubMed Prior JC et al (1990) Spinal bone loss and ovulatory disturbances. N Engl J Med 323(18):1221–1227 CrossRefPubMed
35.
Zurück zum Zitat Prior JC et al (1994) Cyclic medroxyprogesterone treatment increases bone density: a controlled trial in active women with menstrual cycle disturbances. Am J Med 96(6):521–530 CrossRefPubMed Prior JC et al (1994) Cyclic medroxyprogesterone treatment increases bone density: a controlled trial in active women with menstrual cycle disturbances. Am J Med 96(6):521–530 CrossRefPubMed
36.
Zurück zum Zitat Li D et al (2014) Negative spinal bone mineral density changes and subclinical ovulatory disturbances—prospective data in healthy premenopausal women with regular menstrual cycles. Epidemiol Rev 36:137–147 CrossRefPubMed Li D et al (2014) Negative spinal bone mineral density changes and subclinical ovulatory disturbances—prospective data in healthy premenopausal women with regular menstrual cycles. Epidemiol Rev 36:137–147 CrossRefPubMed
Metadaten
Titel
Der Einfluss der Gestagene auf die Knochengesundheit
verfasst von
Dr. med. Maki Kashiwagi
Vanadin Seifert-Klauss
Publikationsdatum
26.08.2019
Verlag
Springer Vienna
Erschienen in
Journal für Gynäkologische Endokrinologie/Schweiz / Ausgabe 3/2019
Print ISSN: 1995-6924
Elektronische ISSN: 2520-8500
DOI
https://doi.org/10.1007/s41975-019-00101-7