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Die multifaktorielle Erkrankung Osteoporose zählt heute mit 5 ± 6 Mio. Betroffenen in der BRD zu einer der häufigsten Erkrankungen der postmenopausalen Frau und weist trotz eines erweiterten Spektrums diagnostischer und therapeutischer Möglichkeiten weiterhin eine deutlich zunehmende Inzidenz auf. Hieraus ergibt sich die Notwendigkeit zur frühzeitigen Identifikation von Risikopatienten sowie die Einleitung individuell angepasster Präventionsmaûnahmen. Dazu zählen neben der Motivation zur knochenstoffwechselgesunden Ernährungsweise bzw. Lebensstil die regelmäûige körperliche Aktivität sowie ggf. eine Kalziumund Vitamin-D-Supplementierung. Zusätzlich steht mit der Östrogen-/Gestagen-Substitution eine weltweit anerkannte, wirkungsvolle und kostengünstige Therapie im Rahmen der Osteoporoseprävention zu Verfügung. Eine groûe Anzahl von Studien hat in den vergangenen 20 Jahren den positiven Einfluss der Östrogene auf den Knochenstoffwechsel sowie die Messergebnisse der Knochendichte an frakturrelevanten Messorten belegt. Hierbei besteht eine Dosis-Wirkung-Beziehung, wobei auch nach langjähriger Substitution kein Wirkungsverlust auftritt und auch bei Beginn der Substitution im hohen Alter noch ein positiver Effekt nachweisbar ist. In Bezug auf die Reduktion osteoporosebedingter Frakturen hat sich in einer Reihe von groûen Fall-Kontroll-und Kohortenstudien sowie in einer kleinen AbstractThe multifactorial disease of osteoporosis is one of the most frequent diseases, affecting about 5 ± 6 Mio. postmenopausal women in Germany, today. In spite of the introduction of new technologies of fracture risk assessment and new pharmacological opportunities the incidence of fracture is still increasing. Therefore, early identification of women at high risk as well as early and individualised preventive measures are essential in the prevention of osteoporosis. Changes of dietary habits as well as lifestyle including an increase in physical activity are of up most importance. In addition to Calcium and Vitamin D supplementation, hormone replacement therapy (HRT) is accepted as the first line and cost effective pharmacological treatment for the prevention of osteoporosis. Numerous cross sectional, case-control and prospective studies showing the effect of HRT on bone reabsorption and bone mineral density (BMD) have been published. HRT reduces bone turnover which is followed by an increase of BMD. A number of case-control and cohort studies as well as a few recent prospective studies have been investigating the effect of HRT on osteoporosis related fracture. These studies confirm that HRT leads to a significant decrease of osteoporosis related fracture (Hip fracture by > 25%). However, randomised, prospective studies are needed to underline the effect on osteoporosis related fracture. Although the effect of HRT on BMD is independent of Originalarbeit 436 Institutsangaben

Estrogen replacement therapy with sequential progestin at greater than monthly intervals has been frequently used in practice to reduce progestational side-effects and bleeding episodes, but clinical trials are still lacking. Two new regimens were tested. The main objective was to evaluate efficacy, predominantly in urogenital complaints, tolerability, and patient acceptance. Transdermal estradiol (0.05 mg/day) and norethisterone acetate orally (2.5 mg/day) were administered for 12 days every 2 or 3 months (group A, n = 83, group B, n = 89) to patients whose menopause had begun at least 4 years earlier. Study duration was three long cycles in each group within 7-10 months. Efficacy was good [group A/B = 94/92%], as was systemic tolerability [95/97%]; major skin reactions occurred in 7 and 4%, respectively. Patients' acceptance for continuation of spaced-out treatment was 88 and 87%, respectively. Progestin-associated withdrawal bleedings occurred in 66 (61%) of patients; mean duration 4.3 +/- 1.9/4.8 +/- 1.6 days, with no significant changes during therapy; intensity decreased during therapy. Breakthrough bleeding which required sonographic or histological work-up occurred in 8 and 13%, respectively. Despite the low dosage, transdermal estradiol proved to be efficacious in urogenital complaints. The high acceptance and the reduction of the overall progestin dose to avoid side-effects are of particular prognostic importance with regard to the prevention of cardiovascular diseases. Transdermal estradiol combined with 2- or 3-monthly progestin may be a valid regimen in the late post-menopause, but further studies using spacing-out regimens are urgently needed.

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