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

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With transdermal estradiol substitution the so called "primary liver passage" is avoided. Taking into account also the low dose of estradiol the risk of hepatic side effects can be reduced. On the other hand, it was assumed that for the same reason desirable lipid effects regarding cardiovascular protection may also not be possible, in contrast to oral estrogen treatment. Treating 26 postmenopausal women with the estradiol patch releasing 0.05 mg daily and with 1 mg oral norethisterone acetate, added at least during 10 days in each cycle, a significant reduction was observed in total cholesterol as well as in LDL- and VLDL-cholesterol of about 15-20%. HDL-cholesterol first showed a decrease and thereafter it increased again to basic level. It is supposed that the reason for this may be different effects on subfractions of HDL-cholesterol. The triglycerides were lowered to about 20%. This result is thought to be important because oral estrogens have been associated with increases in triglycerides. By lowering LDL-cholesterol as well as triglycerides, both serum lipids, most important with respect to cardiovascular protection, are shown to be influenced positively.

Estradiol and sequential levonorgestrel administered in a 7-day transdermal matrix patch for 1 year provide endometrial protection.