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Hormonapplikation und gynäkologische Tumortherapie

Einfluss auf den Knochenstoffwechsel

Hormone administration and gynecological tumor therapy

Influence on bone metabolism

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  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

In der Gynäkologie spielt die Osteoporose eine wesentliche Rolle. Durch gynäkologische und onkologische Therapien kann das Risiko einer Osteoporose verstärkt werden, die durch ein erhöhtes Frakturrisiko Morbidität und Mortalität erhöht, die Lebensqualität drastisch senkt und einen massiven Kostenanstieg im Gesundheitswesen bedingen kann. Klassische Medikamente der Gynäkologie, wie GnRH-Analoga und die Hormontherapeutika, zeigen einen Einfluss auf die Knochengesundheit. In der gynäkologischen Onkologie verbessern moderne Therapien das Überleben. Durch erhöhte Heilungsraten werden Patientinnen vermehrt mit den Langzeitkonsequenzen konfrontiert, wie z. B. der Verlust der Knochenmasse durch vorzeitige Ovarialinsuffizienz, GnRH-Analoga, therapeutische Ovarektomie, Aromatasehemmer und Antiöstrogene. Nebenwirkungen der gynäkologischen und onkologischen Therapien sollten bekannt, abwägbar und beherrschbar sein. Die Prävention eines Knochenverlusts muss eine hohe Priorität haben.

Abstract

Osteoporosis has a fundamental role in gynecology. Gynecological and oncological treatments can increase the risk of osteoporosis; this in turn can raise morbidity and mortality rates through an increased risk of fractures, drastically reducing the patient’s quality of life and leading to a massive increase in costs to the healthcare system. The drugs classically used in gynecology – such as gonadotropin-releasing hormone (GnRH) analogues and hormonal agents – have effects on bone health. Modern forms of treatment used in gynecological oncology are improving survival rates. As a result of increased cure rates, patients are increasingly having to come to terms with such long-term effects as loss of bone mass caused by premature ovarian insufficiency, GnRH analogues, therapeutic ovariectomy, aromatase inhibitors, and antiestrogens. The side effects of gynecological and oncological treatments should be known, capable of being assessed, and manageable. High priority needs to be given to the prevention of bone loss.

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Literatur

  1. Aapro M (2006) Improving bone health in patients with early breast cancer by adding bisphosphonates to letrozole: The Z-ZO-E-ZO-FAST program. Breast (Suppl 1) 15: S30–S40

  2. Agarwal SK (2002) Impact of six months of GnRH agonist therapy for endometriosis. Is there an age-related effect on bone mineral density? J Reprod Med 47: 530–534

    PubMed  CAS  Google Scholar 

  3. Barad D, Kooperberg C, Wactawski-Wende J et al. (2005) Prior oral contraception and postmenopausal fracture: a Women’s Health Initiative observational cohort study. Fertil Steril 84: 374–383

    Article  PubMed  Google Scholar 

  4. Beckmann M, Braendle W, Brucker C et al. (2004) Konsensusempfehlungen zur Hormontherapie im Klimakterium und in der Postmenopause. Frauenarzt 45: 620–624

    Google Scholar 

  5. Beckmann MW, Braendle W, Brucker C et al. (2003) Konsensus-Empfehlungen der DGGG zur Hormontherapie (HAT) im Klimakterium und in der Postmenopause. Frauenarzt 44: 138–141

    Google Scholar 

  6. Bedaiwy MA, Casper RF (2006) Treatment with leuprolide acetate and hormonal add-back for up to 10 years in stage IV endometriosis patients with chronic pelvic pain. Fertil Steril 86: 220–222

    Article  PubMed  CAS  Google Scholar 

  7. Binder H, Dittrich R, Müller A et al. (2006) Fertilitätserhaltung bei onkologischen Therapien. Geburtsh Frauenheilkd 9: R200–R220

    Google Scholar 

  8. Brufsky A, Harker WG, Beck JT et al. (2007) Zoledronic acid inhibits adjuvant letrozole-induced bone loss in postmenopausal women with early breast cancer. J Clin Oncol 25: 829–836

    Article  PubMed  CAS  Google Scholar 

  9. Bruning PF, Pit MJ, Long-Bakker M de et al. (1990) Bone mineral density after adjuvant chemotherapy for premenopausal breast cancer. Br J Cancer 61: 308–310

    PubMed  CAS  Google Scholar 

  10. Cauley JA, Robbins J, Chen Z et al. (2003) Women’s Health Initiative Investigators. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA 290: 1729–1738

    Article  PubMed  CAS  Google Scholar 

  11. Coombes RC, Hall E, Gibson LJ et al. (2004) A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med 350: 1081–1092

    Article  PubMed  CAS  Google Scholar 

  12. Cooper C, Hannaford P, Croft P, Kay CR (1993) Oral contraceptive pill use and fractures in women: a prospective study. Bone 14: 41–45

    Article  PubMed  CAS  Google Scholar 

  13. Cummings SR, Browner WS, Bauer D et al. (1998) Endogenous hormones and the risk of hip and vertebral fractures among older women. Study of osteoporotic fractures research group. N Engl J Med 339: 733–738

    Article  PubMed  CAS  Google Scholar 

  14. Doren M, Nilsson JA, Johnell O (2003) Effects of specific post-menopausal hormone therapies on bone mineral density in post-menopausal women: a meta-analysis. Hum Reprod 18: 1737–1746

    Article  PubMed  CAS  Google Scholar 

  15. Dowsett M, Jones A, Johnston SR et al. (1995) In vivo measurement of aromatase inhibition by letrozole (CGS 20267) in postmenopausal patients with breast cancer. Clin Cancer Res 1: 1511–1515

    PubMed  CAS  Google Scholar 

  16. Fisher B, Costantino JP, Wickerham DL et al. (1998) Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 90: 1371–1388

    Article  PubMed  CAS  Google Scholar 

  17. Fogelman I, Blake GM, Blamey R et al. (2003) Bone mineral density in premenopausal women treated for node-positive early breast cancer with 2 years of goserelin or 6 months of cyclophosphamide, methotrexate and 5-fluorouracil (CMF). Osteoporos Int 14: 1001–1006

    Article  PubMed  CAS  Google Scholar 

  18. Garrett TJ, Vahdat LT, Kinne DW (1997) Systematic adjuvant therapy of breast cancer. J Surg Oncol 64: 167–172

    Article  PubMed  CAS  Google Scholar 

  19. Glackin CA, Murray EJ, Murray SS (1992) Doxorubicin inhibits differentiation and enhances expression of the helix-loop-helix genes Id and mTwi in mouse osteoblastic cells. Biochem Int 28: 67–75

    PubMed  CAS  Google Scholar 

  20. Gnant M (2004) Zoledronic acid effectively counteracts cancer treatment induced bone loss (CTIBL) in premenopausal breast cancer patients receiving adjuvant endocrine treatment with goserelin plus anastrazole versus goserelin plus tamoxifen – bone density subprotocol results of a randomized multicenter trial (ABCSG-12). San Antonio Breast Cancer Symposium: Abstract 5

    Google Scholar 

  21. Goss PE, Strasser-Weippl K (2004) Prevention strategies with aromatase inhibitors. Clin Cancer Res 10: 372S–379S

    Article  PubMed  CAS  Google Scholar 

  22. Gradishar WJ, Schilsky RL (1988) Effects of cancer treatment on the reproductive system. Crit Rev Oncol Hematol 82: 153–171

    Article  Google Scholar 

  23. Hadji P (2006) Möglichkeiten und Grenzen der HRT in der Osteoporoseprävention. Frauenarzt 47: 338–343

    Google Scholar 

  24. Hillner BE, Ingle JN, Chlebowski RT et al. (2004) American Society of Clinical Oncology 2003 update on the role of bisphosphonates and bone health issues in women with breast cancer. J Clin Oncol 21: 4042–4057

    Article  CAS  Google Scholar 

  25. Hirbe A, Morgan EA, Uluckan O, Weilbaecher K (2006) Skeletal complications of breast cancer therapies. Clin Cancer Res 15: 6309s–6314s

    Article  Google Scholar 

  26. Howell A, Cuzick J, Baum M et al. (2005) Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years‘ adjuvant treatment for breast cancer. Lancet 365: 60–62

    Article  PubMed  CAS  Google Scholar 

  27. Hulley SB, Grady D (2004) The WHI estrogen-alone trial – do things look any better? JAMA 291: 1769–1771

    Article  PubMed  CAS  Google Scholar 

  28. Jackson RD, Wactawski-Wende J, LaCroix AZ et al. (2006) Women’s Health Initiative Investigators. Effects of conjugated equine estrogen on risk of fractures and BMD in postmenopausal women with hysterectomy: results from the women’s health initiative randomized trial. J Bone Miner Res 21: 817–828

    Article  PubMed  CAS  Google Scholar 

  29. Kanis JA, Melton LJ III, Christiansen C et al. (1994) The diagnosis of osteoporosis. J Bone Miner Res 9: 1137–1141

    Article  PubMed  CAS  Google Scholar 

  30. Kuohung W, Borgatta L, Stubblefield P (2000) Low-dose oral contraceptives and bone mineral density: an evidence-based analysis. Contraception 61: 77–82

    Article  PubMed  CAS  Google Scholar 

  31. Lux MP, Bani MR, Fasching PA, Beckmann MW (2005) Die prophylaktische Chirurgie des Mamma- und Ovarialkarzinoms. Chirurg 76: 1145–1154

    Article  PubMed  CAS  Google Scholar 

  32. Ma CX, Adjei AA, Salavaggione OE et al. (2005) Human aromatase: gene resequencing and functional genomics. Cancer Res 65: 11071–11082

    Article  PubMed  CAS  Google Scholar 

  33. Mackey JR, Joy A (2005) Skeletal health in postmenopausal survivors of early breast cancer. Int J Cancer 114: 1010–1015

    Article  PubMed  CAS  Google Scholar 

  34. Martins SL, Curtis KM, Glasier AF (2006) Combined hormonal contraception and bone health: a systematic review. Contraception 73: 445–469

    Article  PubMed  CAS  Google Scholar 

  35. Olive DL (2005) The role of add-back therapy in the United States. Drugs Today (Barc) (Suppl A) 41: 23–26

    Google Scholar 

  36. Oppelt PG, Beckmann MW (2001) Risikofaktoren und -beurteilung in der Menopause. Geburtsh Frauenheilkd 61: 257–267

    Article  Google Scholar 

  37. Palomba S, Orio F Jr, Morelli M et al. (2002) Raloxifene administration in women treated with gonadotropin-releasing hormone agonist for uterine leiomyomas: effects on bone metabolism. J Clin Endocrinol Metab 87: 4476–4481

    Article  PubMed  CAS  Google Scholar 

  38. Pfeilschifter J, Diel IJ (2000) Osteoporosis due to cancer treatment: Pathogenesis and management. J Clin Oncol 18: 1570–1593

    PubMed  CAS  Google Scholar 

  39. Reichmann BS, Green KB (1994) Breast cancer in young women: Effect of chemotherapy on ovarian function, fertility, and birth defects. J Natl Cancer Inst Monogr 16: 125–129

    Google Scholar 

  40. Rossouw JE, Anderson GL, Prentice RL et al. (2002) Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the women’s health initiative randomized controlled trial. JAMA 288: 321–333

    Article  PubMed  CAS  Google Scholar 

  41. The North American Menopause Society (2007) Estrogen and progestogen use in peri- and postmenopausal women: March 2007 position statement of The North American Menopause Society. Menopause 31: Epub ahead of print

    Google Scholar 

  42. Torgerson DJ, Bell-Syer SE (2001) Hormone replacement therapy and prevention of nonvertebral fractures: a meta-analysis of randomized trials. JAMA 285: 2891–2897

    Article  PubMed  CAS  Google Scholar 

  43. Vehmanen L, Saarto T, Elomaa I et al. (2001) Long.-term impact of chemotherapy-induced ovarian failure on bone mineral density (BMD) in premenopausal breast cancer patients. The effects of adjuvant clodronate treatment. Eur J Cancer 37: 2373–2378

    Article  PubMed  CAS  Google Scholar 

  44. Vessey M, Mant J, Painter R (1998) Oral contraception and other factors in relation to hospital referral for fracture. Findings in a large cohort study. Contraception 57: 231–235

    Article  PubMed  CAS  Google Scholar 

  45. Vestergaard P, Rejnmark L, Mosekilde L (2006) Oral contraceptive use and risk of fractures. Contraception 73: 571–576

    Article  PubMed  CAS  Google Scholar 

  46. Have M von, Oppelt PG, Müller A et al. (2005) Kontrazeption. Geburtsh Frauenheilkd 9: R174–R199

    Google Scholar 

  47. Wheeler DL, Vander Griend RA, Wronski TJ et al. (1995) The short- and long-term effects of methotrexate on the rat skeleton. Bone 16: 215–221

    Article  PubMed  CAS  Google Scholar 

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  1. Frauenklinik, Universitätsklinikum Erlangen, Universitätsstraße 21–23, 91054, Erlangen, Deutschland

    M.P. Lux, M. Schrauder, M.W. Beckmann & A. Müller

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  1. M.P. Lux
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  2. M. Schrauder
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  3. M.W. Beckmann
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Correspondence to M.P. Lux.

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Lux, M., Schrauder, M., Beckmann, M. et al. Hormonapplikation und gynäkologische Tumortherapie. Gynäkologe 40, 621–628 (2007). https://doi.org/10.1007/s00129-007-2021-8

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