Aim: To compare the effects of one year- long strontium ranelate (SR) and raloxiphene ( R) therapies on bone mineral densities (BMDs) in postmenopausal osteoporotic women.Material and Methods: Female patients diagnosed as postmenopausal osteoporosis who received SR 2 gr/d (Group 1) or R 60 mg/d (Group 2) were analysed retrospectively.. All the patients also received calcium 1000 mg/d, vitamin D 880 IU/d supplementations. Patients also underwent BMD measurements from L2-4, femoral neck and femur total with Lunar-DXA before and after the treatment. Intragroup changes in yearly BMD and t values were calculated and compared with each other.Results: Both groups contained 22 patients without any significant inter-group differences between age, menarche age, duration of postmenopausal period, weight, height, body mass indexes, baseline BMDs and t values (p0.05). After a year-long treatment, a significant improvement in BMD of L2-4 in Group 1 was detected (p 0.0001). In posttreatment t values of the same group a significant improvement was seen for all three regions examined (p 0.05). In Group 1, none of these regions showed significant improvements as for BMD and t values.Conclusion: After a year-long treatment, strontium ranelate demonstrated significant improvements as for BMDs of L2-4, and t values in L2-4, femoral neck, and femur total. An increase in BMDs of femoral neck and femur total was seen which didn’t attain significance. However raloxiphene didn’t lead to significant improvement in BMDs and t values of the three regions examined. After a year-long treatment strontium ranelate was found to be more effective than raloxiphene in terms of improvements in BMDs. (From the World of Osteoporosis 2009;15:16-20)Key words: Osteoporosis treatment, raloxiphene, strontium ranelate
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Giris
Tüm dünyada ortalama yasam süresinin uzamasiyla birlikte insanlarin ileri yasta sahip olduklari kronik hastaliklar önem kazanmaya baslamistir. Dolayisiyla bu hastaliklarin tedavi seçenekleri konusundaki arastirmalar gittikçe artmaktadir. Osteoporoz da bu hastaliklardan biridir. Postmenopozal osteoporozun önlem ve tedavisinde amaç; morbidite ve indirek olarak mortaliteye neden olan kirik sikliginin azaltilmasidir. Postmenopozal osteoporotik kiriklar siklikla 65 yas üzerinde olusmakta olup, bu yasta verilen tedaviler etkili olmaktadir. Bununla birlikte 50 yas civarinda tedavilere baslandiginda, kemik kaybi önlenmekte, yavaslatilmakta veya geriye döndürülmektedir. Bu nedenle bu yasta osteoporozu olan veya gelisme riski olan hastalarin ayrilmaya baslanmasi uygundur (1). Günümüzde osteoporoz tedavisinde kullanilan farmasötik ajanlarin çogu (bifosfonatlar, hormon replasman tedavisi, selektif östrojen-reseptör modülatörleri (SERM), kalsitonin gibi) kemik rezorbsiyonunu inhibe ederek etki göstermektedir (2). Kemik rezorbsiyonunu inhibe eden raloksifen (R), kemigi östrojen agonisti gibi etkilerken, meme ve uterusta antagonistik etkileri olan selektif östrojen reseptör modülatörüdür (3).Stronsiyum Ranelat (SR) tedavisi ise postmenopozal kadinlarda çift etki mekanizmasiyla kemik yapimini uyarir ve kemik yikimini azaltir. In vitro çalismalar stronsiyum ranelatin osteoblast hücre replikasyonu ve aktivitesini arttirdigini göstermistir (4). Ayrica doza bagli olarak osteoklast aktivitesini inhibe ettigi de gösterilmistir (5,6).Bizim bu çalismadaki amacimiz osteoporoz tedavisinde kullanilan ve farkli mekanizmalara sahip iki ilaç olan SR ve R’in postmenopozal osteoporotik kadinlarda bir yil süreyle kullaniminin kemik mineral yogunlugu (KMY) üzerindeki etkilerini karsilastirmaktir.
