| Objective:To compare the effect of long-term and short-term hormone replacement therapy(HRT)on bone mineral density in patients with premature ovarian insufficiency(POI)in different age groups.Methods:From October 2009 to September 2020,the patients diagnosed with POI and treated with hormone replacement therapy in the Gynecological Endocrinology Clinic of the First Hospital of Shanxi Medical University were retrospectively summarized.According to the age of peak bone mass(PBM),the patients were divided into two groups: ≤30years old group(n = 34)and 31～40 years old group(n = 33).The efficacy of bone mineral density was continuously compared for 4 years.According to the different stages of bone mass accumulation before peak,the ≤30 years old group was divided into 2subgroups: ≤ 20 years old group(n = 32)and 21～30 years old group(n = 33).The changes of bone mineral density before and after 1 year of treatment were observed.The treatment regimen was sequential treatment with estrogen and progestin.The patients were divided into two groups: cycle continues [estradiol valerate plus cyproterone acetate(2mg/1mg)in 9 cases,estradiol valerate plus progesterone(2mg/100mg)in 13 cases,conjugated estrogen plus progesterone(0.625mg/100mg)in 12 cases] and sequential cycle [estradiol plus dydrogesterone(2mg/10mg)in 64 cases].Bone mineral density of left femoral neck,left hip bone,the first lumbar vertebra(L1)and total lumbar spine was observed before treatment,1,2,3 and 4 years after treatment.The effect of bone mineral density in each part over time was analyzed and compared.Repeated measurement analysis of variance,paired sample t test,two independent sample t test,one-way analysis of variance(LSD-t test)and chi-square test of paired four-fold table data(Mc Nemar test)were used for statistical analysis.Results:1.The results before enrollment in the group of ≤30 years old and > 30 years old showed that systolic blood pressure,diastolic blood pressure,height,weight,BMI,waist circumference and waist-hip ratio did not change significantly(P > 0.05).2.The results of repeated measurement ANOVA for the ≤30 years and > 30 years groups showed that the time effect,group effect and interaction effect of the left hip and the first lumbar vertebra(L1)BMD in the two groups were statistically significant(P <0.05).Only the time effect of BMD of left femoral neck was statistically significant(P <0.05).The time effect and interaction effect of BMD of total lumbar spine were statistically significant(P < 0.05).3.The results of one-way repeated measurement ANOVA for the ≤30 years and >30 years groups:the BMD of left femoral neck,hip bone,the first lumbar vertebra(L1)and total lumbar spine in patients ≤30 years old were statistically significant(P < 0.05).The increase of the first lumbar vertebra(L1)and total lumbar spine BMD in > 30 years old group were statistically significant(P < 0.05).There was no statistical significance in BMD increase of left femoral neck and hip bone in > 30 years old group(P > 0.05).4.There were no significant changes in systolic blood pressure,diastolic blood pressure,height,weight,BMI,waist circumference and waist-hip ratio before enrollment in the group of ≤20 years old,21～30 years old and 31～40 years old(all P > 0.05).5.Comparison of bone mineral density and Z score before and after 1 year of treatment in groups of ≤20 years,21～30 years and > 30 years:the BMD and Z score of left femoral neck,hip bone,the first lumbar vertebra(L1)and total lumbar spine in the≤20 years and 21～30 years old group increased significantly after treatment(P < 0.05).In the > 30 years old group,BMD and Z score of the first lumbar vertebra(L1)and total lumbar spine increased significantly(P < 0.05).Only Z score of left femoral neck and hip bone increased significantly after treatment(P < 0.05).6.Comparison of bone mineral density and Z score difference before and after 1year of treatment among groups of ≤ 20 years,21～30 years and > 30 years : bone mineral density of left femoral neck,hip bone,the first lumbar vertebra(L1)and total lumbar spine increased significantly(P < 0.05).The Z score difference of left femoral neck,the first lumbar vertebra(L1)and total lumbar spine increased significantly(P <0.05).Only the Z score difference of the left hip bone increased slightly,with no statistical significance(P > 0.05).7.Comparison of abnormal bone mass rate in groups ≤20 years old,21～30 years old and > 30 years old before and after 1 year of treatment : the incidences of Z ≤-2.0(low bone mass)before and after treatment in the left hip bone and total lumbar spine of the ≤ 20 years old group were statistically significant(P < 0.05).There were no significant difference in the left hip bone and total lumbar spine before and after treatment in 21～30 years and 31～40 years groups(P > 0.05).The rate of abnormal bone mass before and after treatment,and the rate of low bone mass improvement after treatment were: total lumbar spine > the left hip bone;(≤20 years old group)>(21～30years old group)>(31～40 years old group).Conclusion:1.The earlier the age of POI,the more obvious the impact on bone metabolism.2.BMD of POI patients increased with the extension of treatment time after HRT.3.Patients who did not reach the peak bone mass age(≤30 years old)had a greater increase in BMD and a better effect than those who reached the peak bone mass age(>30 years old)after HRT.After 4 years of treatment,the BMD of the two groups was close.4.After treatment in patients of different age groups,the smaller the age group,the greater the increase of bone mineral density and Z score,and the better the curative effect.5.In different age groups,the increase of bone mineral density and Z score of lumbar spine were greater than that of hip bone.6.After treatment,the smaller the age group,the better the improvement rate of low bone mass. |
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