Observation Of The Effects Of Hormonal Replacement Therapy On Bone Mineral Density Of Premature Ovarian Insufficiency And Analysis Of Influencing Factors

Objective:To observe the changes of bone mineral density(BMD)in different age groups of low estrogen women before and after hormone therapy and analyze the influencing factors.Methods:A total of 133 POI patients who were treated with Hormone replacement therapy(HRT)and 213 normal age postmenopausal women received Menopausal hormone therapy(MRT)from April 2012 to October 2019 were collected.The general situation of the patients(residence,education,work style,exercise,dietary habits,dietary taste,age,and menopausal duration),Number of births,height,weight),treatment course and the before and after treatment Lumbar spine and left and right femoral neck of bone mineral density(g/cm~2)were collected.Comparisons before and after treatment were performed.Before treatment,BMD was analyzed in random area group.According to the results,chi square test and logistic regression analysis were carried out for the first lumbar vertebra(L1)and left femoral neck.Results:1.Before treatment,the BMD of L1 was lower than that of L2-L4,the difference was statistically significant(P<0.05);the BMD of left femoral neck was lower than that of right femoral neck,the difference was statistically significant(P<0.05);the BMD of femoral neck was lower than that of lumbar spine,the difference was statistically significant(P<0.05).2.After treatment,the BMD of L1 increased in 78 cases(58.6%),no significant change in 45 cases(33.8%),and decreased in 10 cases(7.5%),with an average change percentage of 7.14±9.29%.The BMD of left femoral neck increased in 36 cases(27.0%),no significant change in 93 cases(70.0%),and decreased in 4 cases(3.0%),with an average change percentage of 4.62±8.11%.The percentage difference of bone mineral density between L1 and left femoral neck was 2.52±9.10%(t=2.682,P=0.008).3.Low Z value before treatment,multiple births and long menopause time of POI patients reduce the possibility of increasing lumbar BMD,overweight and exercise increase the possibility of increasing lumbar BMD;long treatment time can increase the possibility of increasing left femoral neck BMD,while the older age and low Z value before treatment reduce the possibility of increasing left femoral neck BMD.4.Before treatment,the BMD of L1 was lower than that of L2-L4 in postmenopausal women of normal age,the difference was statistically significant(P<0.05);the BMD of left femoral neck was lower than that of right femoral neck,the difference was not statistically significant(P>0.05);the BMD of femoral neck was lower than that of lumbar spine,the difference was statistically significant(P<0.05).5.59(27.7%),137(64.3%)and 17(8.0%)of normal age postmenopausal women received hormone therapy,respectively.The average change percentage was 3.07±7.80%.The BMD of left femoral neck increased in 42 cases(19.7%),no significant change in 161 cases(75.6%),and decreased in 10 cases(4.7%),with an average change percentage of 3.18±8.21%.The difference between L1 and the percentage of BMD of left femoral neck was not statistically significant.6.In normal age menopausal women,long time of hormone treatment,overweight and exercise can increase the possibility of increasing BMD of lumbar vertebrae,while in young age,less labor and tibolone can increase the possibility of increasing BMD of left femoral neck.7.The increase of BMD of lumbar vertebrae in postmenopausal women of normal age after hormone therapy was 37.1%lower than that in patients with early ovarian dysfunction.Conclusion:1.The bone mineral density of L1 and left femoral neck of POI patients is relatively low;compared with femoral neck,hormone treatment can significantly improve the level of lumbar bone mineral density.Therefore,we should pay attention to the situation of femoral neck in the process of treatment,early detection of bone loss and prevention of osteoporosis.Early and long-term hormone therapy,keeping normal body shape and keeping exercise are very important to improve bone mineral density.2.Menopausal hormone treatment can maintain the bone mineral density level of normal age menopausal women,while long-term use,overweight and exercise can improve the curative effect.3.The improvement effect of bone mineral density of lumbar vertebrae in POI patients after hormone therapy is better than that in normal menopausal women..4.BMI has different effects on BMD of low estrogen women of different ages.However,both for POI patients and normal age postmenopausal women,it is more important to maintain normal body shape,especially for POI patients.