Вариабельность ответа костно-минерального обмена у женщин с хирургической менопаузой на менопаузальную гормональную терапию

Abstract

Patients with surgical menopause rapidly develop signs of osteopenia and osteoporosis. Hormone replacement therapy (HRT) for menopause increases bone mineral density (BMD). However, the positive metabolic effects of HRT vary widely. The variability of response to HRT may depend on the sensitivity of these cells to steroid hormones, i.e., the level of steroid receptors in them. An indirect indicator of the sensitivity of osteoclasts to HRT components can be the level of transcription of estradiol and progesterone receptors in peripheral blood mononuclear cells (PBMCs). Objective. To determine the transcriptome of PBMCs in patients with surgical menopause against the background of HRT using a combination of 1 mg estradiol and 5 mg dydrogesterone in cyclic regimen and to study its effect on BMD. Patients and methods. A total of 16 women aged 40–55 years with a duration of surgical menopause ranging from 12 months to 6 years were examined. An inclusion criterion for this study was the absence of contraindications for HRT. The subject of the study was determination of BMD by dual-energy X-ray absorptiometry and expression levels of estradiol and progesterone receptor genes by polymerase chain reaction (PCR). Results. Comparative analysis of estrogen and progesterone gene expression in PBMCs revealed a difference in gene expression: a 2-fold decrease in membrane estradiol receptor (mER) expression (p = 0.0420), a 2-fold decrease in nuclear estradiol receptor (ERβ) expression (p = 0.0295), and a 3-fold decrease in nuclear progesterone receptor (PR-B) expression (p = 0.0480) in PBMCs of patients in the group with no HRT effect on BMD. Conclusion. Estradiol (mER and ERβ) and progesterone (PR-B) receptor mRNA levels in PBMCs of women with surgical menopause may serve as a prognostic marker of treatment efficacy. Key words: menopause, hormone replacement therapy, bone mineral density, peripheral blood mononuclear cells, dydrogesterone, estradiol