Mezibuněčná komunikace Inaktivní osteoklasty 4/28/2018 12:55:27 PM Draft 9014 Show 1 Monocyty E2 Stromální buňky IL-1 TNF Osteoblasty Mezibuněčná komunikace IL-6 M-CSF GM-CSF RANKL Časné prekursory osteoklastů Inaktivní osteoklasty Aktivní osteoklasty Dle Pacifici R. J Bone Miner Res. 1996;11:1043-51.

E2V + MPA 1>2+5 2+5 1+5 1+2.5 12 10 8 % změny proti začátku 6 4 2 0,5 1 2 3 4 5 6 7 8 9 roky Heikkinen J., Experience with long term HR therapy, Jindřichův Hradec, 24.-25.9.2004

* * * * * * * * * * Změna (%) Placebo 1mg 17ß estradiol 4/28/2018 12:55:27 PM Draft 9014 Show 1 * 5 * * 4 * * 3 * * * 2 * Změna (%) 1 Placebo 1mg 17ß estradiol 1mg 17ß estradiol + 0.5mg norethisteron acetat 2mg 17ß estradiol + 1mg norethisteron acetat -1 -2 Bederní pateř Krček kosti stehenní Trochanter -3 * Signifikantní (p < 0.001) proti placebu McClung M et al. Bone 1998; 23(5):(Suppl): S465

Klimakterický syndrom Bez klimakterického syndromu 4/28/2018 12:55:27 PM Draft 9014 Show 1 Klimakterický syndrom HRT/ERT Bez klimakterického syndromu OP bez zlomeniny OP se zlomeninou * *riziko zlomeniny, zvyšující se s věkem HRT STEARs Bisfosfonáty Raloxifen Teriparatid Therapeutic Management of Postmenopausal Osteoporosis (Animated slide) This slide portrays the current therapeutic options for the prevention and/or treatment of postmenopausal osteoporosis. The x-axis shows the age, stage of being at risk for or having osteopenia/osteoporosis and the bone mineral density (BMD). The dotted line represents increasing risk of fracture as a function of both age and BMD. The greater one’s age and/or the lower the BMD, the greater the risk for an osteoporotic fracture. The first rectangular area represents the perimenopause/early menopause when the woman is experiencing vasomotor symptoms, especially hot flashes. The therapeutic treatment for this time period may be ERT/HRT to relieve these symptoms. The second rectangular area represents the period of time when the woman is past vasomotor symptoms but has not yet sustained a fracture. After the woman passes through the period of vasomotor symptoms, the primary health concerns become longterm health maintenance. For most women past menopause, the three most common health concerns are osteoporotic fracture, breast cancer and cardiovascular disease. In this context, agents that act on the bone only, may not be as favorable as agents that have a broader profile. There are other options as well, including the bisphosphonates, which are indicated for both the prevention and treatment of osteoporosis. Calcitonin is indicated for treatment of postmenopausal osteoporosis in women 5 years past menopause. The third rectangle represents the stage when the postmenopausal woman has severe osteoporosis. She may be older, has already fractured and has a very low BMD. This is where teriparatide may be an excellent option for treatment of severe osteoporosis. Raloxifene, the bisphosphonates and calcitonin are also options for treatment. Kalcitonin VĚK v riziku/osteopenie osteoporóza těžká osteoporóza STADIUM nižší vyšší T-skóre -2.5 BMD Osteoporosis Int 2002;Suppl 3