A longitudinal study of the effect of vitamin K2 on bone mineral density in postmenopausal women a comparative study with vitamin D3 and estrogen–progestin therapy
Introduction
Several agents including vitamin D3, estrogen, calcitonin, and bisphosphonate, etc have been used for preventing postmenopausal osteoporosis. But, in clinical practice, there are some people who respond poorly or little to those medicines. Recently, much attention have been paid to vitamin K2 because of its action on bone; vitamin K2 both increases bone formation and decreases bone resorption.
Since Bouckaert and Said first reported the effect of vitamin K on fracture healing in 1960 [1], many studies have suggested that vitamin K is closely related with bone metabolism [2], [3]. In our country, vitamin K2 (menatetrenone) has been accepted for clinical application in the treatment of osteoporotic osteopenia from 1995. Orimo et al. [4] reported that vitamin K2 increases the bone mineral density (BMD) of cortical bones in elderly osteoporotic patients. However, to prevent bone fracture, cancellous bones should be examined than the cortical ones. In addition, to prevent osteoporosis effectively, the therapy ought to be started earlier than elderly age. There are very few reports about vitamin K2 therapy so far. Our study is the first report which investigated the BMD of cancellous bones in women just after menopause. In the present study, we performed a longitudinal study of the effect of vitamin K2 on vertebral bone in postmenopausal women for 12 months, comparing with vitamin D3 or estrogen-progestins treatment (HRT). Moreover, we investigated the relationship of the rates of change in BMD (BMD) with age, years since menopause (YSM) and initial BMD of the women who were treated by each regimen.
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Subjects and methods
A total of 72 healthy, non-hysterectomized postmenopausal women who had visted at the outpatient clinic of the Department of Obstetrics and Gynecology, Kagoshima University in Kagoshima, between 1994 and 1996 were selected. Postmenopausal state was defined as the absence of menstruation for at least 12 months. All subjects had no medications and complications, which affected bone metabolism and had no unbalanced diet for vitamin K rich food, e.g. green vegetables and fermented foods. All
Results
Table 1 shows the baseline characteristic of the subjects. There was no significant difference in age, BMI, YSM, and the initial BMD among the groups. Fig. 1 presents the rates of change in BMD (BMD) in each group during the treatment study. The mean±S.E.M of BMD (%) at 12 months were (−2.87±0.51) in control, (0.23±0.47) in vitamin K2 group, (−0.47±0.86) in vitamin D3 group and (4.0±1.12) in HRT group. There was significant difference in BMD between HRT group and control group (P<0.01).
Discussion
There have been many reports in regard to the effect of HRT on BMD; it is generally recognized that HRT has a suppressive effect on bone loss and an enhancing effect of increasing BMD at lumbar spine in postmenopausal women [5]. In the present study, HRT also prevented bone mineral loss. Thus, it is certain that HRT is a good way for preventing osteoporosis. However, HRT has some adverse effects, for example, increasing the risk of thromboembolism. There are some alternative agents for
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