Selección
de Resúmenes de Menopausia
Enero de 2008
Semana del
23 al 29 de Enero de 2008
Juan Enrique Blümel.
Departamento Medicina Sur. Universidad
de Chile
Stroke. 2008 Jan;39(1):30-5. Epub 2007 Dec 6.
Metabolic
syndrome and ischemic stroke risk:
Boden-Albala B, Sacco RL, Lee HS, Grahame-Clarke C, Rundek T, Elkind MV, Wright C, Giardina EG, DiTullio MR, Homma S, Paik MC.
Department of Neurology, Columbia University College
of Physicians and Surgeons, Mailman School of Public Health, New York, NY, USA.
bb87@columbia.edu
BACKGROUND AND PURPOSE: More than 47 million
individuals in the
Del Med J. 2007 Nov;79(11):441-4.
Black
cohosh-induced hepatitis.
Department of Emergency Medicine at Christiana Care Health
System,
Herbal products are widely used by American consumers.
Herbal remedies are not regulated by the Food and Drug Administration, but they
are not immune from serious medication side-effects. We report the case of a
50-year-old woman who presented with fatigue and right upper quadrant pain. The
patient had begun the popular postmenopausal herbal remedy black cohosh two
weeks prior to presentation. Laboratory results revealed acute hepatitis. After
other causes of liver failure were ruled out, the patient was diagnosed with
black cohosh-induced hepatitis. She recovered uneventfully following withdrawal
of the herb. There are five prior reports of hepatitis or hepatic failure
likely caused by the herbal remedy black cohosh in the English literature. This
case illustrates the importance of a broad differential diagnosis for abdominal
pain and highlights the importance of a complete medication list, including
herbs.
Am J Epidemiol. 2008 Jan 23 [Epub
ahead of print]
Incidence
of Dementia in Long-term Hormone Users.
Petitti DB, Crooks VC, Chiu V, Buckwalter JG, Chui HC.
Department of Clinical Analysis, Kaiser Permanente
Southern California,
Results from epidemiologic studies of postmenopausal
hormone use and dementia have been conflicting. Investigators from the Women's
Health Initiative Memory Study reported that the incidence of dementia in women
aged >/=65 years assigned to hormone use was increased. Here the authors
report results from a prospective cohort study of 2,906 dementia-free women
(1,519 hormone users and 1,387 hormone nonusers) aged >/=75 years who were
recruited from a Southern California health plan in 1999 and followed through
2003. Cognitive status was assessed annually using the Telephone Interview of
Cognitive Status-modified, supplemented by the Telephone Dementia Questionnaire
and medical record review. The mean self-reported age at initiation of hormone
use was 48.3 years for users of estrogen alone (n = 1,072) and 54.9 years for
users of estrogen plus progestin (n = 447); self-reported mean durations of
hormone use were 30.5 years and 23.2 years, respectively. There were 283
incident dementia cases identified during follow-up. After adjustment for age,
education, and medical history, hazard ratios for incident dementia were 1.34
(95% confidence interval: 0.95, 1.89) in estrogen/progestin users and 1.23 (95%
confidence interval: 0.94, 1.59) in estrogen users. These findings do not
provide support for an effect of estrogen or estrogen/progestin use in
preventing dementia.
J Clin Invest. 2008 Jan 24 [Epub
ahead of print
Pharmacologic
targeting of a stem/progenitor population in vivo is associated with enhanced
bone regeneration in mice.
Mukherjee S, Raje N, Schoonmaker JA, Liu JC, Hideshima T, Wein MN, Jones DC, Vallet S, et al.
Center for Regenerative Medicine,
Drug targeting of adult stem cells has been proposed
as a strategy for regenerative medicine, but very few drugs are known to target
stem cell populations in vivo. Mesenchymal stem/progenitor cells (MSCs) are a
multipotent population of cells that can differentiate into muscle, bone, fat,
and other cell types in context-specific manners. Bortezomib (Bzb) is a
clinically available proteasome inhibitor used in the treatment of multiple
myeloma. Here, we show that Bzb induces MSCs to preferentially undergo osteoblastic
differentiation, in part by modulation of the bone-specifying transcription
factor runt-related transcription factor 2 (Runx-2) in mice. Mice implanted
with MSCs showed increased ectopic ossicle and bone formation when recipients
received low doses of Bzb. Furthermore, this treatment increased bone formation
and rescued bone loss in a mouse model of osteoporosis. Thus, we show that a
tissue-resident adult stem cell population in vivo can be pharmacologically
modified to promote a regenerative function in adult animals.
Endocr J. 2008 Jan 24 [Epub
ahead of print
Increased
Bone Turnover in Patients with Hypercholesterolemia.
Majima T, Komatsu Y, Shimatsu A, Satoh N, Fukao A, Ninomiya K, Matsumura T, Nakao K.
Department of Endocrinology and Metabolism, Clinical
Research Institute for Endocrine Metabolic Diseases, National Hospital
Organization, Kyoto Medical Center.
Osteoporosis has been linked with arteriosclerotic
vascular diseases, suggesting that hypercholesterolemia or dyslipidemia may be
a common pathogenetic factor underlying these diseases. However, little is known
about the relationship between osteoporosis and hypercholesterolemia. The
purpose of this study was, therefore, to investigate the effects of
hypercholesterolemia upon bone metabolism, by measuring bone turnover markers
in hypercholesterolemic patients. This study included 281 Japanese patients
with hypercholesterolemia, and 267 control subjects. Serum bone-specific
alkaline phosphatase (BAP) of the patients was significantly higher than that
of the controls in women. Serum N-terminal telopeptide of type I collagen (NTx)
of the patients was significantly higher than that of the controls in both men
and women. In addition, both BAP and NTx in men showed a significantly negative
correlation with high density lipoprotein cholesterol (HDL-C). On the other hand,
in women, both BAP and NTx showed a significantly positive correlation with
total cholesterol and low density lipoprotein cholesterol (LDL-C). These
results indicate increased bone turnover in hypercholesterolemic or
dyslipidemic patients regardless of gender, and suggest the importance of
treating hypercholesterolemia or dyslipidemia in order to prevent not only
arteriosclerotic complications but also osteoporotic bone loss and subsequent
fractures.
Breast Cancer Res Treat. 2008 Jan 23 [Epub
ahead of print
Effect
of a low-fat, high-carbohydrate dietary intervention on change in mammographic
density over menopause.
Martin LJ, Greenberg CV, Kriukov V, Minkin S, Jenkins DJ, Yaffe M, Hislop G, Boyd NF.
Campbell Family Institute for Breast Cancer Research,
Ontario Cancer Institute,
We have previously shown that a low-fat dietary
intervention for 2 years in women with extensive mammographic density decreased
mammographic density to a greater extent than in the control group. Post-hoc
analysis indicated that this effect was strongest in women who became
postmenopausal during the follow-up period. The purpose of the present study
was to determine if this potentially important finding could be confirmed in a
new and larger group of subjects with a longer follow-up time. Participants in
a low-fat dietary intervention trial who were premenopausal at entry and became
postmenopausal during follow-up were examined. Total breast, dense, and
non-dense area and percent density were measured in baseline and postmenopause
mammograms using a computer-assisted method. Total breast and non dense area
increased more in the control group compared to the intervention group (for
breast area 2.6 and
Digestion. 2008 Jan
21;77(1):4-9 [Epub ahead of print
Hormone
Replacement Therapy and Symptomatic Gallstones - A Prospective Population Study
in the EPIC-Norfolk Cohort.
Hart AR, Luben R, Welch A, Bingham S, Khaw KT.
Background/Aims: Hormone replacement therapy (HRT) may
increase the risk of symptomatic gallstones, but this association has not been
investigated in a prospective study in a European population. The aim of the
study was to investigate the relationship between HRT and the development of
symptomatic gallstones in a free-living population. Methods: Use of HRT was
ascertained by questionnaire in 13,433 women aged 45-74 years living in
Lancet. 2008 Jan 16 [Epub ahead of print]
Maternal
and child undernutrition: consequences for adult health and human capital.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS; for the Maternal and Child Undernutrition Study Group.
Universidade Federal de Pelotas,
In this paper we review the associations between
maternal and child undernutrition with human capital and risk of adult diseases
in low-income and middle-income countries. We analysed data from five long-standing
prospective cohort studies from Brazil, Guatemala, India, the Philippines, and
South Africa and noted that indices of maternal and child undernutrition
(maternal height, birthweight, intrauterine growth restriction, and weight,
height, and body-mass index at 2 years according to the new WHO growth
standards) were related to adult outcomes (height, schooling, income or assets,
offspring birthweight, body-mass index, glucose concentrations, blood
pressure). We undertook systematic reviews of studies from low-income and
middle-income countries for these outcomes and for indicators related to blood
lipids, cardiovascular disease, lung and immune function, cancers,
osteoporosis, and mental illness. Undernutrition was strongly associated, both
in the review of published work and in new analyses, with shorter adult height,
less schooling, reduced economic productivity, and-for women-lower offspring
birthweight. Associations with adult disease indicators were not so clear-cut.
Increased size at birth and in childhood were positively associated with adult
body-mass index and to a lesser extent with blood pressure values, but not with
blood glucose concentrations. In our new analyses and in published work, lower
birthweight and undernutrition in childhood were risk factors for high glucose
concentrations, blood pressure, and harmful lipid profiles once adult body-mass
index and height were adjusted for, suggesting that rapid postnatal weight
gain-especially after infancy-is linked to these conditions. The review of
published works indicates that there is insufficient information about
long-term changes in immune function, blood lipids, or osteoporosis indicators.
Birthweight is positively associated with lung function and with the incidence
of some cancers, and undernutrition could be associated with mental illness. We
noted that height-for-age at 2 years was the best predictor of human capital
and that undernutrition is associated with lower human capital. We conclude
that damage suffered in early life leads to permanent impairment, and might
also affect future generations. Its prevention will probably bring about
important health, educational, and economic benefits. Chronic diseases are
especially common in undernourished children who experience rapid weight gain after
infancy.
J Aging Phys Act. 2008
Jan;16(1):53-60.
Enhanced
rate of resting energy expenditure in women using hormone-replacement therapy:
preliminary results.
Aubertin-Leheudre M, Goulet ED, Dionne IJ.
Research Centre on Aging, Faculty of Physical
Education and Sports, University of Sherbrooke, Sherbrooke, QC, Canada.
Hormone-replacement therapy (HRT) attenuates the
menopause-associated alterations in body composition. It is not known, however,
whether this effect is a result of a concomitant increase in energy
expenditure. The authors examined whether women submitted to a long-term HRT
treatment presented greater energy expenditure than women who had never used
HRT. We compared 13 postmenopausal women using HRT (>1 yr) with 13 age-
(+/-2 yr) and body-mass-index-matched (BMI; +/-1.5kg/m2) postmenopausal women
not using HRT. Resting energy expenditure (REE; indirect calorimetry), body
composition, and daily (
Menopause. 2008 Jan 18 [Epub
ahead of print
Associations
of endogenous sex hormones with the vasculature in menopausal women: the Study
of Women's Health Across the Nation (SWAN).
Wildman RP, Colvin AB, Powell LH, Matthews KA, Everson-Rose SA, Hollenberg S, Johnston JM, Sutton-Tyrrell K.
of Epidemiology and Population Health,
OBJECTIVE:: As associations between endogenous sex
hormones and the vasculature are not well characterized, the objective was to
examine the cross-sectional associations of menopausal status and endogenous
sex hormones with vascular characteristics. DESIGN:: Common carotid artery
adventitial diameter and intima-media thickness were determined using B-mode
ultrasonography among 483 middle-aged women enrolled in the
Semana del 16 al 22 de Enero de 2008
Climacteric. 2008
Feb;11(1):84-8.
Black
cohosh: a cause of abnormal postmenopausal liver function tests.
Locum Consultant Gastroenterologist,
The health scares restricting the use of hormone
replacement therapy have made women tend to opt for 'natural' remedies that are
generally perceived as safe. Unfortunately, there is lack of definite opinion
on the safety of herbal remedies. Black cohosh is commonly used for
postmenopausal symptoms. We present two cases of liver toxicity related to this
and recommend close monitoring of women on this herbal preparation.
Climacteric. 2008
Feb;11(1):74-83
Lipid
levels and cardiovascular risk in elderly women: a general population study of
the effects of hormonal treatment and lipid-lowering agents.
Dupuy AM, Carrière I, Scali J, Cristol JP, Ritchie K, Dartigues JF, Gambert P, Ancelin ML.
Inserm U888,
Objective To evaluate plasma lipid levels in elderly
women in the general population as a function of use of lipid-lowering agents
(LLA) and hormone therapy (HT). Methods A total of 4271 women aged over 65
years were recruited from three French cities. Analyses were performed after
stratification by LLA treatment and HT and adjusting for a large range of
sociodemographic and clinical factors. Results Fifteen percent of women
currently used HT (78% transdermal estradiol), and 30% were taking LLA. In this
population, 4.6% of women were taking both HT and LLA (fibrate for 2.4% and
statin for 2.2%). In non-LLA-treated women, current HT was associated with
lower total cholesterol, low density lipoprotein cholesterol (LDL-C), and
non-high density lipoprotein cholesterol (non-HDL-C) compared to never users.
Women treated with LLA also had lower total cholesterol, LDL-C, and non-HDL-C
compared to non-LLA users, whereas triglyceride levels were the highest in
statin users and lowest in fibrate users. Fibrate use was associated with a
more favorable lipid pattern than statin treatment independently of HT use. In
women without coronary heart disease or diabetes, HT, statin or fibrate use
were associated with lower LDL-C level risk based on National Cholesterol
Education Program guidelines (adjusted odds ratio (OR) = 0.67 (95% confidence
interval (CI) = 0.53-0.85), 0.38 (95% CI = 0.29-0.47), and 0.32 (95% CI =
0.25-0.42), respectively) with a possible interaction between fibrate and HT
(0.18 (95% CI = 0.10-0.30)). Conclusions Estradiol-based HT may lower
atherogenic lipoproteins in postmenopausal women. In primary prevention of
coronary heart disease, combining HT and a fibrate may provide additional
benefits compared to fibrate use.
Climacteric. 2008
Feb;11(1):63-73
Ultra-low-dose
continuous combined estradiol and norethisterone acetate: improved bleeding
profile in postmenopausal women.
Sturdee
DW, Archer
DF, Rakov
V, Lang
E, Investigators
OB.
Department of Obstetrics and Gynecology,
Objective To evaluate the effect of two ultra-low-dose
hormone treatments containing estradiol (E2) 0.5 mg and norethisterone acetate
(NETA) 0.1 or 0.25 mg on the endometrium and bleeding. Methods A prospective,
randomized, placebo-controlled trial of 6 months. Local Ethics Committee
approval and informed consent were obtained prior to initiation and enrolment.
Out of 577 postmenopausal women randomized, 575 took E2/NETA 0.1 (n = 194), or
E2/NETA 0.25 (n = 181) or placebo (n = 200). Endometrial bleeding was monitored
by daily diary cards and endometrial thickness by transvaginal ultrasound at
baseline and on completion. An endometrial biopsy was obtained when indicated
clinically. Results In months 1-6, the amenorrhea rates with E2/NETA 0.1 were
89%, 89%, 86%, 85%, 89% and 89%, respectively and the no-bleeding rates were
correspondingly high: 95%, 94%, 93%, 90%, 95% and 95%. The amenorrhea and
spotting-only rates were similar with both ultra-low-dose combinations. The
withdrawal rates due to bleeding were very low and the same in all three
treatment arms (n = 1; 1%). There was a slight increase in the mean endometrial
thickness in all three groups, which remained less than
Climacteric. 2008
Feb;11(1):55-62
The
relationship of reports of aches and joint pains to the menopausal transition:
a longitudinal study.
Szoeke CE, Cicuttini FM, Guthrie JR, Dennerstein L.
Office for Gender and Health, Department of
Psychiatry,
Objectives Part I: To determine factors associated
with reported joint symptoms across the menopausal transition. Part II: To
investigate the relationship between symptom reporting and radiological
arthritis in postmenopausal women. Design Part I: The Melbourne Women's
Mid-life Health Project, commenced in 1991, is a population-based prospective
study of 438 Australian-born women, aged 45-55 years and menstruating at
baseline; they were interviewed annually over 8 years. The retention rate was
88% (n = 387). Part II: After 12 years of follow-up, 257 (57%) women returned
for assessment and 224 agreed to undergo X-rays of their hands and knees.
Methods Part I: Annual fasting blood collection, physical measurements, and
interviews including questions about bothersome aches or stiff joints in the
previous 2 weeks. A score for this symptom was calculated from the product of
the severity and frequency data. These data were analyzed using random-effects
time-series regression models. Part II: X-rays were scored for evidence of
osteoarthritis using a validated scale, by two investigators who were blinded
to questionnaire results. Results Part I: 'Aches and stiff joints' were the
most commonly reported symptom and reporting increased over time in the
longitudinal study. Variables significantly associated with reporting
bothersome aches and stiff joints were high body mass index (BMI) (p <
0.001), high negative mood (p < 0.01), not being employed (p < 0.001),
and experiencing the menopausal transition (p < 0.05). A higher severity and
frequency of this symptom were associated with BMI (p < 0.01), not being
employed (p < 0.05) and high negative mood (p < 0.005). Part II: The
relationship between radiological osteoarthritis and symptom reports approached
statistical significance (p = 0.06). Knee osteoarthritis was significantly
associated with symptom reports (p = 0.008) but not hand osteoarthritis (p =
0.2). Conclusion Menopausal status, BMI, employment status and depressed mood
were all associated with the experience of bothersome aches and stiff joints.
Aches and stiff joints, common in postmenopausal women, are not necessarily
indicative of radiological osteoarthritis.
Acta Med Port. 2007 Jul-Aug;20(4):299-306. Epub 2007 Nov 15.
Nutritional
intake and bone mineral density in female adolescents
Centro de Investigação
INTRODUCTION: Adolescence is a critical time in
skeletal development, during which the amount of bone gained along with the
subsequent rate of bone loss have a crucial impact on an individual's total
bone mass in adulthood and old age. Factors believed to influence bone
accretion and peak bone mass include adequate nutritional intake, namely for
calcium. However, the findings of several studies have raised questions about
the benefit of the total dietary calcium consumption for young adult bone
health. The objective of this study was to evaluate the association between
nutritional intake, namely calcium, and bone mineral density in female
teenagers. METHODS: The study design was a cross-sectional analysis and data
derived from a school-based survey of adolescents from high schools. In all,
the study sample included 254 female adolescents with ages between 15 and 17
years. The questionnaire was anonymous and confidential, and provided
information on the following variables: bone mineral density (BMD), evaluated
in the calcaneus by ultrasound through the Sahara Clinical Bone Sonometer from
Hologic; weight and height, measured according to international standards;
nutritional intake assessed by a food-frequency questionnaire developed by the
Epidemiology Department, Faculty of Medicine, University of Porto;
sociodemographic characteristics; age of first menstruation; regularity of
menstrual cycles; use of contraceptives and drugs; history of bone fractures;
smoking habits; and physical activity. In order to study the association
between nutritional intake and BMD, uni and multivariate regression analysis
(with adjustment for confounders, namely irregular menses, energy and protein
intake) was used. RESULTS: The following main results were reached: positive
and significant effects were found for calcium intake in BMD, even after
adjustment for confounders (ss = 0.003, 95% CI = 0.000 - 0.006, p = 0.031);
15.1% of adolescents showed t-scores that suggested osteopenia; mean calcium
intake (1229 +/- 778 mg/day) was lower than recommended for optimal bone
acquisition in achieving maximal peak bone mass. CONCLUSION: Calcium intake was
positively associated with BMD, but mean calcium intake was lower tan
recommended. It should be therefore important to assure good dietary habits and
adequate calcium intake in female adolescents for the development of peak bone
mass, and reducing the risk of osteoporosis later in life.
Cancer Epidemiol Biomarkers Prev. 2008
Jan;17(1):51-66
Full-term
Pregnancy Induces a Specific Genomic Signature in the Human Breast.
Russo J, Balogh GA, Russo IH; and the Fox Chase Cancer Center Hospital Network Participants.
Breast Cancer Research Laboratory,
Breast cancer risk has traditionally been linked to
nulliparity or late first full-term pregnancy, whereas young age at first
childbirth, multiparity, and breast-feeding are associated with a reduced risk.
Early pregnancy confers protection by inducing breast differentiation, which
imprints a specific and permanent genomic signature in experimental rodent
models. For testing whether the same phenomenon was detectable in the atrophic
breast of postmenopausal parous women, we designed a case-control study for the
analysis of the gene expression profile of RNA extracted from epithelial cells
microdissected from normal breast tissues obtained from 18 parous and 7
nulliparous women free of breast pathology (controls), and 41 parous and 8
nulliparous women with history of breast cancer (cases). RNA was hybridized to
cDNA glass microarrays containing 40,000 genes; arrays were scanned and the
images were analyzed using ImaGene software version 4.2. Normalization and statistical
analysis were carried out using Linear Models for Microarrays and GeneSight
software for hierarchical clustering. The parous control group contained 2,541
gene sequences representing 18 biological processes that were differentially
expressed in comparison with the other three groups. Hierarchical clustering of
these genes revealed that the combined parity/absence of breast cancer data
generated a distinct genomic profile that differed from those of the breast
cancer groups, irrespective of parity history, and from the nulliparous
cancer-free group, which has been traditionally identified as a high-risk
group. The signature that identifies those women in whom parity has been
protective will serve as a molecular biomarker of differentiation for evaluating
the potential use of preventive agents.
Climacteric. 2008
Feb;11(1):32-43
Frequency
and severity of vasomotor symptoms among peri- and postmenopausal women in the
Williams RE, Kalilani L, Dibenedetti DB, Zhou X, Granger AL, Fehnel SE, Levine KB, Jordan J, Clark RV.
Worldwide Epidemiology,
Objective To describe characteristics of vasomotor
symptoms, specifically daily frequency and severity, among women 40-65 years
old in the United States (US). Design A survey was completed by a nationally
representative sample of 4402 US women aged 40-65 years old. A questionnaire focusing
on menopausal symptoms was administered online in April 2005. Results The
prevalence of vasomotor symptoms was 79% in peri- and 65% in postmenopausal
women. Women with daily vasomotor symptoms had an average of 2.5 very
mild/mild, 2.6 moderate, 2.5 severe, and 1.4 very severe daytime hot flushes in
a typical day. Women with night sweats every night had an average of 2.4
moderate, 3.2 severe, and 2.7 very severe night sweats in a typical night.
Overall, 9% of peri- and 7% of postmenopausal women reported 7+ moderate to
very severe vasomotor symptoms in a typical day. Although some women reported
that symptoms were worse in the evening and in the summer, many women reported
they were consistent, both throughout the day and throughout the seasons of the
year. Conclusions The Menopause Epidemiology Study builds upon existing
literature by providing data on daily frequency and severity of vasomotor
symptoms. There are many women with frequent and severe vasomotor symptoms who
may benefit from treatment.
Climacteric. 2008
Feb;11(1):17-25
Effects of the addition of
methyltestosterone to combined hormone therapy with estrogens and progestogens
on sexual energy and on orgasm in postmenopausal women.
Penteado SR, Fonseca AM, Bagnoli VR, Abdo CH, Júnior JM, Baracat EC.
Department of Psychiatry,
Objective To evaluate the effect of the addition of
methyltestosterone to estrogen and progestogen therapy on postmenopausal sexual
energy and orgasm. Methods Sixty postmenopausal women in a stable relationship
with a partner capable of intercourse, and presenting sexual complaints that
appeared after menopause, were randomly divided into two groups: EP (n = 29)
received one tablet of equine estrogens (CEE) 0.625 mg plus medroxyprogesterone
acetate (MPA) 2.5 mg and one capsule of placebo; EP + A (n = 31) received one
tablet of CEE 0.625 mg plus MPA 2.5 mg and one capsule of methyltestosterone
2.0 mg; The treatment period was 12 months. The effects of treatment on sexual
energy were assessed using the Sexual Energy Change Scale. The ability to reach
orgasm in sexual relations with the partner was verified through monthly
calendars and by calculating the ratio between monthly frequency of orgasms in
sexual relations and monthly sexual frequency. Results There was a significant
relationship between improvement in level of sexual energy and the addition of
methyltestosterone to CEE/MPA treatment (p = 0.021). No significant effect on
orgasmic capacity was noted after the treatment period. Conclusion Addition of
methyltestosterone to CEE/MPA therapy may increase sexual energy, but might not
affect the ability to obtain orgasm in sexual relations.
BMJ. 2008 Jan 15 [Epub ahead of print
Vascular
events in healthy older women receiving calcium supplementation: randomised
controlled trial.
Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, Gamble GD, Grey A, Reid IR.
Department of Medicine, Faculty of Medical and Health
Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand.
OBJECTIVE: To determine the effect of calcium
supplementation on myocardial infarction, stroke, and sudden death in healthy
postmenopausal women. DESIGN: Randomised, placebo controlled trial. SETTING:
Academic medical centre in an urban setting in
Semana del 9 al 15 de Enero de 2008
ALERTA DE LA FDA (7 Enero de 2008)
La FDA
está destacando la posibilidad de dolor de hueso, articulaciones y/o
músculos (músculo esquelético) severo y algunas veces
incapacitante en pacientes tomando bisfosfonatos. A pesar de que el dolor
músculo esquelético severo está incluido en la
información para prescribir de todos los bisfosfonatos, la
asociación entre bisfosfonatos y dolor músculo esquelético
severo puede ser pasada por alto por los profesionales de la salud, retardando
el diagnóstico, prolongando el dolor y/o el deterioro, y haciendo
necesario el uso de analgésicos. El dolor músculo
esquelético severo puede ocurrir dentro de los primeros días,
meses o años después de iniciar un bisfosfonatos. Algunos
pacientes han reportado alivio complete de los síntomas
después de descontinuarlos bisfosfonatos, mientras que otros han
reportado resolución lenta o incompleta. Se desconocen los
factores de riesgo y la incidencia del dolor músculo esquelético
severo asociado con bisfosfonatos. Este dolor músculo esquelético
severo es en contraste con la respuesta de fase aguda caracterizada por fiebre,
escalofríos, dolor óseo, mialgias, y artralgias que algunas veces
acompaña a la administración inicial de bisfosfonatos
intravenosos y puede ocurrir con la exposición inicial a bisfosfonatos
orales una vez por semana o una vez por mes. Los síntomas relacionados
con la respuesta de fase aguda tienden a resolverse dentro de los primeros
días con el uso continuado del medicamento. Los profesionales de la
salud deben considerar si el uso de bisfosfonatos puede ser responsable de dolor
músculo esquelético severo en pacientes que presenten estos
síntomas y considerar la suspensión temporal o permanente del
medicamento. Esta información refleja el análisis de los datos
disponibles por la FDA concernientes a estos fármacos. La FDA intenta
actualizar éstos, cuando hay información o análisis
disponibles.
Am J Epidemiol. 2008 Jan 11 [Epub
ahead of print]
The Association
between In Utero Cigarette Smoke Exposure and Age at Menopause.
Strohsnitter WC, Hatch EE, Hyer M, Troisi R, Kaufman RH, Robboy SJ, Palmer JR, Titus-Ernstoff L, Anderson D, Hoover RN, Noller KL.
Department of Obstetrics and Gynecology,
Menopause onset, on average, occurs earlier among
women who smoke cigarettes than among women who do not smoke. Prenatal smoke
exposure may also influence age at menopause through possible effects on
follicle production in utero. Smoking information was obtained from the mothers
of 4,025 participants in the National Cooperative Diethylstilbestrol Adenosis
(DESAD) Project, a
Menopause. 2008 Jan 9 [Epub
ahead of print]
Vulvovaginal
atrophy is strongly associated with female sexual dysfunction among sexually
active postmenopausal women.
Levine KB, Williams RE, Hartmann KE.
Department of Epidemiology,
OBJECTIVE: The relationship between vulvovaginal
atrophy and female sexual dysfunction is unclear. We investigated this
association among sexually active postmenopausal women. DESIGN: The Menopause
Epidemiology Study is a cross-sectional, population-based study of women 40 to
65 years old in the
Osteoporos Int. 2008 Jan 11 [Epub
ahead of print]
Positive
effects of exercise on falls and fracture risk in osteopenic women.
Hourigan SR, Nitz JC, Brauer SG, O'Neill S, Wong J, Richardson CA.
Division of Physiotherapy, The
Exercise may affect osteopenic women at risk of falls
and fractures. A workstation approach to exercise was evaluated in a randomised
study of 98 women. The intervention group improved in measures of balance,
strength and bone density. This study supports a preventative exercise approach
that aims to reduce risk factors for fractures and falls, in women already at
risk, through balance training and weight-bearing activity. INTRODUCTION: The
objective of this study was to determine the effects of a workstation balance
training and weight-bearing exercise program on balance, strength and bone
mineral density (BMD) in osteopenic women. A single-blinded randomised
controlled trial (RCT) was undertaken for 20 weeks with measurements at
baseline and completion. MATERIALS AND METHODS: Ninety-eight (98) community-dwelling
osteopenic women aged 41-78 years were recruited through the
Results Probl Cell Differ. 2008 Jan 12 [Epub
ahead of print]
Structure
and Function of Ghrelin.
Molecular Genetics, Institute of Life Science, Kurume
University, Hyakunenkouen, Fukuoka, Japan.
The endogenous ligand for growth-hormone secretagogue
receptor (GHS-R) was purified from the stomach and we named it
"ghrelin", after a word root ("ghre") in
Proto-Indo-European languages meaning "grow", since ghrelin has
potent growth hormone (GH) releasing activity. In addition, ghrelin stimulates
appetite by acting on the hypothalamic arcuate nucleus, a region known to
control food intake. Ghrelin is orexigenic; it is secreted from the stomach and
circulates in the blood stream under fasting conditions, indicating that it
transmits a hunger signal from the periphery to the central nervous system.
Taking into account all these activities, ghrelin plays important roles for
maintaining growth hormone release and energy homeostasis in vertebrates. The
diverse functions of ghrelin raise the possibility of its clinical application
for GH deficiency, eating disorder, gastrointestinal disease, cardiovascular
disease, osteoporosis and aging, etc.
Int J Obes (Lond). 2008 Jan 8 [Epub
ahead of print]
Adipocytokine
and ghrelin levels in relation to cardiovascular disease risk factors in women at
midlife: longitudinal associations.
Wildman RP, Mancuso P, Wang C, Kim M, Scherer PE, Sowers MR.
1Department of Epidemiology and Population Health,
Background:There are limited data concerning the
relationships between changes in adipocytokines and cardiovascular disease
(CVD) risk factors.Objective:To examine the longitudinal associations between
leptin, adiponectin, resistin and ghrelin levels and CVD risk factor levels in
women at midlife.Design:Prospective, observational study.Subjects and
measurements:Leptin, adiponectin, resistin, ghrelin levels and CVD risk factors
were measured in specimens collected from 40 women at 3 points in time
corresponding to the pre-, peri- and postmenopause stages of their natural
menopause transition.Results:In longitudinal analyses adjusted for CVD risk
factors and leptin at the previous menopausal stage, aging, education, smoking
and physical activity, greater increases in leptin over the menopause
transition were associated with greater decreases in high-density lipoprotein
cholesterol (HDL-c) and greater increases in diastolic blood pressure, glucose,
insulin and insulin resistance (all P<0.05). Larger decreases in adiponectin
over the menopause transition were associated with greater increases in
systolic blood pressure, insulin and insulin resistance and with greater
decreases in HDL-c. Greater increases in ghrelin levels over the menopausal
transition were associated with greater low-density lipoprotein cholesterol
increases (P=0.014). Resistin was not associated with CVD risk factor
changes.Conclusion:There were significant adverse associations of adipocytokines
and ghrelin with multiple CVD risk factor changes in women across midlife.
Given that this time period is dynamic for CVD risk, these data underscore the
need for additional prospective studies.
J Clin Endocrinol Metab. 2008 Jan 8 [Epub
ahead of print]
Post-Menopausal
Women with a History of Irregular Menses and Elevated Androgen Measurements at High
Risk for Worsening Cardiovascular Event-Free Survival: Results from the
National Institutes of Health National Heart, Lung, and Blood Institute (NHLBI)
Sponsored Women's Ischemia Syndrome Evaluation (WISE).
Shaw LJ, Merz CN, Azziz R, Stanczyk FZ, Sopko G, Braunstein GD, Kelsey SF, Kip KE, Cooper-Dehoff RM, Johnson BD, Vaccarino V, Reis SE, Bittner V, Hodgson TK, Rogers W, Pepine CJ.
Division of Cardiology, Department of Medicine,
Background: Women with polycystic ovary syndrome
(PCOS) have a greater clustering of cardiac risk factors. However, the link
between PCOS and cardiovascular (CV) disease is incompletely described.
Objective: The aim of this analysis was to evaluate the risk of CV events in
390 postmenopausal women enrolled in the NIH-NHLBI sponsored Women's Ischemia
Syndrome Evaluation (WISE) study according to clinical features of PCOS.
Methods: A total of 104 women had clinical features of PCOS defined by a
premenopausal history of irregular menses and current biochemical evidence of
hyperandrogenemia. Hyperandrogenemia was defined as the top quartile of
androstenedione (>/=701 pg/ml), testosterone (T; >/=30.9 ng/dl), or free
T (>/=4.5 pg/ml). Cox proportional hazard model was fit to estimate CV death
or myocardial infarction (MI) (n = 55). Results: Women with clinical features
of PCOS were more often diabetic (p<0.0001), obese (p=0.005), had the
metabolic syndrome (p<0.0001), and more angiographic coronary artery disease
(CAD, p=0.04) compared to women without clinical features of PCOS. Cumulative
5-yr CV event-free survival was 78.9% for women with clinical features of PCOS
(n=104) versus 88.7% for women without clinical features of PCOS (n = 286)
(p=0.006). PCOS remained a significant predictor (p<0.01) in prognostic
models including diabetes, waist circumference, hypertension, and angiographic
CAD as covariates. Conclusion: Among postmenopausal women evaluated for
suspected ischemia, clinical features of PCOS are associated with more angiographic
coronary artery disease and worsening CV event-free survival. Identification of
postmenopausal women with clinical features of PCOS may provide an opportunity
for risk factor intervention for the prevention of CAD and CV events.
J Clin Oncol. 2008 Jan
10;26(2):279-82.
Is there
an association between meningioma and hormone replacement therapy?
Blitshteyn
S, Crook
JE, Jaeckle
KA.
Department of Neurology and Biostatistics Unit, Mayo
Clinic,
PURPOSE: Molecular and clinical observations suggest a
role of sex steroid hormones in the occurrence of meningioma. However, there is
limited and often conflicting data on the use of hormone replacement therapy
(HRT) as a possible risk factor for meningioma. The goal of this study was to
investigate whether there is an association between a diagnosis of meningioma
and either current or past HRT use in women. METHODS: We retrospectively
reviewed records in the Mayo Clinic Jacksonville electronic patient database
between 1993 and 2003 to identify women with a diagnosis of either symptomatic
or incidentally discovered, clinically silent meningioma. Records were also
searched to identify women with a documented history of either current or past
HRT use. RESULTS: Of the 355,318 women, ages 26 to 86, evaluated for any
medical issue, 18,037 (5%) were documented as current or past HRT users. A
total of 1,390 women with a history of symptomatic or incidentally discovered
meningiomas were identified, 156 (11%) of whom were either current or past HRT
users. A logistic regression analysis, adjusted for age, demonstrated a
positive association between a diagnosis of meningioma and HRT use, with an
odds ratio of 2.2 (95% CI, 1.9 to 2.6; P < .0001). The frequency of
meningioma in women with either current or past HRT use was
Osteoporos Int. 2008 Jan 8 [Epub
ahead of print]
Progression
of vascular calcifications is associated with greater bone loss and increased
bone fractures.
Naves
M, Rodríguez-García
M, Díaz-López
JB, Gómez-Alonso
C, Cannata-Andía
JB.
Bone and Mineral Research Unit, Instituto Reina
Sofía de Investigación, Hospital Universitario Central de Asturias,
Universidad de Oviedo, Oviedo, Spain.
In this prospective study, we found a positive
relationship between the prevalence of aortic calcifications and age. Aortic
calcifications at baseline were positively associated with osteoporotic
fractures. In addition, progression of aortic calcifications was also
positively associated with the rate of decline in BMD at lumbar spine.
INTRODUCTION: The aim of this study was to analyze the relationship between the
progression of abdominal aortic calcification and osteoporosis in a Spanish
cohort of men and women older than 50. METHODS: Men and women (n = 624) aged 50
and over underwent two lateral X-rays of thoracic and lumbar spine and a dual
X-ray absorptiometry (DXA) study at lumbar spine and hip, and were followed during
4 years. Abdominal aortic calcifications were classified as absent,
mild-moderate and severe. RESULTS: There was a positive relationship between
the prevalence of aortic calcifications and age. In both sexes, prevalent
severe aortic calcifications were positively associated with prevalent
osteoporotic fractures [odds ratio (OR) = 1.93 (1.02-3.65)]. The association
was stronger when only vertebral fracture was considered [OR = 2.45
(1.23-4.87)]. In addition, progression of aortic calcifications showed a
positive association with the rate of decline in bone mineral density (BMD) at
lumbar spine. CONCLUSIONS: Aortic calcifications at baseline were positively
associated with osteoporotic fractures. The progression of aortic
calcifications was also positively associated with the rate of decline in BMD
at lumbar spine.
Semana del
3 al 8 de Enero de 2008
Gynecol Obstet Fertil. 2008 Jan 3 [Epub
ahead of print]
Postmenopausal
malignant transformation of extragenital endometriosis. A case report.
Chung Fat B, Terzibachian JJ, Govyadovskiy A, Grisey A.
Service de gynécologie–obstétrique,
centre hospitalier de Belfort–Montbéliard, 14, rue de Mulhouse,
90016 Belfort cedex, France.
Malignant transformation of endometriosis is a rare
event. The ovaries are the most common sites reported in the literature.
Postmenopausal cancer arising in extragenital endometriosis is still more
exceptional. Hormone replacement therapy and perhaps, to a lesser extent,
Tamoxifen could be risk factors for the malignant transformation of
endometriosis. We herein report the case of a patient who has developed, after
11years of hormone replacement therapy, an extragenital endometrioid carcinoma
in the vesico-uterine pouch.
Am J Gastroenterol. 2008 Jan 2 [Epub
ahead of print]
Hormonal
Replacement Therapy After Menopause Is Protective of Disease Activity in Women
With Inflammatory Bowel Disease.
Mayo Clinic,
BACKGROUND AND AIMS: The nature of inflammatory bowel
disease (IBD) following menopause has not been previously studied. The aim of
this study was to characterize the effect of menopause on disease activity and
identify possible modifiers of disease activity. METHODS: This was a
retrospective study of women followed at the
Am J Clin Nutr. 2008
Jan;87(1):175-80.
Chocolate
consumption and bone density in older women.
Hodgson JM, Devine A, Burke V, Dick IM, Prince RL.
Royal Perth Hospital Unit, the University of Western
Australia School of Medicine and Pharmacology, Perth, Australia; Western
Australian Institute for Medical Research, Perth, Australia.
BACKGROUND: Nutrition is important for the development
and maintenance of bone structure and for the prevention of osteoporosis and
fracture. The relation of chocolate intake with bone has yet to be
investigated. OBJECTIVE: We investigated the relation of chocolate consumption
with measurements of whole-body and regional bone density and strength. DESIGN:
Randomly selected women aged 70-85 y (n = 1460) were recruited from the general
population to a randomized controlled trial of calcium supplementation and
fracture risk. We present here a cross-sectional analysis of 1001 of these
women. Bone density and strength were measured with the use of dual-energy
X-ray absorptiometry, peripheral quantitative computed tomography, and
quantitative ultrasonography. Frequency of chocolate intake was assessed with
the use of a questionnaire and condensed into 3 categories: <1 time/wk, 1-6
times/wk, >/=1 time/d. RESULTS: Higher frequency of chocolate consumption
was linearly related to lower bone density and strength (P < 0.05). Daily
(>/=1 times/d) consumption of chocolate, in comparison to <1 time/wk, was
associated with a 3.1% lower whole-body bone density; with similarly lower bone
density of the total hip, femoral neck, tibia, and heel; and with lower bone
strength in the tibia and the heel (P < 0.05, for all). Adjustment for
covariates did not influence interpretation of the results. CONCLUSIONS: Older
women who consume chocolate daily had lower bone density and strength.
Additional cross-sectional and longitudinal studies are needed to confirm these
observations. Confirmation of these findings could have important implications
for prevention of osteoporotic fracture.
Maturitas. 2008 Jan 3 [Epub
ahead of print]
The
medical management of menopause: A four-country comparison care in urban areas.
Sievert LL, Saliba M, Reher D, Sahel A, Hoyer D, Deeb M, Obermeyer CM.
Department of Anthropology, Machmer Hall, 240 Hicks
Way, UMass Amherst, Amherst, MA 01003-9278, USA.
OBJECTIVE: To compare the medical management of menopause
across urban areas in four countries which differ by level of income and degree
of medicalization. METHODS: Surveys of health providers who advise women on the
menopausal transition were carried out in
Cell Metab. 2008 Jan;7(1):7-10.
Bone
remodeling, energy metabolism, and the molecular clock.
Maine Medical Center Research Institute,
The adult skeleton is constantly renewed through bone
remodeling. Four recent papers (Baldock et al., 2007; Lee et al., 2007;
Lundberg et al., 2007; Sato et al., 2007) provide new insights into central and
peripheral control of this remodeling sequence. Two of the studies add to our
knowledge of the complex hypothalamic modulation of bone turnover mediated by
NMU and NPY via the sympathetic nervous system, while the other two focus on
the peripheral neural target, the osteoblast, and its regulation by
neuropeptides and osteocalcin. These findings support a new paradigm concerning
the regulation of bone remodeling and provide a foundation for novel approaches
to preventing osteoporosis.
Calcif Tissue Int. 2008 Jan 4 [Epub
ahead of print]
Dietary
Intake of Folate, but not Vitamin B(2) or B (12), Is Associated with Increased
Bone Mineral Density 5 Years after the Menopause: Results from a 10-Year
Follow-Up Study in Early Postmenopausal Women.
Rejnmark L, Vestergaard P, Hermann AP, Brot C, Eiken P, Mosekilde L.
The Osteoporosis Clinic, Department of Endocrinology
and Metabolism C, Aarhus Sygehus, Aarhus University Hospital, Aarhus Sygehus,
Tage-Hansens Gade 2, DK-8000, Aarhus C, Denmark, rejnmark@post6.tele.dk.
Folate, vitamin B(2) (riboflavin), and vitamin B(12
)may affect bone directly or through an effect on plasma homocysteine levels.
Previously, a positive association has been found between plasma levels and
bone mineral density (BMD) as well as risk of fracture. However, there are
limited data on whether dietary intakes affect bone. Our aim was to investigate
whether intake of folate, vitamin B(2,) and vitamin B(12), as assessed by food
records affects BMD and fracture risk. In a population-based cohort including
1,869 perimenopausal women from the Danish Osteoporosis Prevention Study,
associations between intakes and BMD were assessed at baseline and after 5
years of follow-up. Moreover, associations between intakes and 5- and 10-year
changes in BMD as well as risk of fracture were studied. Intakes of folate,
vitamin B(2), and vitamin B(12) were 417 (range 290-494) mug/day, 2.70 (range
1.70-3.16) mg/day, and 4.98 (range 3.83-6.62) mug/day, respectively, i.e.,
slightly above the intakes recommended by the United Nations Food and
Agriculture Organization. At year 5, but not at baseline, cross-sectional
analyses showed positive correlations between daily intake from diet and from
diet plus supplements of folate and BMD at the femoral neck (P < 0.01).
However, no associations were found between intakes and changes in BMD. During
10 years of follow-up, 360 subjects sustained a fracture. Compared with 1,440
controls, logistic regression analyses revealed no difference in intakes
between cases and controls. A high dietary intake of folate, but not vitamin
B(2) or B(12), exerts positive effects on BMD; but further studies are needed
to confirm this association.
J Vasc Surg. 2008
Jan;47(1):55-62.
The
relationship between serum levels of vascular calcification inhibitors and
carotid plaque vulnerability.
Kadoglou NP, Gerasimidis T, Golemati S, Kapelouzou A, Karayannacos PE, Liapis CD.
Department of Vascular Surgery, Medical School,
University of Athens, Athens, Greece; First Department of Internal Medicine,
"Hippokratio" General Hospital, Thessaloniki, Greece.
OBJECTIVE: Osteopontin (OPN) and osteoprotegerin (OPG)
are well-known vascular calcification inhibitors, which have been recently
demonstrated to correlate with inflammation and cardiovascular events
incidence. The aim of this cross-sectional study is to survey whether OPN and
OPG are involved in carotid plaque vulnerability. For this reason, we assessed
serum OPN and OPG levels in patients with carotid stenosis, and we explored
their relationship with carotid plaque echogenicity and subsequent
cerebrovascular ischemic events. METHODS: A total of 164 Whites were selected
from a large cohort of 297 subjects to participate. In particular, 114 patients
(61 men, 53 women), aged 55 to 80, had recently-diagnosed