Selección de Resúmenes de Menopausia
Agosto de 2007
Dr. Juan
Enrique Blümel - Departamento Medicina Sur. Universidad de Chile
Semana del 22 al 28 de Agosto de 2007
Lancet. 2007 Aug 25;370(9588):657-66.
Use of calcium or
calcium in combination with vitamin D supplementation to prevent fractures and
bone loss in people aged 50 years and older: a meta-analysis.
Tang
BM, Eslick GD, Nowson C,
Smith C, Bensoussan A.
Centre
for Complementary Medicine Research,
BACKGROUND:
Whether calcium supplementation can reduce osteoporotic fractures is uncertain.
We did a meta-analysis to include all the randomised trials in which calcium,
or calcium in combination with vitamin D, was used to prevent fracture and
osteoporotic bone loss. METHODS: We identified 29 randomised trials (n=63 897)
using electronic databases, supplemented by a hand-search of reference lists,
review articles, and conference abstracts. All randomised trials that recruited
people aged 50 years or older were eligible. The main outcomes were fractures
of all types and percentage change of bone-mineral density from baseline. Data
were pooled by use of a random-effect model. FINDINGS: In trials that reported
fracture as an outcome (17 trials, n=52 625), treatment was associated with a
12% risk reduction in fractures of all types (risk ratio 0.88, 95% CI
0.83-0.95; p=0.0004). In trials that reported bone-mineral density as an
outcome (23 trials, n=41 419), the treatment was associated with a reduced rate
of bone loss of 0.54% (0.35-0.73; p<0.0001) at the hip and 1.19%
(0.76-1.61%; p<0.0001) in the spine. The fracture risk reduction was
significantly greater (24%) in trials in which the compliance rate was high
(p<0.0001). The treatment effect was better with calcium doses of 1200 mg or
more than with doses less than 1200 mg (0.80 vs 0.94;
p=0.006), and with vitamin D doses of 800 IU or more than with doses less than
800 IU (0.84 vs 0.87; p=0.03). INTERPRETATION:
Evidence supports the use of calcium, or calcium in combination with vitamin D
supplementation, in the preventive treatment of osteoporosis in people aged 50
years or older. For best therapeutic effect, we recommend minimum doses of 1200
mg of calcium, and 800 IU of vitamin D (for combined calcium plus vitamin D
supplementation).
J Steroid Biochem Mol Biol. 2007 May 24; [Epub ahead of print]
Endogenous estrogen,
testosterone and progesterone levels in relation to breast cancer risk.
Channing
Laboratory, Department of Medicine, 181 Longwood Avenue, Harvard Medical School
and Brigham and Women's Hospital, MA 02115, United States; Department of
Epidemiology, Harvard School of Public Health, Boston, MA, United States.
Multiple
lines of evidence support a central role of hormones in the etiology
of breast cancer. In epidemiologic studies, considerable effort has focused on
delineating the role of endogenous hormones in risk of breast cancer among
postmenopausal women. Recently, substantial additional data has accrued from
prospective studies where endogenous hormones are measured in study subjects
prior to disease diagnosis. In this review, the epidemiologic evidence linking
sex steroids-estrogens, testosterone, and progesterone, specifically-with
subsequent risk of breast cancer in both premenopausal and postmenopausal women
is summarized. Overall, a strong positive association between breast cancer
risk and circulating levels of both estrogens and testosterone has now been
well confirmed among postmenopausal women; women with hormone levels in the top
20% of the distribution (versus bottom 20%) have a two- to three-fold higher
risk of breast cancer. Evidence among premenopausal women is more limited,
though increased risk associated with higher levels of testosterone is
consistent. However, both positive and null associations have been observed
with estrogens and progesterone and clearly more evaluation is needed.
J Basic Clin Physiol Pharmacol. 2007;18(2):115-27
Glucocorticoids and oxidative stress.
Bjelaković G, Beninati S, Pavlović D, Kocić G, Jevtović T, Kamenov B, Saranac LJ, Bjelaković B, Stojanović I, Banić J.
Glucocorticoids (GC) are used widely for
the treatment of patients with various disorders, including autoimmune
diseases, allergies, and lymphoproliferative
disorders. Glucocorticoid therapy is often limited by
several adverse reactions associated with GC excess. Excess GC can elicit a
variety of symptoms and signs, including growth retardation in children; immunosuppression; cardiovascular disorders like
hypertension and atherosclerosis; osteoporosis; myopathy;
and diabetes mellitus. Currently, attention is focused on oxidative stress as
one of the major determinants of endothelial dysfunction and cardiovascular
senescence. The main reason for all unwanted effects of GC is that dexamethasone induces the overproduction of reactive oxygen
species, causing dysregulation of physiological
processes. Humans and animals with GC-induced hypertension exhibit reduced
nitric oxide levels; patients with excess GC levels also suffer from depression
as a consequence of low levels of serotonin and melatonin. The common cofactor
for the production of these vasoactive molecules is tetrahydrobiopterin (BH4), which is required for nitric
oxide synthesis.
Gynecol Obstet
Invest. 2007 Aug 22;65(1):47-51 [Epub
ahead of print
Changes in Hemostatic Variables Induced by Estrogen Replacement
Therapy: Comparison of Transdermal and Oral
Administration in a Crossover-Designed Study.
Fait T, Vrablik M, Zizka Z, Kostirova M.
D. of Obstetrics and Gynecology, Faculty of
Medicine,
Aim:
The purpose of this study was to determine the changes of biochemical risk
factors for thromboembolisms using different
administration routes of early estrogen replacement
therapy. Methods: In a 12-week prospective, randomized crossover trial,
estradiol was administered orally (2 mg daily) or transdermally
(0.05 mg daily). Forty-five healthy early postmenopausal women were included
into the study within 12 weeks after hysterectomy and oophorectomy.
Forty-one women (age 49 +/- 6 years) completed the study, and their data were
analyzed. The hemocoagulation parameters were
determined prior to beginning of the study and at the end of each treatment
period, separated by a 1-week washout period. Results: After oral therapy, the
average tissue factor pathway inhibitor levels decreased statistically
significantly (p < 0.0001) from 87.5 +/- 39.1 to 68 +/-
37.49 ng/ml. The plaminogen activator
inhibitor-1 levels also decreased statistically significantly (p = 0.001) after
the oral estrogen therapy from 11.39 +/- 12.02 to 5.0
+/- 5.27 IU/l. These changes were also significant when compared with the nonsignificant changes after the transdermal
therapy. No significant changes occurred in the levels of D-dimers.
After both treatment methods, the antithrombin III
and fibrinogen levels decreased, but within their physiological ranges.
Conclusions: Oral administration of estrogen
statistically significantly reduced the tissue factor pathway inhibitor and plasminogen activator inhibitor-1 levels when compared with
the transdermal route. These changes cannot be
unambiguously considered risky, and the zero change of D-dimers
suggests that there was no activation of the coagulation cascade. We consider
the neutral effect of the transdermal therapy more
beneficial.
Adv Exp Med Biol. 2007;601:395-413
Therapeutic
potential of cannabinoid-based drugs.
Cannabinoid-based drugs modeled on cannabinoids
originally isolated from marijuana are now known to significantly impact the
functioning of the endocannabinoid system of mammals.
This system operates not only in the brain but also in organs and tissues in
the periphery including the immune system. Natural and synthetic cannabinoids are tricyclic terpenes, whereas the endogenous physiological ligands are eicosanoids. Several
receptors for these compounds have been extensively described, CB1 and CB2, and
are G protein-coupled receptors; however, cannabinoid-based
drugs are also demonstrated to function independently of these receptors. Cannabinoids regulate many physiological functions and
their impact on immunity is generally antiinflammatory
as powerful modulators of the cytokine cascade. This anti-inflammatory potency
has led to the testing of these drugs in chronic inflammatory laboratory
paradigms and even in some human diseases. Psychoactive and nonpsychoactive
cannabinoid-based drugs such as
Delta9-tetrahydrocannabinol, cannabidiol, HU-211, and
ajulemic acid have been tested and found moderately
effective in clinical trials of multiple sclerosis, traumatic brain injury,
arthritis, and neuropathic pain. Furthermore, although clinical trials are not
yet reported, preclinical data with cannabinoid-based
drugs suggest efficacy in other inflammatory diseases such as inflammatory
bowel disease, Alzheimer's disease, atherosclerosis, and osteoporosis.
Obesity
(Silver Spring). 2007 Aug;15(8):1980-7.
Extreme obesity
reduces bone mineral density: complementary evidence from mice and women.
Núñez NP, Carpenter CL, Perkins SN, Berrigan D, Jaque SV, Ingles SA, Bernstein L, Forman MR, Barrett JC, Hursting SD.
Division of Nutritional Sciences,
OBJECTIVE:
To evaluate the effects of body adiposity on bone mineral density in the
presence and absence of ovarian hormones in female mice and postmenopausal
women. RESEARCH METHODS AND PROCEDURES: We assessed percentage body fat, serum leptin levels, and bone mineral density in ovariectomized and non-ovariectomized
C57BL/6 female mice that had been fed various calorically dense diets to induce
body weight profiles ranging from lean to very obese. Additionally, we assessed
percentage body fat and whole body bone mineral density in 37 overweight and
extremely obese postmenopausal women from the Women's Contraceptive and
Reproductive Experiences study. RESULTS: In mice, higher levels of body
adiposity (>40% body fat) were associated with lower bone mineral density in
ovariectomized C57BL/6 female mice. A similar trend
was observed in a small sample of postmenopausal women. DISCUSSION: The
complementary studies in mice and women suggest that extreme obesity in
postmenopausal women may be associated with reduced bone mineral density. Thus,
extreme obesity (BMI > 40 kg/m(2)) may increase the
risk for osteopenia and osteoporosis. Given the obesity epidemic in the U.S.
and in many other countries, and, in particular, the rising number of extremely
obese adult women, increased attention should be drawn to the significant and
interrelated public health issues of obesity and osteoporosis.
J Clin Oncol. 2007 Aug 20; [Epub
ahead of print
Randomized
Dose-Ranging Trial of Tamoxifen at Low Doses in
Hormone Replacement Therapy Users.
Decensi A, Gandini S, Serrano D, Cazzaniga M, Pizzamiglio M, Maffini F, Pelosi G, Daldoss C, Omodei U, Johansson H, Macis D, Lazzeroni M, Penotti M, Sironi L, Moroni S, Bianco V, Rondanina G, Gjerde J, Guerrieri-Gonzaga A, Bonanni B.
Divisions
of Chemoprevention, Epidemiology and Biostatistics, Radiology, Pathology,
Laboratory Medicine, Preventive Gynecology, European
Institute of Oncology; Mangiagalli Clinic; Buzzi Hospital, Milan; Division of Gynecology,
University of Brescia, Brescia; Division of Medical Oncology, Galliera Hospital, Genoa, Italy; Hormone Laboratory, Haukeland Hospital, University of Bergen; and the Section
for Endocrinology, Institute of Medicine, University of Bergen, Bergen, Norway.
PURPOSE:
The combination of hormone replacement therapy (HRT) and low-dose tamoxifen may retain the benefits while reducing the risks
of either agent. We assessed the optimal biologic dose and schedule of tamoxifen in HRT users using surrogate end point biomarkers
and menopausal symptoms. Subjects and METHODS: Two hundred ten current or de
novo HRT users were randomly assigned to one of the following four arms: tamoxifen 1 mg/day and placebo/week, placebo/day and tamoxifen 10 mg/week, tamoxifen 5
mg/day and placebo/week, or both placebos for 12 months. The primary end point
was the change of plasma insulinlike growth factor 1
(IGF-I) through 12 months, and secondary end points were IGF-I/IGF binding
protein-3 (IGFBP-3) ratio, fibrinogen, antithrombin
III, C reactive protein, C-telopeptide, mammographic
percent density, and endometrial thickness. Endometrial proliferation was
assessed by Pipelle biopsy in superficial, deep glandular, and stromal
compartments after 12 months. RESULTS: Compared with placebo, IGF-I declined in
all tamoxifen arms (P = .005), with a greater change
on 5 mg/day (P = .019 v 10 mg/week or 1 mg/day). Tamoxifen
increased IGFBP-3 and lowered antithrombin-III, C reactive
protein, and mammographic density, with greater effects of 5 mg/day. Tamoxifen increased endometrial thickness but not Ki-67
expression, which was lower on 5 mg/day among the three doses. Menopausal
symptoms were not significantly worsened by tamoxifen.
CONCLUSION: Doses of tamoxifen </= 5 mg/day
modulate favorably biomarkers of breast
carcinogenesis and cardiovascular risk in HRT users with no increase of
endometrial proliferation and menopausal symptoms. A dose of 5 mg/day was the
most effective and has been selected for a phase III trial in HRT users.
Circulation. 2007 Aug 20; [Epub
ahead of print
Visceral and
Subcutaneous Adipose Tissue Volumes Are Cross-Sectionally
Related to Markers of Inflammation and Oxidative Stress. The
Pou KM, Massaro JM, Hoffmann U, Vasan RS, Maurovich-Horvat P, Larson MG, Keaney JF Jr, Meigs JB, Lipinska I, Kathiresan S, Murabito JM, O'donnell CJ, Benjamin EJ, Fox CS.
National Heart, Lung, and Blood Institute’s Framingham Heart Study,
BACKGROUND:
-Excess adiposity is associated with greater systemic inflammation. Whether
visceral adiposity is more proinflammatory than subcutaneous
abdominal adiposity is unclear. Methods and Results-We examined the relations
of abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue
(VAT), assessed by multidetector computerized
tomography, to circulating inflammatory and oxidative stress biomarkers in 1250
Framingham Heart Study participants (52% women; age 60+/-9 years). Biomarkers
were examined in relation to increments of SAT and VAT after adjustment for
age, sex, smoking, physical activity, menopause, hormone replacement therapy,
alcohol, and aspirin use; additional models included body mass index and waist
circumference. SAT and VAT were positively and similarly (with respect to
strength of association) related to C-reactive protein, fibrinogen,
intercellular adhesion molecule-1, interleukin-6, P-selectin,
and tumor necrosis factor receptor-2 (multivariable
model R(2) 0.06 to 0.28 [SAT] and 0.07 to 0.29 [VAT]). However, compared with
SAT, VAT was more highly associated with urinary isoprostanes
and monocyte chemoattractant
protein-1 (SAT versus VAT comparison: isoprostanes, R(2) 0.07 versus 0.10, P=0.002; monocyte
chemoattractant protein-1, R(2) 0.07 versus 0.08,
P=0.04). When body mass index and waist circumference were added to the models,
VAT remained significantly associated with only C-reactive protein (P=0.0003
for women; P=0.006 for men), interleukin-6 (P=0.01), isoprostanes
(P=0.0002), and monocyte chemoattractant
protein-1 (P=0.008); SAT only remained associated with fibrinogen (P=0.01).
Conclusions-The present cross-sectional data support an association between
both SAT and VAT with inflammation and oxidative stress. The data suggest that
the contribution of visceral fat to inflammation may not be completely
accounted for by clinical measures of obesity (body mass index and waist
circumference).
Osteoporos Int. 2007 Aug 15; [Epub
ahead of print
Intrauterine
programming of bone. Part 1:
Alteration of the osteogenic environment.
Lanham SA, Roberts C, Cooper C, Oreffo RO.
Bone and Joint Research Group, Developmental Origins of Health and
Disease,
Osteoporosis
is believed to partly be programmed in utero. Rat
dams were given a low protein diet during pregnancy and 135 offspring studied
at different ages. Bone biochemistry showed altered characteristics. Altered in
utero diet has consequences for later life.
INTRODUCTION: Epidemiological studies suggest skeletal growth is programmed
during intrauterine and early postnatal life. We have investigated this in a
rat model of maternal protein insufficiency. METHODS: Dams received either 18%
w/w (control) or 9% w/w (low protein) diet during pregnancy, and the offspring
were studied at selected time points (4, 8, 12, 16, 20, 47 weeks). RESULTS:
Alkaline phosphatase activity in controls reached
peak levels from
Osteoporos Int. 2007 Aug 18; [Epub
ahead of print
Intrauterine
programming of bone. Part 2:
Alteration of skeletal structure.
Lanham SA, Roberts C, Perry MJ, Cooper C, Oreffo RO.
Bone and Joint Research Group, Developmental Origins of Health and
Disease,
Osteoporosis is believed to be partly
programmed in utero. Rat dams were given a low
protein diet during pregnancy, and offspring were studied at different ages.
Old aged rats showed site-specific strength differences. In utero
nutrition has consequences in later life. INTRODUCTION: Epidemiological studies
suggest skeletal growth is programmed during intrauterine and early postnatal
life. We hypothesize that age-related decrease in bone mass has, in part, a fetal origin and investigated this using a rat model of
maternal protein insufficiency. METHODS: Dams received either 18% w/w (control)
or w/w 9% (low protein) diet during pregnancy, and the offspring were studied
at selected time points (4, 8, 12, 16, 20, 47, 75 weeks). RESULTS: Using
micro-CT, we found that at 75 weeks of age female offspring from mothers fed a
restricted protein diet during pregnancy had femoral heads with thinner, less
dense trabeculae, femoral necks with closer packed trabeculae, vertebrae with thicker, denser trabeculae and midshaft tibiae
with denser cortical bone. Mechanical testing showed the femoral heads and midshaft tibiae to be structurally weaker, whereas the
femoral necks and vertebrae were structurally stronger. CONCLUSIONS: Offspring
from mothers fed a restricted protein diet during pregnancy displayed
significant differences in bone structure and density at various sites. These
differences result in altered bone characteristics indicative of significantly
altered bone turnover. These results further support the need to understand the
key role of the nutritional environment in early development on programming of
skeletal development and consequences in later life.
Semana del 15 al 21 de
Agosto 2007
Osteoporos Int. 2007 Aug 17; [Epub ahead of print]
Relationships between insulin-like growth
factor-I (IGF-I) and OPG, RANKL, bone mineral density in healthy Chinese women.
Zhao HY, Liu JM, Ning G, Zhao YJ, Chen Y, Sun LH, Zhang LZ, Xu MY, Chen JL.
Serum IGF-I level was negatively
correlated with OPG and OPG/RANKL ratio, but positively correlated with RANKL.
Serum OPG level in the highest quintile of IGF-I was significantly lower than
that in the lowest. We conclude that the effect of IGF-I on bone remodeling may be mediated by the OPG/RANKL system.
INTRODUCTION: Insulin-like growth factor I (IGF-I) is an important factor in
coupling bone remodeling, activating both formation
and resorption. Compared with the many studies on the
role of IGF-I in bone formation, the information regarding its effects on bone resorption is limited and conflicting. The balance of the
two peptides produced by osteoblasts, osteoprotegerin (OPG) and receptor activator of nuclear
factor-kappaB ligand (RANKL), is critical for the bone resorption
process. Our study was designed to analyze the relationships of serum
concentrations of IGF-I with OPG, RANKL, OPG/RANKL ratio as well as BMDs in
healthy Chinese women. METHODS: BMDs at lumbar spine and proximal femur in 504
pre- and postmenopausal women were measured by DXA. Serum levels of IGF-I, OPG
and RANKL were also measured. Pearson's correlation and partial correlation
analysis, ANOVA, covariance analysis and stepwise multiple regression analysis
were used as appropriate. RESULTS: Age was negatively correlated with serum
levels of IGF-I (r = -0.702, p < 0.001). IGF-I was negatively correlated
with OPG and OPG/RANKL ratio, but positively correlated with RANKL. The
relationship between IGF-I and BMDs disappeared after adjustment for age. In
postmenopausal women, IGF-I was lower in women with osteoporosis than in those
with normal BMD (p = 0.056), but no differences were found among OPG, RANKL and
OPG/RANKL ratio. Serum levels of OPG in the highest quintile of IGF-I were
significantly lower than those in the lowest quintile of IGF-I, while no
difference was found in RANKL. In the multiple regression analysis model, serum
levels of IGF-I were the main determinants of the bone mass in Chinese women.
CONCLUSIONS: In conclusion, the relationship between decreasing IGF-I and BMDs
in healthy Chinese women influenced by age, whereas the effect of IGF-I on bone
remodeling (bone resorption)
may be mediated by the OPG/RANKL system.
Breast Cancer Res. 2007 Aug 13;9(4):R53 [Epub
ahead of print
No relationship between circulating levels of sex steroids and breast
density: the prospect-EPIC cohort.
Verheus M, Peeters PH, van Noord PA, van der Schouw YT, Grobbee DE, van Gils CH.
BACKGROUND: High breast
density is associated with increased breast cancer risk. Epidemiologic studies
have shown an increase in breast cancer risk in postmenopausal women with high
levels of sex steroids. Hence, sex steroids may increase postmenopausal breast
cancer risk via an increase of breast density. The objective was to study the
relation between circulating estrogens and androgens as well as sex hormone
binding globulin (SHBG) in relation to breast density. METHODS: We conducted a
cross-sectional study among 969 postmenopausal women, using baseline data of a
random sample of the Prospect-EPIC study. Prospect-EPIC is one of two Dutch
cohorts participating in the European Prospective Investigation into Cancer and
Nutrition (EPIC), and women were recruited via a breast cancer screening programme. At enrolment, a non-fasting blood sample was
taken and a mammogram was made. Estrone, estradiol, dehydroepiandrosterone
sulfate, androstenedione, testosterone and SHBG
levels were measured, using double-antibody radioimmunoassays.
Concentrations of free estradiol and free testosterone were calculated from
estradiol, testosterone and SHBG. Mammographic dense and non-dense areas were
measured using a semi quantitative computerized method and percent breast
density was calculated. Mean breast measures for quintiles of hormone or SHBG
levels were estimated using linear regression analyses. RESULTS: None of the
estrogens or androgens showed clear relationships with percent breast density
or the dense breast area, but all, except free testosterone, were inversely
associated with the non-dense area (for free estradiol; 93.5 cm2 in the highest
versus 99.4 cm2 in the lowest quintile, Ptrend=0.09).
High levels of SHBG were weakly associated with higher dense area and with
higher percent density. CONCLUSION: The results of our study do not support the
hypothesis that sex steroids increase postmenopausal breast cancer risk via an
increase in breast density.
J Obstet Gynaecol. 2007 Jul;27(5):503-5
Can thyroid
dysfunction explicate severe menopausal symptoms?
Departments of
Obstetrics and Gynecology.
Many of the menopausal
manifestations look like those accredited to thyroid hyperfunction
or hypofunction. Can thyroid dysfunction explicate
severe menopausal symptoms? The study comprised 350 women with different
menopausal symptoms. All women had serum TSH, T3 and free T4 estimated. Women
with thyroid dysfunction were appropriately treated and other women were
treated with ERT. The study showed that 21 women (6%) had hypothyroidism and 18
(5.1%) had hyperthyroidism. Marked improvement in the menopausal-like symptoms
occurred after treatment of the thyroid dysfunction. Elderly women with severe
or resistant menopausal symptoms can be offered TSH, T3 and T4 assays to rule
out the thyroid disturbances before attempting hormone replacement therapy.
Gynecol Endocrinol. 2007 Jul;23(7):398-403
Comparison
of the effects of raloxifene and low-dose hormone
replacement therapy on bone mineral density and bone turnover in the treatment
of postmenopausal osteoporosis.
Dane C, Dane B, Cetin A, Erginbas M.
Department of Gynecology & Obstetrics,
The aim of the present study
was to compare the effects of raloxifene and low-dose
hormone replacement therapy (HRT) on bone mineral density (BMD) and bone
turnover markers in the treatment of postmenopausal osteoporosis. Methods. Forty-two postmenopausal osteoporotic women, who
were randomized to receive raloxifene 60 mg or estradiol 1 mg/norethisterone
acetate 0.5 mg daily for 1 year, were studied. All women received calcium 600
mg/day and vitamin D 400 IU/day. BMD and markers of bone turnover were measured
at baseline and at 12 months. Results. After 12 months
of treatment, there were statistically significant increases in BMD in both
groups at all sites (all p < 0.05). For the lumbar spine, the increase in
BMD was 2.3% for raloxifene compared with 5.8% for
low-dose HRT and corresponding values for total body BMD were 2.9% for raloxifene and 4.6% for low-dose HRT; the increases being
significantly greater in the low-dose HRT group (p < 0.001 and p = 0.02,
respectively). Although the increase in BMD at the hip was significant for both
raloxifene (2.1%) and low-dose HRT (3.2%) compared
with baseline, the difference between the two regimens did not reach
statistical significance. The decrease in serum C-terminal telopeptide
fragment of type I collagen and serum osteocalcin
levels for the low-dose HRT group (-53% and -47%, respectively) was
significantly greater than for the raloxifene group
(-23% and -27%, respectively; both p < 0.01). Conclusions.
In postmenopausal women with osteoporosis, low-dose HRT produced significantly
greater increases in BMD of the lumbar spine and total body and greater
decreases in bone turnover than raloxifene at 12
months.
Gynecol Endocrinol. 2007 Jul;23(7):391-7
Breast cancer incidence and hormone replacement therapy: Results from
the
Espié M, Daures JP, Chevallier T, Mares P, Micheletti MC, de Reilhac P.
Hôpital Saint-Louis, Paris, France.
Background. The MISSION Study
(Menopause: Risk of Breast Cancer, Morbidity and Prevalence) is a
historical-prospective study with random patient selection to determine breast
cancer incidence in postmenopausal women with or without hormone replacement
therapy (HRT). The first prospective follow-up phase started on
Diabetologia. 2007 Aug 14; [Epub ahead of print
Plasma sex steroid hormones and risk of developing type 2 diabetes in
women: a prospective study.
Ding EL, Song Y, Manson JE, Rifai N, Buring JE, Liu S.
Division of
Preventive Medicine, Department of Medicine,
AIMS/HYPOTHESIS: Prospective
data directly investigating the role of endogenous sex hormones in diabetes
risk have been scant, particularly in women. We aimed to examine
comprehensively plasma sex hormones in connection with risk of developing type 2 diabetes in postmenopausal women. METHODS: We conducted a
prospective, nested case-control study of plasma oestradiol,
testosterone and dehydroepiandrosterone sulfate and risk of type 2 diabetes in a cohort of women
health professionals with a mean age of 60.3 and 12.2 years since menopause.
Among women not using hormone therapy and free of baseline cardiovascular
disease, cancer and diabetes, 359 incident cases of type 2 diabetes were
matched with 359 controls during an average follow-up of 10 years. RESULTS: Oestradiol and testosterone were each strongly and
positively associated with risk of type 2 diabetes. After adjustment for BMI,
family history, lifestyle and reproductive variables, the multivariable
relative risks (95% CI) comparing the highest vs lowest
quintile were 12.6 (2.83-56.3) for total oestradiol
(p = 0.002 for trend), 13.1 (4.18-40.8) for free oestradiol
(p < 0.001 for trend), 4.15 (1.21-14.2) for total testosterone (p = 0.019
for trend) and 14.8 (4.44-49.2) for free testosterone (p < 0.001 for trend).
These associations remained robust after adjusting and accounting for other
metabolic syndrome components and baseline HbA(1c) levels.
CONCLUSIONS/INTERPRETATION: In postmenopausal women, higher plasma levels of oestradiol and testosterone were strongly and prospectively
related to increased risk of developing type 2 diabetes.
These prospective data indicate that endogenous levels of sex hormones may play
important roles in the pathogenesis of type 2 diabetes.
Aging Male. 2007 Sep;10(3):139-53
Testosterone therapy in the aging male.
Faculty of Life
Sciences,
The decline, with aging, in
serum concentrations of biologically active forms of testosterone in men is an
indisputable fact and some men will eventually develop symptoms of late-onset hypogonadism (LOH) with its clinical consequences. LOH
reduces quality of life and may pose important risk factors for frailty,
changes in body composition, cardiovascular disease, sexual dysfunction and
osteoporosis. Testosterone supplementation in cases of LOH will restore serum
testosterone levels into the physiologic range; will restore metabolic parameters
to the eugonadal state, increase muscle mass,
strength, and function; maintaine or improve BMD
reducing fracture risk; will improve neuropsychological function (cognition and
mood); libido and sexual functioning; and enhance quality of life. The ultimate
goals, however, are to maintain or regain a high quality of life, to reduce
disability, to compress major illnesses into a narrow age range and to add life
to years. To achieve these goals men must also adjust their lifestyle to
optimize dietary habits, as well as to exercise and to abstain from smoking
life-long. Monitoring these patients is a shared responsibility that cannot be
taken lightly. The physician must emphasize to the patient the need for
periodic evaluations and the patient must agree to comply with these
requirements. The physician's evaluation should include an assessment of the
clinical response and monitoring must be tailored to the indications and
individual needs of the patient.
J Natl Cancer Inst. 2007 Aug 14; [Epub
ahead of print
Declines in Invasive Breast Cancer and Use
of Postmenopausal Hormone Therapy in a Screening Mammography Population.
Kerlikowske K, Miglioretti DL, Buist DS, Walker R, Carney PA.
Affiliations of authors:
Department of Epidemiology and Biostatistics, University of California, San
Francisco, CA (KK); General Internal Medicine Section, Department of Veterans
Affairs, University of California, San Francisco, CA (KK); Group Health Center for Health Studies, Seattle, WA (DLM, DSMB, RW);
Department of Biostatistics, University of Washington, Seattle, WA (DLM, RW);
Departments of Family Medicine and Public Health & Preventive Medicine,
Oregon Health and Science University, Portland, OR (PAC).
Whether a recent large decline
in use of postmenopausal hormone therapy after the release of the Women's
Health Initiative findings in July 2002 and/or a decline in screening
mammography use is related to a recently reported
decline in breast cancer incidence in the
J Clin Endocrinol Metab. 2007 Aug
14; [Epub ahead of print
Prevalence of Symptomatic Androgen
Deficiency in Men.
Araujo AB, Esche GR, Kupelian V, O'donnell AB, Travison TG, Williams RE, Clark RV, McKinlay JB.
Context: Despite recognition
that androgen deficiency in men should be defined according to biochemical and
clinical criteria, most prevalence estimates are based on low testosterone
levels alone. Objective: To examine the association between symptoms of
androgen deficiency and low total and calculated free testosterone levels and
estimate the prevalence of symptomatic androgen deficiency in men. Design:
Population-based, observational survey. Participants: 1,475 Black, Hispanic,
and White Boston randomly-selected men from the Boston Area Community Health
(BACH) Survey, between the ages of 30-79 years, with complete data on
testosterone, sex hormone-binding globulin, and symptoms of androgen
deficiency, and who are not taking medications that impact sex steroid levels.
Outcome: Symptomatic androgen deficiency, defined as low total (<300 ng/dL)
and free (<5 ng/dL)
testosterone plus presence of low libido, erectile dysfunction, osteoporosis or
fracture, or two or more of following symptoms: sleep disturbance, depressed
mood, lethargy, or diminished physical performance. Results: Mean age of the
sample was 47.3+/-12.5 y. Approximately 24% of
subjects had total testosterone <300 ng/dL and 11% of subjects had free testosterone <5 ng/dL. Prevalence of symptoms were as follows: low libido (12%), erectile dysfunction
(16%), osteoporosis/fracture (1%), and two or more of the non-specific symptoms
(20%). Low testosterone levels were associated with symptoms, but many men with
low testosterone levels were asymptomatic (e.g., in men 50+ years, 47.6%).
Crude prevalence of symptomatic androgen deficiency was 5.6% (95% CI: 3.6%,
8.6%), and was not significantly related to race and ethnic group. Prevalence
was low in men <70 y (3.1%-7.0%), and increased markedly with age to 18.4%
among 70-year-olds. Projection of these estimates to the year 2025 suggests
that there will be as many as 6.5 million American men 30-79 years with
symptomatic androgen deficiency, an increase of 38% from 2000 population
estimates. Conclusions: Prevalence of symptomatic androgen deficiency in men 30
and 79 y of age is 5.6%, and increases substantially with age. The aging of the
Arch Intern Med. 2007 Aug 13-27;167(15):1676-85
A prospective study of inflammatory
cytokines and diabetes mellitus in a multiethnic cohort of postmenopausal
women.
Liu S, Tinker L, Song Y, Rifai N, Bonds DE, Cook NR, Heiss G, Howard BV, Hotamisligil GS, et al
Department of
Epidemiology,
BACKGROUND: Inflammatory
cytokines, including tumor necrosis factor alpha,
IL-6 (interleukin 6), and high-sensitivity C-reactive protein (hsCRP), have been related to both insulin resistance and
type 2 diabetes mellitus. However, prospective studies that comprehensively
assess their roles in the development of type 2 diabetes are few, especially in
minority populations. METHODS: Among 82,069 postmenopausal women aged 50 to 79
years without cardiovascular disease or diabetes mellitus who participated in
the Women's Health Initiative Observational Study, we prospectively examined
the relationships of plasma levels of tumor necrosis
factor alpha receptor 2, IL-6, and hsCRP to diabetes
risk. During a median follow-up period of 5.9 years, 1584 women who had
clinical diabetes were matched by age, ethnicity, clinical center,
time of blood draw, and duration of follow-up to 2198 study participants who
were free of the disease. RESULTS: After adjustment for matching factors and
known diabetes risk factors, all 3 markers were significantly associated with
increased diabetes risk; the estimated relative risks comparing the highest
with the lowest quartiles were 1.47 (95% confidence interval [CI], 1.10-1.97)
for tumor necrosis factor alpha receptor 2, 3.08 (95%
CI, 2.25-4.23) for IL-6, and 3.46 (95% CI, 2.50-4.80) for hsCRP
(P for trend, <.01 for all biomarkers). When mutually adjusted, IL-6 and hsCRP remained significant in each ethnic group. While no
statistically significant interactions were observed between ethnicity and
these biomarkers on diabetes risk, there were consistent trends for the
associations of hsCRP and IL-6 with increased
diabetes risk in all ethnic groups. CONCLUSION: These prospective data showed
that elevated levels of IL-6 and hsCRP were
consistently and significantly associated with an increased risk of clinical
diabetes in postmenopausal women.
Am J Epidemiol. 2007 Aug 13; [Epub ahead of print
Differential Dietary Nutrient Intake according to Hormone Replacement
Therapy Use: An Underestimated Confounding Factor in Epidemiologic Studies?
Vercambre MN, Fournier A, Boutron-Ruault MC, Clavel-Chapelon F, Ringa V, Berr C.
INSERM, ERI 20, EA
4045, and Institut Gustave Roussy,
Observational studies and
randomized controlled trials have produced divergent results concerning the
effect of hormone replacement therapy (HRT) on cardiovascular disease and, to a
lesser extent, dementia. Residual confounding (confounding that remains even
after adjustment for various socioeconomic and lifestyle factors) is one
explanation that has been offered for these divergent results. The authors used
data collected between 1990 and 1995 from 6,697 French women aged 61-72 years
participating in a prospective cohort study to explore the hypothesis that
nutritional intake varies according to HRT use and thus may be a source of
residual confounding. After the authors adjusted for health and lifestyle
factors, HRT users, compared with never users, had significantly higher intakes
of alcohol; omega3 fatty acids; vitamins B(6), B(12), and D; and phosphorus and
a lower intake of starch. These differential nutrient intakes were related to
differences in eating habits. In particular, HRT users in the studied sample,
compared with nonusers, ate significantly more fish. Most of the dietary
differences were seen in both early users and delayers of HRT. To limit
residual confounding in observational studies, dietary factors may be important
parameters to be taken into account in analyses of HRT use and health outcomes.
Metabolism. 2007 Sep;56(9):1159-66
Measuring insulin sensitivity in postmenopausal women covering a range
of glucose tolerance: comparison of indices derived from the oral glucose
tolerance test with the euglycemic-hyperinsulinemic
clamp.
Piché ME, Lemieux S, Corneau L, Nadeau A, Bergeron J, Weisnagel SJ.
Institute of Nutraceuticals and Functional Foods,
This study compares indices of
insulin sensitivity derived from fasting and oral glucose tolerance test (OGTT)
glucose and insulin measurements, with respect to the reference measure (M/I),
obtained from the euglycemic-hyperinsulinemic clamp,
in postmenopausal women with varying glucose tolerance status. Fasting plasma
insulin index, homeostasis model assessment index, and OGTT-derived indices
(insulin 120-minute, Matsuda, metabolic clearance rate [MCR] of glucose,
insulin sensitivity [ISI], and Cederholm indices)
were calculated and compared with the M/I value in 112 postmenopausal women.
All indices examined were significantly correlated with M/I (0.28 </= r(2) </= 0.56). Association studies revealed that on
average, 48% of women were grouped in the same tertile
of insulin sensitivity when using M/I and fasting plasma insulin index, and 54%
when using M/I and insulin 120-minute index. However, concordance with M/I tertiles were 57%, 58%, 64%, 64%, and 68% for homeostasis
model assessment, Matsuda, MCR, ISI, and Cederholm
indices, respectively. Finally, correlation coefficients between M/I and
insulin sensitivity indices were generally lower in women with normal glucose
tolerance compared with women with impaired glucose tolerance or type 2
diabetes mellitus. These results suggest that in postmenopausal women,
surrogate indices of insulin sensitivity obtained from OGTT data and
incorporating a measurement of body weight or body mass index) (Cederholm, ISI, and MCR indices) appear to be superior to
those without OGTT data or body weight-body mass index measurements and,
therefore, could offer a better estimate of insulin sensitivity, allowing an
improved clinical evaluation of this population at higher risk of
cardiovascular disease and type 2 diabetes mellitus.
Ann Epidemiol. 2007 Aug 11; [Epub ahead of print
Socioeconomic Position and the Metabolic Syndrome in Early, Middle, and
Late Life: Evidence from NHANES 1999-2002.
Loucks EB, Magnusson KT, Cook S, Rehkopf DH, Ford ES, Berkman LF.
PURPOSE: To evaluate whether there
is an association between socioeconomic position (SEP) and the metabolic
syndrome at various ages, including adolescent, middle-aged and older
participants in gender-specific analyses. METHODS: Participants were from the
1999-2002 National Health and Nutrition Examination Survey. SEP was measured by
income and years of education. Metabolic syndrome was measured in adults using
the American Heart Association guidelines and in adolescents using methods
based on national reference data. Cross-sectional multivariable-adjusted
logistic regression analyses were performed. RESULTS: In women aged 25 to 45
and 46 to 65 years, income below the poverty line (poverty income ratio [PIR]
less than one) was associated with higher odds of metabolic syndrome compared with
PIR greater than 3 (odds ratio [OR] = 4.90; 95% confidence interval (CI) =
2.24, 10.71, and OR = 2.54; CI = 1.38, 4.67, for the respective age groups)
after adjustment for age, race/ethnicity, and menopause. Similar findings were
observed for educational attainment. In adolescents, older adults (aged >65
years), and males, income and education were not related to the metabolic
syndrome. CONCLUSIONS: This report demonstrates that SEP is associated with the
metabolic syndrome in females aged 25 to 65 years and is less strongly
associated in males, adolescents, or older participants. These findings provide
physiologic mechanistic evidence linking SEP to risk for coronary heart
disease.
Menopause. 2007 Aug 9;Publish Ahead of Print [Epub ahead of print]
Association of pelvic organ prolapse and
fractures in postmenopausal women: analysis of baseline data from the Women's
Health Initiative Estrogen Plus Progestin trial.
Medical
OBJECTIVE::
Testing a hypothesis that pelvic organ prolapse (POP)
is a focal manifestation of disordered connective tissue, we evaluated whether
there is an association between POP and history of fracture. DESIGN:: This was a case-control study. Baseline data were from
postmenopausal women aged 60 years or older enrolled in the Women's Health
Initiative Estrogen Plus
Progestin trial. Distinct variants (cystocele, rectocele, and uterovaginal) and
severity (mild, moderate, or severe) of POP were recognized. A history of
"fracture after age 55" was considered as the event of interest.
RESULTS:: Moderate to severe POP was identified in 9%
of 11,096 participants aged 60 years or older. Women with moderate to severe rectocele were significantly more likely to report fracture
(odds ratio: 1.37, 95% CI: 1.06-1.77, P = 0.02) compared with those with absent
to mild prolapse. Of the subset of participants who
underwent bone mineral density assessment, those with moderate to severe prolapse demonstrated significantly lower whole-body bone
mineral density (beta = -0.03, SE 0.02); this difference was of borderline
significance (P = 0.05) compared with that for participants with absent to mild
POP. Multivariate logistic regression analysis confirmed an independent
association between moderate to severe rectocele and
fracture (odds ratio: 1.45, 95% CI: 1.08-1.95, P = 0.01). CONCLUSIONS:: We demonstrate a relationship between moderate to severe
POP and low bone mineral density in postmenopausal women enrolled in the
Women's Health Initiative Estrogen Plus Progestin
trial. Our findings of an association between clinically significant (moderate
to severe) POP, specifically rectocele, and a history
of fracture suggest that suboptimal collagen status purported to associate with
POP may also involve bone collagen and hence translate into skeletal
compromise.
Semana del 8 al 14 de
Agosto
Am J Obstet Gynecol. 2007 Aug;197(2):139.e1-7.
Long-term use of postmenopausal estrogen
and progestin hormone therapies and the risk of endometrial cancer.
Doherty JA, Cushing-Haugen
KL, Saltzman
BS, Voigt LF, Hill DA, Beresford
SA, Chen C, Weiss NS.
Program in Epidemiology,
Division of Public Health Sciences,
OBJECTIVE: The purpose of this
study was to assess whether endometrial cancer risk among long-term users of
(1) sequential estrogen plus progestin 10-24 days per month exceeds that of
nonusers and (2) daily estrogen plus progestin (continuous combined hormone
therapy) is below that of nonusers. STUDY DESIGN: In this population-based
case-control study with 1038 endometrial cancer cases diagnosed in 1985-1999 and
1453 control subjects, exclusive users of a single form of hormone therapy were
compared with never users of hormone therapy. RESULTS: For sequential therapy,
only long-term use (> or = 6 years) was associated with increased risk (odds
ratio, 2.0; 95% CI, 1.2-3.5). Continuous combined therapy was associated with
decreased risk (odds ratio, 0.59; 95% CI, 0.40-0.88), with no increased risk
among long-term users (odds ratio, 0.77; 95% CI, 0.45-1.3). CONCLUSION: These
results support the hypotheses that continuous combined therapy does not
increase (and may decrease) endometrial cancer risk and that long-term
sequential therapy can lead to a modest increased risk. However, the collective
results of all studies of these questions and their clinical implications
remain unclear.
Am J Obstet Gynecol. 2007 Aug;197(2):137.e1-7.
Body composition
during treatment with conjugated estrogens with and without medroxyprogesterone
acetate: analysis of the women's Health, Osteoporosis, Progestin, Estrogen
(HOPE) trial.
Thorneycroft
IH, Lindsay R, Pickar JH.
Department of
Obstetrics and Gynecology,
OBJECTIVE: The objective of
the study was to determine the effects of several doses of conjugated estrogens
(CE) and CE plus medroxyprogesterone acetate (MPA) on
body composition (BC). STUDY DESIGN: This was a randomized, double-blind,
placebo-controlled substudy of the Women's Health,
Osteoporosis, Progestin, Estrogen (HOPE) trial. Healthy women (n = 822, 1-4
years after menopause) were randomly assigned to receive the following
treatments daily for 2 years: CE, 0.625 mg; CE, 0.625 mg, and MPA, 2.5 mg; CE,
0.45 mg; CE, 0.45 mg, and MPA, 2.5 mg; CE, 0.45 mg, and MPA, 1.5 mg; CE, 0.3
mg; CE, 0.3 mg, and MPA, 1.5 mg; or placebo. Body weight (BW) was assessed
every 3-4 cycles and fat body mass (FBM), lean body mass (LBM), and percent
body fat (PBF) at cycles 6, 13, 19, and 26. RESULTS: In the placebo group, BW,
FBM, and PBF increased at each visit during the study. Changes in these
parameters were smaller in the active groups. These effects were independent of
CE dose and the presence of MPA. Changes in LBM were small and comparable
across groups. CONCLUSION: Treatment with CE or CE and MPA for up to 2 years
does not affect BC.
Am J Obstet Gynecol. 2007 Aug;197(2):134.e1-6.
Transdermal hormonal contraception: benefits and
risks.
Department of
Obstetrics and Gynecology,
Transdermal drug delivery
systems have been available in the
Ortop Traumatol
Rehabil. 2001 Sep 30;3(3):338-44.
The most common errors in the densitometric diagnosis of osteoporosis.
Katedra i Oddział Kliniczny Ortopedii, Slaska Akademia Medyczna,
A review of world literature on
the subject indicates that, given the present state of our knowledge, and the
technological possibilities and availability of the apparatus, the most useful
method for the evaluation of bone metabolism, especially the diagnosis of
osteoporosis, is dual energy X-ray absorptiometry
(DEXA). However, this method is not free of errors that can exert a negative
impact on the final results of examination. On the basis of heir own
experience, the authors have presented here the most common errors encountered
in the densitometric technique. A DPV-L densitometric apparatus (Lunar Corporation) was used in
this research. Errors in densitometric testing are
divided into three groups: those dependent on the object investigated, those
dependent on densitometric data analysis, and others.
In the first group we took into account factors which can lead to either
overestimating (+) or underestimating (-) the final test results: degenerative
changes (+), scoliosis (+), the presence of foreign bodies, such as metal (-),
status post fracture (+), the presence of pathological structures (+ or -),
osteoporotic fractures (+), and incorrect arrangement of the investigated
object (+ or -). Errors in data analysis included erroneous data entry
regarding the patient's age, height, body mass (affecting the value of the
Z-score), and sex (distorting the T-score and the Z-score), and incorrect
settings regarding the measurement field. Other errors to densitometric
technique included failure to calibrate or improper calibration of the measurement
apparatus and errors in computer programming. Individual errors were
responsible for falsifying results from 1 to 37%. If several of these errors
are accumulated, the accuracy of examination may change more than 100%. Densitometric examinations of the lumbar spine are the most
subject to error. The repeatability of the results generated by the DEXA
apparatus (as stated in the equipment specifications) ranges for particular
skeletal regions from 0,9% to 2,5% of the coefficient
of variance, while the precision ranges from 3% to 5%. This means that even if
we follow the strictest guidelines for test procedures, the margin of error is
still several percent. We also cannot exclude the impact of errors of the three
types listed above on the final results. We are convinced that the DEXA method
is an excellent instrument for the diagnosis of osteoporosis (in static bone
evaluation). However, its value diminishes in monitoring dynamic changes in
bone tissue, even at 1-2 year intervals.
Gynecol Obstet
Invest. 2007 Aug 8;65(1):35-38 [Epub
ahead of print]
Hormone Replacement Therapy after Treatment
of Endometrial Cancer.
Tangjitgamol S, Manusirivithaya S, Hanprasertpong J, Kavanagh JJ.
Gynecologic
Oncology Unit, Department of Obstetrics and Gynecology,
Hormone replacement therapy
(HRT) after endometrial cancer (EMC) treatment is an uncertain subject with
limited exploration among gynecologic cancer research. Because estrogen is a
well-recognized etiologic factor of EMC, most physicians are probably reluctant
to provide a replacement therapy, or limit its use to only a selected group of
patients. In order to give an overview on this subject, we searched the
English-language literature to identify relevant studies or reports. We found
that HRT did not appear to increase the recurrence or death rates in EMC.
However, most information came from retrospective studies with selection bias,
or from a small prospective non-randomized study. The only randomized
controlled trial of the Gynecologic Oncology Group could also not provide a
definite answer regarding its safety and recommendation. In conclusion, on the
basis of the currently available studies, HRT after EMC treatment does not
appear to have an adverse effect on EMC. Nevertheless, because of a limitation
of data, the physician should thoroughly consider all possible benefits and theoretical
risks of recurrence or mortality in each individual to provide the best of care
for their patients.
Bone. 2007 Jun 26; [Epub ahead of print]
Walking intensity for postmenopausal bone
mineral preservation and accrual.
Borer KT, Fogleman K, Gross M, La New JM, Dengel D.
Department of Movement
Science, Division of Kinesiology, The
INTRODUCTION::
Mechanical stresses on the bone are an important aspect of physical activity
that promotes bone preservation and increases in bone mass. Exercise
intensities leading to bone preservation and accrual have not been adequately
defined for humans in general, and postmenopausal
women in particular. MATERIALS AND METHODS:: To quantify parameters of
effective walking intensity for preservation and accrual of bone mineral,
healthy postmenopausal women engaged in 30 weeks of supervised walking, 4.8 km
per day, 4 days a week at intensities of 102% or 123% of the ventilatory threshold (VT) equivalent to 67% and 86% of
maximal effort (VO(2) max). Subjects were matched by age, body mass, hormone
replacement status (HRT) and VT. Areal bone mineral density (aBMD) determined by DXA (n=25) and bone formation markers osteocalcin (OC), and bone-specific alkaline phosphatase (bALP) (n=43), were
measured at the outset and at 15-week intervals. Peak vertical forces at
corresponding intensities were measured (n=9) on a force plate. RESULTS:: aBMD of legs and whole body,
but not of other sites, and lean mass of legs, but not of arms, increased after
15 weeks of high intensity, compared to moderate losses for low intensity
training. Leg and total body aBMD was preserved and
slightly increased with loads greater than 872.3 newtons
(N) with a walking intensity above 115% of VT or 74% of VO(2) max, speeds above
6.14 km/h, and heart rates above 82.3% of age-specific maximum. OC and bALP did not correlate with training-induced changes in aBMD. CONCLUSIONS:: At exercise intensities above 115% of
VT or 74% of VO(2) max, and walking speeds above 6.14 km/h, mechanical loading
of 872.3 N or 1.22 times body weight is sufficient for increases in leg muscle
mass and preservation of BMD in postmenopausal women.
Public
Health Nutr. 2007 Aug 9;:1-9 [Epub ahead of print]
Effects of meat consumption and vegetarian diet on risk of wrist
fracture over 25 years in a cohort of peri- and
postmenopausal women.
Thorpe DL, Knutsen SF, Lawrence
Beeson W, Rajaram S, Fraser GE.
Department of
Physical Therapy, School of Allied Health Professions,
BACKGROUND: Evidence
suggesting that a diet high in fruits and vegetables may be beneficial to bone
health has sparked interest in the potential benefit of a vegetarian diet.
However, other studies have raised a question regarding the adequacy of protein
in such a diet. OBJECTIVE: The aim of the present study was to take a whole
foods approach in examining the effects of foods high in protein on the risk of
wrist fracture (WF) in a cohort with a significant proportion consuming a
meat-free diet. DESIGN: A cohort study of women who completed two lifestyle
surveys 25 years apart. SUBJECTS: One thousand eight hundred and sixty-five peri- and postmenopausal women at the time of the first
survey. RESULTS: There was a significant interaction between meat consumption
and foods high in vegetable protein. Among vegetarians, those who consumed the
least vegetable protein intake were at highest risk for fracture. However,
increasing levels of plant-based high-protein foods decreased WF risk, with a
68% reduction in risk (hazard ratio (HR) = 0.32, 95% confidence interval (CI)
0.13-0.79) in the highest intake group. Among those with lowest vegetable
protein consumption, increasing meat intake decreased the risk of WF, with the
highest consumption decreasing risk by 80% (HR = 0.20, 95% CI 0.06-0.66).
CONCLUSIONS: The finding that higher consumption frequencies of foods rich in
protein were associated with reduced WF supports the importance of adequate
protein for bone health. The similarity in risk reduction by vegetable protein
foods compared with meat intake suggests that adequate protein intake is
attainable in a vegetarian diet.
Forum Nutr. 2007;60:25-30.
Nutrigenetics.
Department of
Nutritional Sciences, Faculty of Medicine, University of
Nutrients interact with the
human genome to modulate molecular pathways that may become disrupted,
resulting in an increased risk of developing various chronic diseases. Genetic
polymorphisms affect the metabolism of dietary factors, which in turn affects
the expression of genes involved in a number of important metabolic processes.
Genetic polymorphisms affecting nutrient metabolism may explain some of the
inconsistencies among epidemiological studies relating diet to chronic diseases
such as cancer, diabetes, rheumatoid arthritis, osteoporosis and cardiovascular
disease. Understanding how genetic variations influence nutrient digestion,
absorption, transport, biotransformation, uptake and elimination will provide a
more accurate measure of exposure to the bioactive food ingredients ingested.
Furthermore, genetic polymorphisms in the targets of nutrient action such as
receptors, enzymes or transporters could alter molecular pathways that
influence the physiological response to dietary interventions. Among the
candidate genes with functional variants that affect nutrient metabolism are
those that code for xenobiotic-metabolizing enzymes
(also called drug-metabolizing enzymes). These enzymes are involved in the
phase I and II biotransformation reactions that produce metabolites with either
increased or decreased biological activity compared to the parent compound. A
number of dietary factors are known to alter the expression of these genes
that, in turn, metabolize a vast array of foreign chemicals including dietary
factors such as antioxidants, vitamins, phytochemicals,
caffeine, sterols, fatty acids and alcohol. Knowledge of the genetic basis for
the variability in response to these dietary factors should result in a more
accurate measure of exposure of target tissues of interest to these compounds
and their metabolites. Examples of how 'slow' and 'fast' metabolizers
respond differently to the same dietary exposures will be discussed.
Identifying relevant diet-gene interactions will benefit individuals seeking
personalized dietary advice as well as improve public health recommendations by
providing sound scientific evidence linking diet and health.
Am J Clin Nutr. 2007 Aug;86(2):434-43.
High folate intake is associated with lower breast cancer
incidence in postmenopausal women in the
Ericson U, Sonestedt E, Gullberg B, Olsson H, Wirfält E.
Department of
Clinical Sciences,
BACKGROUND: Epidemiologic
studies of associations between folate intake and
breast cancer are inconclusive, but folate and other
plant food nutrients appear protective in women at elevated risk. OBJECTIVE:
The objective was to examine the association between folate
intake and the incidence of postmenopausal breast cancer. DESIGN: This
prospective study included all women aged >/=50 y (n = 11699) from the Malmö Diet and Cancer cohort. The mean follow-up time was
9.5 y. We used a modified diet-history method to collect nutrient intake data.
At the end of follow-up, 392 incident invasive breast cancer cases were
verified. We used proportional hazard regression to calculate hazard ratios
(HRs). RESULTS: Compared with the lowest quintile, the incidence of invasive
breast cancer was reduced in the highest quintile of dietary folate intake (HR: 0.56; 95% CI: 0.35, 0.90; P for trend =
0.02); total folate intake, including supplements
(HR: 0.56; 95% CI: 0.34, 0.91; P for trend = 0.006); and dietary folate equivalents (HR: 0.59; 95% CI: 0.36, 0.97; P for
trend = 0.01). CONCLUSION: A high folate intake was
associated with a lower incidence of postmenopausal breast cancer in this
cohort.
Eur J Vasc
Endovasc Surg. 2007 Aug 1; [Epub ahead of print]
The Impact of Hormone Replacement Therapy
on the Pathophysiology of Peripheral Arterial
Disease.
Davies RS, Vohra RK, Bradbury
AW, Adam DJ.
University Department of
Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, UK;
Department of Vascular Surgery, University Hospital Birmingham NHS Foundation
Trust, Birmingham, UK.
BACKGROUND: Hormone replacement
therapy (HRT) is recommended to post-menopausal women to control menopausal
symptoms and prevent osteoporosis. The management of women with peripheral
arterial disease (PAD) and who are taking HRT is controversial. AIM: To summarise what is known about HRT and its effect on the
natural progression of PAD and its subsequent treatment. METHODS: A MEDLINE
(1966-2004) and Cochrane library search for articles relating to HRT and PAD
was undertaken. RESULTS: The potential benefits of unopposed estrogen therapy
on atherosclerotic progression and limb microcirculation are outweighed by the
increased risk of endometrial dysplasia and thrombotic complications. Only one
major study (
Fertil Steril. 2007 Aug 4; [Epub ahead of print]
The ReSTAGE Collaboration: defining optimal
bleeding criteria for onset of early menopausal transition.
Harlow SD, Mitchell
ES, Crawford S, Nan B, Little R, Taffe J; for the ReSTAGE Collaboration.
Epidemiology.
OBJECTIVE: Criteria for
staging the menopausal transition are not established. This article evaluates
five bleeding criteria for defining early transition and provides empirically
based guidance regarding optimal criteria. DESIGN/SETTING: Prospective
menstrual calendar data from four population-based cohorts: TREMIN, Melbourne
Women's Midlife Health Project (MWMHP), Seattle Midlife Women's Health Study
(SMWHS), and Study of Women's Health Across the Nation (SWAN) with annual serum
FSH from MWMHP and SWAN. PARTICIPANTS: 735 TREMIN, 279 SMWHS, 216 MWMHP, and
2270 SWAN women aged 35-57 at baseline who maintained menstrual calendars. MAIN
OUTCOME MEASURE(S): Age at and time to menopause for: standard deviation >6
and >8 days, persistent difference in consecutive segments >6 days,
irregularity, and >/=45 day segment. Serum FSH
concentration. RESULT(S): Most women experienced each of the bleeding
criteria. Except for a persistent >6 day difference that occurs earlier, the
criteria occur at a similar age and at approximately the same age as late
transition in a large proportion of women. FSH was associated with all proposed
markers. CONCLUSION(S): The early transition may be best described by ovarian
activity consistent with the persistent >6 day difference, but further study
is needed, as other proposed criterion are consistent
with later menstrual changes.
Ultrasound Obstet Gynecol. 2007 Aug 10; [Epub
ahead of print]
Ultrasound assessment of endometrial morphology and vascularity
to predict endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness >/= 4.5 mm.
Opolskiene G, Sladkevicius P, Valentin L.
Department of
Obstetrics and Gynecology,
OBJECTIVES: To determine which
endometrial morphology characteristics as assessed by gray-scale ultrasound and
which endometrial vessel characteristics as assessed by power Doppler
ultrasound are useful for discriminating between benign and malignant endometrium in women with postmenopausal bleeding (PMB) and
sonographic endometrial thickness >/= 4.5 mm and
to develop logistic regression models to calculate the individual risk of
endometrial malignancy in women with PMB, endometrial thickness >/= 4.5 mm,
good visibility of the endometrium and detectable
Doppler signals in the endometrium. METHODS: Of 223
consecutive patients with PMB and sonographic
endometrial thickness >/= 4.5 mm, 120 fulfilled our inclusion criteria. They
underwent transvaginal gray-scale and power Doppler
ultrasound examination, which was videotaped for later analysis by two
examiners with more than 15 years' experience in gynecological ultrasonography. They independently assessed endometrial
morphology and vascularity using predetermined
criteria. Their agreed-upon description was compared with the histological
diagnosis. Univariate and multivariate logistic
regression analyses were used. The best diagnostic test was defined as the one
with the largest area under the receiver-operating characteristics curve (AUC).
RESULTS: Thirty (25%) endometria were malignant.
Inter-observer agreement for the description of endometrial morphology and vascularity was moderate to good (Kappa 0.49-0.78). The
best ultrasound variables to predict malignancy were heterogeneous endometrial echogenicity (AUC 0.83), endometrial thickness (AUC 0.80),
and irregular branching of endometrial blood vessels (AUC 0.77). A logistic
regression model including endometrial thickness and heterogeneous endometrial echogenicity had an AUC of 0.91. Its mathematically best
risk cut-off yielded a positive likelihood ratio of 4.4, and a negative
likelihood ratio of 0.1. Adding Doppler information to the model improved
diagnostic performance marginally (AUC 0.92). CONCLUSIONS: In selected
high-risk women with PMB and an endometrial thickness of >/= 4.5 mm,
calculation of the individual risk of endometrial malignancy using regression
models including gray-scale and Doppler characteristics can be used to tailor
management. These models would need to be tested prospectively before
introduction into clinical practice.
Semana del 1 al 7 de Agosto
2007
Menopause. 2007 Jul
18;Publish Ahead of Print [Epub
ahead of print]
Past
oral contraceptive and hormone therapy use and endogenous hormone
concentrations in postmenopausal women.
Chan MF, Dowsett M, Folkerd E, Wareham N, Luben R, Welch A, Bingham S, Khaw KT.
Public Health and Primary Care, University of
Objective: Exogenous sex hormone use is
associated with many health effects. Current exogenous hormone use influences
endogenous sex hormone levels, but little is known about longer term effects on
endogenous hormones after cessation of use. The aim of this study was to
examine the relationship between past hormone use and current endogenous
hormone status. DESIGN:: This was a cross-sectional
study of 1,983 postmenopausal women aged 55 to 81 years from the general
community. The women were not currently using exogenous hormones. Past use of
oral contraceptives (OCs) and hormone therapy (HT) as well as circulating
endogenous sex hormones and sex hormone-binding globulin concentrations were evaluated.
Results: Past OC users had significantly lower endogenous estradiol,
estrone, androstenedione,
testosterone, and sex hormone-binding globulin concentrations compared with
never users independent of age, body mass index, smoking, physical activity,
and reproductive factors. Past HT users had significantly lower testosterone
and 17alpha-hydroxyprogesterone concentrations. Past OC use and HT use were
both independently associated with lower testosterone concentrations: -9% (95%
CI: -16% to -2%) for ever OC use compared with never OC use and -7% (95% CI:
-17% to -2%) for ever HT use compared with never HT use. The magnitude of 5% to
10% differences in endogenous hormone concentrations was similar or greater for
past OC use compared with past HT use, although OC use occurred earlier in the
past. Conclusions: Past OC use and HT use seem to be related to long-term
differences in endogenous sex hormones and sex hormone-binding globulin
concentrations in postmenopausal women many years after cessation of use. These
findings have implications for understanding the longer term effects of
exogenous hormone exposures earlier in life with health and disease risk in
later life.
Menopause. 2007 Jul
6;Publish Ahead of Print [Epub
ahead of print]
Vaginal,
endometrial, and reproductive hormone findings: randomized, placebo-controlled
trial of black cohosh, multibotanical
herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for
Menopause (HALT) Study.
Reed SD, Newton KM, Lacroix AZ, Grothaus LC, Grieco VS, Ehrlich K.
Objective: To evaluate vaginal, endometrial,
and reproductive hormone effects of three herbal regimens compared with placebo
and hormone therapy (HT). Design: This was a 1-year, randomized, double-blind,
placebo-controlled trial of 351 women, ages 45 to 55, with two or more
vasomotor symptoms per day. Women were randomly assigned to (1) black cohosh, (2) a multibotanical
containing black cohosh, (3) the same multibotanical plus dietary soy counseling,
(4) HT, or (5) placebo. Women were ineligible if they had used HT in the
previous 3 months or menopausal herbal therapies in the previous month. Data on
vaginal cytology and dryness were collected (at baseline and 3 and 12 mo). Daily menstrual diaries were maintained by 313 women
with a uterus, and abnormal bleeding was evaluated. Serum estradiol,
follicle-stimulating hormone, luteinizing hormone, and steroid hormone-binding
globulin were assessed (baseline and 12 mo) among 133 postmenopausal women. Gynecologic outcomes of the five groups were compared.
Results: The five groups did not vary in baseline vaginal cytology profiles,
vaginal dryness, menstrual cyclicity, or hormone
profiles. The HT group had a lower percentage of parabasal
cells and vaginal dryness than the placebo group at 3 and 12 months (P<
0.05). Abnormal bleeding occurred in 53 of 313 (16.9%) women. There were no
differences in frequency of abnormal bleeding between any of the herbal and
placebo groups, whereas women in the HT group had a greater risk than those in
the placebo group (P<0.001). Among
postmenopausal women, HT significantly decreased FSH hormone and
increased estradiol; none of the herbal interventions showed significant
effects on any outcomes at any time point. Conclusions: Black cohosh, used alone or as part of a multibotanical
product with or without soy dietary changes, had no effects on vaginal
epithelium, endometrium, or reproductive hormones.
Menopause. 2007 May
21;Publish Ahead of Print [Epub
ahead of print
Raloxifene slows
down the progression of intima-media thickness in
postmenopausal women.
Colacurci N, Fornaro F, Cobellis L, De Franciscis P, Torella M, Sepe E, Arciello A, Cacciapuoti F, Paolisso G, Manzella D.
Department of Obstetrics, Gynecology, and Neonatology,
Objective: To investigate the effect of raloxifene on atherosclerosis progression in healthy
postmenopausal women. DESIGN: In a prospective fashion, a total of 155 healthy
postmenopausal women were randomly assigned to receive raloxifene
60 mg/day or a matching placebo for 18 months. Atherosclerosis progression was
evaluated by B-mode ultrasonography measuring the intima-media thickness (IMT) of the carotid arteries.
Plasma levels of triglycerides, low-density lipoprotein cholesterol, soluble
forms of intercellular adhesion molecule-1 and vascular cell adhesion
molecule-1, E-selectin, interleukin-6, tumor necrosis factor alpha, adiponectin,
and the degree of insulin resistance by the homeostatic model assessment method
were also determined. Results: The progression slope of carotid IMT was 0.0112
mm/18 months in the raloxifene group and 0.0857mm/18
months in the placebo group (P < 0.004). Raloxifene
treatment compared with placebo produced a significant decrease in plasma
triglycerides (P < 0.02), low-density lipoprotein cholesterol (P < 0.02),
soluble forms of intercellular adhesion molecule-1 (P < 0.005) and vascular
cell adhesion molecule-1 (P < 0.04), E-selectin (P
< 0.02), interleukin-6 (P < 0.005), tumor
necrosis factor alpha (P < 0.005) levels, and homeostatic model assessment
index (P < 0.005) and a significant increase in plasma adiponectin
levels (P < 0.001). Logistic regression analysis indicated that women
receiving raloxifene had a lower risk of IMT
progression (odds ratio = 0.41; 95% CI: 0.32-0.70). Conclusions: Raloxifene treatment, possibly through an increase in
plasma adiponectin levels, may slow the progression
of IMT in postmenopausal women.
Menopause. 2007 Mar
7;Publish Ahead of Print [Epub
ahead of print]
Correlation
between estrogens and serum adipocytokines in
premenopausal and postmenopausal women.
Hong SC, Yoo SW, Cho GJ, Kim T, Hur JY, Park YK, Lee KW, Kim SH.
Department of Obstetrics and Gynecology,
Objective: The purpose of this study was to
investigate the association between serum adipocytokines
(adiponectin, resistin, leptin, and tumor necrosis factor
alpha [TNF-alpha]) and endogenous estrogen (estrone and estradiol) levels in
healthy premenopausal and postmenopausal women. DESIGN::
This study included 53 healthy premenopausal women, 45 healthy postmenopausal
women, and 10 postmenopausal women with the metabolic syndrome who were
participating in general health examinations. A secondary analysis was
performed on levels of adiponectin, resistin, leptin, TNF-alpha, estrone (E1), and estradiol (E2).
Results: After accounting for body mass index, TNF-alpha was significantly
increased (1.5 +/- 0.1 vs 2.0 +/-
0.1 pg/mL, P < 0.05) in healthy
postmenopausal women as compared with healthy premenopausal women, whereas leptin was decreased (5.6 ± 1.1 vs
4.0 ± 1.1 ng/mL). Estrogen (E1 and E2) was positively correlated with leptin in only healthy premenopausal women, whereas estrogen did not correlate with any adipocytokine
in healthy postmenopausal women. In the multiple regression analysis, only leptin significantly contributed to insulin resistance.
Combining healthy premenopausal and postmenopausal women, E1 correlated
negatively with TNF-alpha (r = -0.23, p< 0.05) and positively with leptin (r = 0.35, p< 0.01) and did not correlate with resistin. E2 correlated negatively with TNF-alpha (r =
-0.24, p< 0.05) and positively with leptin (r =
0.34, p< 0.01); it did not correlate with adiponectin
or resistin. Leptin might
stimulate the increase of plasma gonadotropin-releasing
hormone levels, which could result in a positive correlation with estrogen in premenopausal women but not in postmenopausal
women. Conclusions: Estrogen deficiency resulted in
increased TNF-a levels. Serum leptin levels
correlated positively with estrogen levels in
premenopausal women. However, the increase in obesity in postmenopausal women
increased leptin, which increases insulin resistance.
Obstet Gynecol. 2007 Aug;110(2):230-240
Symptoms Associated
With Menopausal Transition and Reproductive Hormones in Midlife Women.
Freeman EW, Sammel MD, Lin H, Gracia CR, Pien GW, Nelson DB, Sheng L.
Department of Medicine,
Objective: To test the hypothesis that
prevalence of women with menopausal symptoms of hot flushes; aches, joint pain,
and stiffness; depressed mood; poor sleep; decreased libido; or vaginal dryness
increases with progression through the menopausal transition. Methods: Women in
the Penn Ovarian Aging Study were assessed longitudinally for 9 years. Data
were obtained from structured interviews, a validated symptom questionnaire,
menstrual bleeding dates and early follicular hormone measures (estradiol [E2],
follicle-stimulating hormone [FSH], and inhibin b).
Menopausal stages were based on menstrual bleeding patterns. Other risk factors
included age, race, history of depression, current
smoking, body mass index, and perceived stress. Generalized linear regression
models for repeated measures were used to estimate associations among the
variables with each symptom. Results: The prevalence of hot flushes; aches,
joint pain, and stiffness; and depressed mood increased in the menopausal
transition. Menopausal stage was associated with hot flushes (P<.001); aches
joint pain, and stiffness (P<.001); and depressed mood (P=.002).
Within-woman fluctuations of E2 were associated with hot flushes and aches.
Poor sleep, decreased libido, and vaginal dryness were not associated with menopausal
stages. There was 80% power to detect an absolute difference of 11% for libido
and vaginal dryness and 17% for poor sleep in the prevalence of these symptoms
in the late menopausal transition compared with premenopausal status.
Conclusion: The study highlights the role of menopausal stages for some
symptoms of midlife women and indicates that stages in the transition to
menopause are associated with hot flushes; aches, joint pain, and stiffness;
and depressed mood. Fluctuations of E2, decreased levels of inhibin
b, and increased FSH levels were associated with these symptoms. EVIDENCE: II.
Cancer Causes Control. 2007 Jul 31; [Epub ahead of print
Protection of
mammography screening against death from breast cancer in women aged 40-64
years.
Norman SA, Russell Localio A, Weber AL, Coates RJ, Zhou L, Bernstein L, Malone KE, Marchbanks PA, Weiss LK, Lee NC, Nadel MR.
Center for Clinical
Epidemiology and Biostatistics,
Objective: This study assessed the efficacy of
community-based screening mammography in protecting against breast cancer
death, asking whether age differences in efficacy persisted in the 1990s.
Methods: In a case-control study with follow-up, odds ratios (OR) were used to
estimate the relative mortality rates from invasive breast cancer among women
with at least one screening mammogram in the two years prior to a baseline
reference date compared to non-screened women, adjusting for potential
confounding. The multicenter population-based study included 553 black and
white women diagnosed during 1994-1998 who died in the following five years,
and 4016 controls without breast cancer. Results: Efficacy for reducing the
rate of breast cancer death within five years after diagnosis was greater at
ages 50-64 years (OR = 0.47, 95% confidence interval (CI) 0.35-0.63) than at
ages 40-49 (OR = 0.89, 95% CI 0.65-1.23), and greater among postmenopausal (OR
= 0.45, 95% CI 0.33-0.62) than premenopausal women (OR = 0.74, 95% CI
0.53-1.04). Estimates of efficacy were conservative, as shown by sensitivity
analyses addressing whether cancer was discovered by a screening mammogram, age
at which screening was received, the length of the screening observation
window, and years of follow-up after diagnosis. Conclusions: Despite the
persistence of age differences in efficacy of mammography screening, with
greater observed benefit for women aged 50-64 years,
these findings support current screening recommendations for women 40-64 years
old.
Rev Assoc Med Bras. 2007 May-Jun;53(3):229-33
Quantitative calcaneal ultrasound evaluation allows distinguishing women
with and without fractures.
Velho LA, Bellangero W, Bahamondes L.
Faculade de Ciências Médicas, Universidade
Estadual de Campinas.
Objective: International studies have pointed
out quantitative ultrasound as an important method to assess bone fragility and
risk of fracture. This study was performed to compare quantitative ultrasound
(QUS) in two groups of Brazilian women, those with a fracture and those with no
previous history of fracture. The aim was to assess whether there was any
difference between the right and the left foot s and whether two sequential
measurements in each foot were statistically equivalent. METHODS: A total of 52
women, 26 with and 26 with no fractures, matched by age (+/- 2 years), years
since menopause (+/- 2 years), and body mass index (kg/m(2))
(+/- 2) were evaluated. Results: Results were compared by the Student's t test
for matched samples. Values (mean +/- SD) for the stiffness index (SI) were
54.9 (+/- 16.6) and 80.4 (+/- 17.3), and for the T Score were -2.9 (+/- 0.94)
and -1.3 (+/- 0.95) for the groups with and with no fractures, respectively.
The first and second measurements of the SI for the right foot and the mean
measurement of each foot were found similar when compared. There was a
statistical significance (p<0.01). Conclusions: The QUS was shown to
distinguish between women with and with no fractures. Also, no differences were
observed in the QUS of the left or right foot as well as in the first or second
measurements of each foot in the women under study.
QJM. 2007 Jul
30; [Epub ahead of print
The
effect of hormone replacement therapy on cognitive function in post-menopausal
women.
Lavi R, Doniger GM, Simon E, Hochner-Celnikier D, Zimran A, Elstein D.
Gaucher
Clinic,
Background: Despite interest in causes of
dementia in older persons, particularly in post-menopausal women, it is unclear
whether hormone replacement therapy (HRT) is a risk factor. AIM: To assess
cognitive function in post-menopausal women with high educational status
receiving HRT, compared to non-users. Design:
Cognitive functioning was assessed with in women aged 55-60 years with at least
university-level education, using the Mindstreams
system, a computerized cognitive battery with multiple domains. Results: 0f 165
women meeting the inclusion/exclusion criteria, 82 women (49.7%) declined
participation. Of the remaining 83, 40 (48.2%) had never received HRT; the
remainder was divided into women receiving 5-9 years HRT (n = 29)versus those with >/=10 years HRT (n = 11). There were
no statistically significant differences between HRT users and non-users in
global scores or sub-domains of cognitive functioning, and no difference
between those women receiving HRT for 5-9 years vs. >/=10 years.
Discussions: Long-term HRT does not appear to impair cognitive functioning in
highly-educated women. Recommendations regarding post-menopausal HRT should be
made on an individual basis.
Future Microbiol. 2006 Jun;
Viruses
and human breast cancer.
Lawson JS, Günzburg WH, Whitaker NJ.
There are well-established risk factors for
breast cancer, most of which relate to estrogens and growth hormones in
females. These include early-age menarche, late-age menopause, postmenopausal
obesity and use of hormone therapy. However, these factors do not account for
the sixfold difference in breast cancer incidence and
mortality between countries and the fact that these differences dramatically
lessen after migration; nor do they account for male breast cancer.
Accordingly, hormone-responsive viruses have become major suspects as
etiological agents for human breast cancer. Human papillomaviruses,
mouse mammary tumor virus and Epstein-Barr virus are the prime candidate
viruses as causes of human breast cancer. Human papillomaviruses
and the mouse mammary tumor virus have hormone responsive elements that appear
to be associated with enhanced replication of these viruses in the presence of
corticosteroid and other hormones. This biological phenomenon is particularly
relevant because of the hormone dependence of breast cancer. Viral genetic
material for each of these candidate viruses has been identified by polymerase
chain reaction in breast tumors but rarely in normal breast tissue controls.
Pooled data from controlled studies show substantial odds ratios for the
presence of viral genetic material in breast tumors compared with normal
controls. These and additional data provide substantial, but not conclusive,
evidence that human papillomavirus, the mouse mammary
tumor virus and Epstein-Barr virus may have a role in the etiology of human
breast cancer. If conclusive evidence for a role of these viruses in breast
carcinogenesis can be developed, there is a practical possibility of primary
prevention.
Int J Epidemiol. 2007 Jul
26; [Epub ahead of print
Experience
of famine and bone health in post-menopausal women.
Kin CF, Shan WS, Shun LJ, Chung LP, Jean W.
Department of Community and Family Medicine,
School of Public Health, Hong Kong SAR.
Background: Famines have occurred in all areas
of the world in every period of history. Many studies have shown that poor
growth and development and adverse environmental conditions in childhood are
associated with osteoporosis in later life. However, little information is
available on the relation between famine and bone health. METHODS: This study
examines the hypothesis that past experience of famine has an adverse impact on
bone health, using data from Ms Os (