Selección de Resúmenes
de Menopausia
Agosto de 2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de
Chile
Semana
del 29 de Julio al 4 de Agosto de 2009
Hum Reprod. 2009 Jul 30. [Epub
ahead of print]
Anti-Mullerian hormone and inhibin
B levels as markers of premature ovarian aging and transition to menopause in
type 1 diabetes mellitus.
Soto N, Iñiguez G, López P, Larenas G, Mujica V, Rey RA, Codner E.
Endocrinology and Diabetes Unit, San Borja-Arriarán
Hospital, Santiago, Chile.
BACKGROUND
Serum anti-Müllerian hormone (AMH) levels decrease
early during the transition to menopause and women with type 1 diabetes
mellitus (DM1) experience menopause at a younger age. We hypothesized that
older women with DM1 will have lower AMH levels than controls. METHODS We studied ovarian function in women with DM1 (n = 66) and
healthy controls (n = 58), all <45 years old. Steroids, gonadotrophins,
AMH and inhibin B levels were measured during the
follicular phase. RESULTS Piece-wise regression analysis demonstrated that AMH
levels begin to decrease at 33 years of age in both groups. This age limit was
used to compare data in both groups. AMH levels were lower in DM1 women than in
controls >33 years (4.1 +/- 4.2 versus 9.5 +/- 7.9 pmol/l,
mean +/- SD, P = 0.006). A higher proportion of women with DM1 showed AMH
levels in the menopausal range compared with controls (16.7% versus 3.4%,
respectively, P = 0.02). For all patients, those with DM1 exhibited lower inhibin B levels than controls (89.3 +/- 51.7 versus 113.2 +/- 76.0 ng/ml, P < 0.05). FSH
and estradiol were similar in both groups. Regression
analysis showed an earlier decline in AMH levels in women with DM1 than
controls. Even after age adjustment, DM1 was a significant factor for the
determination of inhibin B and AMH levels.
CONCLUSIONS
Int J Cancer. 2009 Jul 29. [Epub ahead of print]
Birth weight and mammographic density among
postmenopausal women in Sweden.
Tamimi RM, Eriksson
L, Lagiou P, Czene K, Ekbom A, Hsieh
CC, Adami HO, Trichopoulos D, Hall
P.
Department of Epidemiology, Harvard School of
Public Health, Boston, MA 02115, USA.
Birth weight is a significant predictor of breast
cancer risk in adult life and mammary gland mass could be an intermediate stage
in this long process. We have studied the association of birth size
measurements with mammographic density, a marker of mammary gland mass. For a
population-based sample of 893 postmenopausal women without previous cancer in
J Relig Health. 2009
Jul 30. [Epub ahead of print]
Spirituality and
Severity of Menopausal Symptoms in a Sample of Religious Women.
Clinical Psychology, Brigham Young University, 284 TLRB, Provo, UT,
84602, USA, steffen@byu.edu.
Menopause
represents an important life change, particularly for religious women whose
identity is significantly related to family. Two competing hypotheses are
examined: one, because religious women have their identity focused on family
and child rearing, spirituality will be related to increased menopausal
symptoms because menopause represents a loss of identity and purpose; and two,
because spirituality can provide strength and comfort during difficult times,
it will, therefore, be related to decreased menopausal symptoms. To test these
competing hypotheses, questionnaires were administered to 218 women (average
age 55, 35% premenopausal, 26% peri-menopausal, 39%
postmenopausal) who were members of the Church of Jesus Christ of Latter Day
Saints. Regression analyses indicated that higher levels of spiritual strength
were related to decreased levels of reported menopausal symptoms. Spiritual
strength was also related to increased benefit finding during menopause,
decreased concern with body appearance, and increased use of adaptive coping
strategies. We conclude that finding strength in spirituality may help
religious women cope better with the life changes associated with menopause.
Expert Opin Pharmacother. 2009
Jul 29. [Epub ahead of print]
Lasofoxifene, a new selective estrogen receptor modulator for the treatment of
osteoporosis and vaginal atrophy.
Selective estrogen
receptor modulators (SERMs) represent a class with a growing number of compounds
that act as either estrogen receptor (ER) agonists or
antagonists in a tissue-specific manner. The purpose of this article is to
review the effects of lasofoxifene, a new-generation
SERM that has completed the Phase III development program for the prevention
and treatment of osteoporosis and vaginal atrophy in postmenopausal women. This
compound selectively binds to both ERs with high affinity. Lasofoxifene
also has a remarkably improved oral bioavailability with respect to other SERMs
such as raloxifene and tamoxifen,
owing to increased resistance to intestinal wall glucuronidation.
In both preclinical and short-term clinical studies, this compound showed a favorable safety profile and demonstrated a proven efficacy
in preventing bone loss and lowering cholesterol levels. More recently, Phase
III clinical trials have confirmed the efficacy and safety of this new SERM in
the prevention of bone loss and vertebral and nonvertebral
fractures. Moreover, in postmenopausal women with osteoporosis, lasofoxifene treatment also reduced ER positive breast
cancer risk and the occurrence of vaginal atrophy. With its increased potency
and efficacy on the prevention of nonvertebral
fractures and its positive effects on the vagina, this new SERM may represent
an alternative therapy for osteoporosis in postmenopausal women.
Climacteric. 2009 Jul 28:1-6. [Epub ahead of print]
Breast
arterial calcification is a predictive factor of cardiovascular disease in
Brazilian postmenopausal women.
Ferreira JA, Pompei LM, Fernandes CE, Azevedo LH, Peixoto S.
ABC
Objective
The objectives of this study were to evaluate the association between
cardiovascular disease (CVD) and breast arterial calcification (BAC), as well
as the prevalence rates of these conditions in Brazilian postmenopausal women.
Methods A cross-sectional study was performed in 307 women over 40 years of age
who were receiving care at the gynecology clinic of
the Center for Women's Integrated Healthcare (CAISM),
ABC School of Medicine. All these women had been amenorrheic
for at least 12 months and had undergone mammography in the preceding 12
months. Cardiovascular disease and its subtypes were evaluated, as well as its
association with BAC. Means and standard deviations, absolute frequencies and
percentages were calculated, and univariate analysis
and multiple logistic regression were performed. Results The mean age of the
patients was 55.2 +/- 6.8 years; age at menopause was 48.5 +/- 4 years. Time
since menopause was 80.2 +/- 75.4 months; 96.1% of the patients were
non-smokers and 46.3% were using hormone therapy. Of the patients, 33.6% had
systemic arterial hypertension, 4.9% had diabetes mellitus and 5.2% had
hypercholesterolemia. The mean body mass index was 27.3 +/- 4.3 kg/m(2). CVD
was found in 6.8% and BAC in 8.5% of the women. Significantly more women with
BAC had CVD compared to the women who did not have this condition (23.1% vs.
5.3%, p = 0.0006). BAC was associated with an odds ratio of 8.13 (95%
confidence interval 2.68-24.64) for predicting CVD. Conclusions In
postmenopausal women, breast arterial calcification may represent a higher
likelihood of cardiovascular disease.
Fertil Steril. 2009 Jul 22. [Epub ahead of print]
Efficacy
of tissue-selective estrogen complex of bazedoxifene/conjugated estrogens for osteoporosis prevention
in at-risk postmenopausal women.
Lindsay R, Christopher Gallagher J, Kagan R, Pickar JH, Constantine G.
Department
of Medicine,
Objetive: To
evaluate the efficacy of the tissue-selective estrogen
complex, bazedoxifene/conjugated estrogens (BZA/CE),
for postmenopausal osteoporosis prevention. Design: Multicenter, randomized,
double-blind, placebo- and active-controlled, phase 3 trial (Selective estrogen Menopause And Response to Therapy [SMART]-1).
Setting: Outpatient clinical study. Patient: Women (n = 3,397) more than 5
years and 1-5 years postmenopause were enrolled in
the Osteoporosis Prevention I and II Substudies, respectively.
Intervention: Single tablets of BZA (10, 20, or 40 mg) each with CE (0.625 or
0.45 mg), raloxifene (60 mg), or a placebo taken
daily for 2 years. Main outcomes: The primary outcome for both substudies was change in bone mineral density of the lumbar
spine; bone mineral density was also measured at the hip. Results: In both substudies, bone mineral density increased significantly
more with all BZA/CE doses compared with placebo at the lumbar spine and total
hip, and for most BZA/CE doses compared with raloxifene
at the lumbar spine. Osteocalcin and N-telopeptide significantly decreased with all BZA/CE doses
vs. placebo and most BZA/CE doses vs. raloxifene.
Conclusion: BZA/CE combinations decreased bone turnover and bone loss in
postmenopausal women at increased risk for osteoporosis.
Fertil Steril. 2009 Jul 22. [Epub ahead of print]
Evaluation
of bazedoxifene/conjugated estrogens for the treatment
of menopausal symptoms and effects on metabolic parameters and overall safety
profile.
Lobo RA, Pinkerton JV, Gass ML, Dorin MH, Ronkin S, Pickar JH, Constantine G.
OBJECTIVE:
To evaluate the effects of a tissue-selective estrogen
complex (TSEC) composed of bazedoxifene/conjugated
estrogens (BZA/CE) on menopausal symptoms, metabolic parameters, and overall
safety. DESIGN: Multicenter, double-blind, placebo- and active-controlled phase
3 trial (Selective estrogens, Menopause, And Response to Therapy [SMART]-1).
SETTING: Outpatient clinical. PATIENT(S): Healthy, postmenopausal women (n =
3,397) age 40 to 75 with an intact uterus. INTERVENTION(S): Single tablets of
BZA (10, 20, or 40 mg), each with CE (0.625 or 0.45 mg); raloxifene
60 mg; or placebo taken daily for 2 years. MAIN OUTCOME MEASURE(S): Hot
flushes, breast pain, vaginal atrophy, metabolic parameters, and adverse
events. RESULT(S): BZA (20 mg)/CE (0.625 or 0.45 mg) significantly reduced the
frequency and severity of hot flushes and improved measures of vaginal atrophy
compared with placebo. At week 12, the daily number of hot flushes decreased by
51.7% to 85.7% with all BZA/CE doses vs. 17.1% for placebo. BZA/CE improved
lipid parameters and homocysteine levels, did not
significantly change carbohydrate metabolism, and had only minor effects on
some coagulation parameters. The incidences of breast pain and adverse events
were similar between BZA/CE and placebo. CONCLUSION: The TSEC composed of BZA
(20 mg)/CE (0.625 or 0.45 mg) is an effective and safe treatment for menopausal
symptoms.
Fertil Steril. 2009 Jul 22. [Epub ahead of print]
Bazedoxifene/conjugated
estrogens (BZA/CE): incidence of uterine bleeding in postmenopausal women.
Archer DF, Lewis V, Carr BR, Olivier S, Pickar JH.
CONRAD
Clinical
OBJECTIVE:
To evaluate the effect of bazedoxifene/conjugated
estrogens (BZA/CE), a tissue selective estrogen
complex, on uterine bleeding in postmenopausal women. DESIGN: International,
multicenter, randomized, double-blind, placebo- and active-controlled, phase
III study (Selective estrogen Menopause And Response
to Therapy [SMART]-1). SETTING: Outpatient clinical. PATIENT(S): Healthy,
postmenopausal women (N = 3,397) aged 40 to 75 years with an intact uterus.
INTERVENTION(S): Daily oral therapy with BZA 10, 20, or 40 mg, each with CE
0.625 or 0.45 mg, raloxifene 60 mg, or placebo. MAIN
OUTCOME MEASURE(S): Cumulative amenorrhea profiles and the incidence of
bleeding or spotting over 2 years. RESULT(S): Treatment with BZA 20 or 40 mg
with CE 0.625 or 0.45 mg was associated with rates of cumulative amenorrhea
(>83% during cycles 1-13 and >93% during cycles 10-13) and bleeding or
spotting that were comparable to those with placebo. Subjects who received BZA
10 mg/CE 0.625 mg experienced slightly lower cumulative amenorrhea rates
throughout the study compared with placebo-treated subjects. CONCLUSION(S):
Postmenopausal women treated with BZA 20 or 40 mg with CE 0.625 or 0.45 mg had
high rates of cumulative amenorrhea that were similar to those reported with
placebo. This new menopausal therapy may offer a favorable
bleeding and tolerability profile.
Fertil Steril. 2009 Jul 22. [Epub ahead of print]
Endometrial
effects of a tissue selective estrogen complex
containing bazedoxifene/conjugated estrogens as a
menopausal therapy.
Pickar JH, Yeh IT, Bachmann G, Speroff L.
Wyeth
Research,
OBJECTIVE:
To evaluate the endometrial safety of a tissue selective estrogen
complex (TSEC; pairing of a selective estrogen
receptor modulator [SERM] with estrogens) composed of bazedoxifene/conjugated
estrogens (BZA/CE) in postmenopausal women. DESIGN: Randomized, double-blind,
multicenter, placebo- and active-controlled, phase 3 study (Selective estrogen Menopause And Response to Therapy [SMART]-1).
SETTING: Outpatient clinical. PATIENT(S): Healthy, postmenopausal women (n =
3,397) age 40-75 with an intact uterus. INTERVENTION(S): Single tablets of BZA
(10, 20, or 40 mg) combined with CE (0.625 or 0.45 mg); raloxifene
(60 mg); or placebo daily for 2 years. MAIN OUTCOME MEASURE(S): Incidence of
endometrial hyperplasia at 12 months in the efficacy evaluable population. RESULT(S):
Treatment with BZA (20 or 40 mg)/CE (0.625 or 0.45 mg) was associated with low
rates (<1%) of endometrial hyperplasia that were not significantly different
from those reported with placebo over 24 months. Endometrial thickness with BZA
(20 or 40 mg)/CE (0.625 or 0.45 mg) was not significantly different from that
with placebo. CONCLUSION(S): When combined with CE (0.625 mg or 0.45 mg), BZA
(20 mg) was the lowest effective dose that prevented endometrial hyperplasia
over 2 years of study, creating the possibility for a new, progestin-free
menopausal therapy.
Ann Med. 2009 Jul
24:1-8. [Epub ahead of print]
Cannabinoids and the
skeleton: From marijuana to reversal of bone loss.
Bone
Laboratory, the Hebrew
The
active component of marijuana, Delta(9)-tetrahydrocannabinol,
activates the CB1 and CB2 cannabinoid receptors, thus
mimicking the action of endogenous cannabinoids. CB1
is predominantly neuronal and mediates the cannabinoid
psychotropic effects. CB2 is predominantly expressed in peripheral tissues,
mainly in pathological conditions. So far the main endocannabinoids,
anandamide and 2-arachidonoylglycerol, have been
found in bone at 'brain' levels. The CB1 receptor is present mainly in skeletal
sympathetic nerve terminals, thus regulating the adrenergic tonic restrain of
bone formation. CB2 is expressed in osteoblasts and osteoclasts, stimulates bone formation, and inhibits bone resorption. Because low bone mass is the only spontaneous
phenotype so far reported in CB2 mutant mice, it appears that the main
physiologic involvement of CB2 is associated with maintaining bone remodeling at balance, thus protecting the skeleton against
age-related bone loss. Indeed, in humans, polymorphisms in CNR2, the gene encoding
CB2, are strongly associated with postmenopausal osteoporosis. Preclinical
studies have shown that a synthetic CB2-specific agonist rescues ovariectomy-induced bone loss. Taken together, the reports
on cannabinoid receptors in mice and humans pave the
way for the development of 1) diagnostic measures to identify
osteoporosis-susceptible polymorphisms in CNR2, and 2) cannabinoid
drugs to combat osteoporosis.
Maturitas. 2009 Jul 24. [Epub
ahead of print]
The
menopause and the female larynx, clinical aspects and therapeutic options: A
literature review.
D'haeseleer E, Depypere H, Claeys S, Van Borsel J, Van Lierde K.
During
lifetime the female larynx is very sensitive to sex hormone fluctuations. The
menopause forms a critical event in a women's life and also affects the
laryngeal tissues. The present report gives an overview of the recent
literature about the impact of the menopause on the female larynx and vocal
quality. The article discusses the symptoms, aetiology and different treatment
options for laryngeal changes during the menopause. The literature pertaining
to the impact of the menopause on the voice and the larynx was reviewed to
provide a critical summary about the menopausal voice, aetiology and
therapeutic options. In postmenopausal women laryngeal changes like oedema and
muscular and mucosal dystrophy and atrophy were found. For the voice, the most
important acoustic changes in postmenopausal women are a decreased vocal
frequency range, decreased fundamental frequency and a higher frequency
perturbation. Potential direct and indirect causes for these changes are
discussed. Hormone replacement therapy is prescribed in some women for the
treatment of menopausal complaints. The first reports in the literature point
out a tendency towards a positive, organ-conserving effect of hormone treatment
on the larynx and probably the voice. The type and the form of application of
hormone therapy seem to be important in the outcome of the studies.
Semana del 5 al 11 de Agosto de 2009
Climacteric. 2009 Aug 3:1-8. [Epub ahead of print]
Hormone therapy in Brazilian postmenopausal women with chronic hepatitis
C: a pilot study.
Padua MA, Fonseca AM, Deguti MM, Bagnoli VR, Farias AQ, Maciel GA, Soares JM Jr, Carilho FJ, Baracat EC.
Departments of
Obstetrics and Gynecology.
Objective To
evaluate liver function and hemostatic parameters in
postmenopausal women who have chronic infection with the hepatitis C virus and
climacteric symptoms and are undergoing hormone therapy (HT) (standard dose of transdermal continuous combined hormone therapy). Design
Fifty out of 336 postmenopausal patients with chronic infection with the
hepatitis C virus were selected. The non-inclusion criteria were other chronic
or systemic liver diseases, severe vascular diseases, autoimmune diseases or
malignant tumors. The patients were randomized into
two groups: the HT group with 25 patients to be given transdermal
hormone therapy (50 mug estradiol plus 170 mug norethisterone/day) and the control group with the other 25
patients (no medication). Hepatic tests (alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase,
total alkaline phosphatase, albumin, serum bilirubin) and hemostatic
parameters (prothrombin time, factor V, fibrinogen)
were evaluated at baseline and at 1, 4, 7 and 9 months of treatment. Results No
significant changes in parameters were found in the comparison between the
treated group and the controls, except for a decrease in total alkaline phosphatase (p = 0.002), presumably due to changes in bone
remodelling. Conclusions There were no changes in liver function after a
9-month treatment with transdermal estradiol plus norethisterone in
symptomatic postmenopausal patients with hepatitis C.
Climacteric. 2009 Aug 4:1-8. [Epub ahead of print]
LEI (Lack of tEstosterone Impact) survey in a
clinical sample with surgical menopause.
Nappi RE, Lello S, Melis GB, Albani F, Polatti F, Genazzani AR.
Objectives To
assess perception of sexuality and awareness of the impact of testosterone on
sexual desire in a clinical sample of Italian women with surgical menopause.
Methods In the present cross-sectional study, a structured interview on
sexuality-related menopausal symptoms, attitudes towards sexuality and
menopausal profile was administered to 568 women (age range 35-69 years) with
bilateral oophorectomy with and without hysterectomy
for benign conditions. Results The majority of women (58% yes; 36% most of the
time) reported they were satisfied with their sexual life before surgical
menopause. After oophorectomy, 79.3% noted the
appearance/worsening of vaginal dryness, whereas the reduction of sexual desire
was reported by 78.7%. Women with low sexual desire (n = 436) were
significantly distressed (59.7%) and reported an impairment (24.8% yes/yes,
very much) in the relationship with their partner. Sexual reactions of the
partner reported by women included reduced sexual desire (17.8%), sexual
dysfunction (5.1%) and fears of giving pain/lack of pleasure (28.3%). A high
number of women (88.2%) would be willing to discuss sexual matters with their
doctors and would consider therapeutic options. Only 36.8% were aware that a
lack of testosterone might impact on sexual desire but 71% would like to know
more about the role of testosterone. Hormone replacement therapy was used by
38.4% of the women. Conclusions These data suggest that women experience
significant vaginal dryness and low sexual desire and report a significant
distress in the relationship with their partner after surgical menopause.
Sexual counseling is mandatory in order to discuss
potential therapeutic strategies, including testosterone use.
J Cereb Blood Flow Metab. 2009 Aug 5. [Epub ahead of print]
Frontal cerebral blood flow changes after hormone replacement therapy in
depressed postmenopausal women.
Yao WJ, Pan HA, Wang ST, Yang YK, Yu CY, Lin HD.
Department of
Nuclear Medicine,
We investigated
the effects of hormone replacement therapy (HRT) on frontal cerebral blood flow
(CBF), depressive symptoms, and cognitive function in depressed postmenopausal
women. Fourteen postmenopausal women with depressive symptoms underwent HRT,
and seven controls not undergoing HRT were studied. We evaluated frontal CBF,
expressed as frontal/cerebellum (F/C) ratio, using Tc-99m hexamethyl
propylene amine oxime single photon emission computed
tomography (Tc-99m HMPAO SPECT), cognitive function using the Mini-Mental
Status Examination (MMSE), and depression using the HAD (Hospital Anxiety and
Depression) scale. All studies were carried out at initial status and after 9
months. Single photon emission computed tomography was performed at rest and at
activation during the Wisconsin Card Sorting Test (WCST). Initial frontal CBF
was not different between groups. After 9 months, resting frontal CBF was
similar between groups. However, activated frontal CBF was significantly higher
in the HRT group than in controls (F/C ratio: 0.924+/-0.04 versus 0.853+/-0.05,
P=0.007). Furthermore, the increase in the activated F/C ratio was inversely
associated with years since menopause. Mini-Mental Status Examination scores
improved after HRT, but depression scores did not. Hormone replacement therapy
improved frontal CBF and cognitive function but not depression in
postmenopausal women. The changes in frontal CBF were detected only during WCST
activation and were most apparent during early postmenopausal years.
CMAJ. 2009 Aug 4. [Epub ahead of print]
Relation between fractures and mortality: results from the Canadian
Multicentre Osteoporosis Study.
Ioannidis
G, Papaioannou A, Hopman WM, Akhtar-Danesh N, Anastassiades T, Pickard L, Kennedy CC, Prior JC, Olszynski WP, Davison KS, Goltzman D, Thabane L, Gafni A, Papadimitropoulos EA, Brown JP, Josse RG, Hanley DA, Adachi JD.
BACKGROUND:
Fractures have largely been assessed by their impact on quality of life or
health care costs. We conducted this study to evaluate the relation between
fractures and mortality. METHODS: A total of 7753 randomly selected people
(2187 men and 5566 women) aged 50 years and older from across
Mol Nutr
Food Res. 2009 Aug 3. [Epub ahead of print]
Efficacy of isoflavones in relieving vasomotor
menopausal symptoms - A systematic review.
Jacobs A, Wegewitz U, Sommerfeld C, Grossklaus R, Lampen A.
Department of Food
Safety, Federal Institute for Risk Assessment,
This review
assessed the efficacy of isoflavone supplements to
reduce vasomotor symptoms in menopausal women by reviewing all published
randomized controlled trials. Systematic literature searches were carried out
in 70 databases. Randomized and placebo controlled studies were included if
they investigated the treatment of isoflavone
supplements derived from soy or red clover on vasomotor symptoms in peri- or postmenopausal women for at least 12 wks. Data
were analyzed concerning outcome and methodological quality of the study.
Twenty-three trials met the inclusion criteria, thereof 17 investigated soy isoflavones and 6 red clover isoflavones.
Without exception, selected trials examining the effect of red clover isoflavones were already assessed in several meta-analyses
and were therefore excluded from this evaluation. As the soy isoflavone studies were very heterogeneous concerning
interventions and outcome measures, meta-analysis could not be performed and
trials were systematically assessed in a structured approach. Included soy isoflavone studies had numerous quality deficiencies and
did not consistently show a reduction of flushes after treatment with soy isoflavones. Therefore, there is no conclusive evidence,
but only some indication of a benefit of soy isoflavones
on hot flush frequency or severity.
Cancer Epidemiol
Biomarkers Prev. 2009 Aug;18(8):2207-13.
The use of herbal preparations to alleviate climacteric disorders and
risk of postmenopausal breast cancer in a German case-control study.
Obi N, Chang-Claude
J, Berger J, Braendle W, Slanger T, Schmidt M, Steindorf K, Ahrens W, Flesch-Janys D.
Institute for
Cancer Epidemiology eV,
BACKGROUND: The
use of herbal preparations (HEP) to alleviate climacteric disorders is expected
to increase as women seek alternatives to menopausal hormone therapy to avoid
the associated breast cancer risk. Data are sparse on the long-term effects of
HEP containing phytoestrogens and black cohosh on breast cancer risk. METHODS: Within a German
case-control study, associations between patterns of HEP use and incident
breast cancer were investigated in 10,121 postmenopausal women (3,464 cases,
6,657 controls). Information on HEP use was collected in face-to-face
interviews supported by a list of brand names. Multivariate logistic and polytomous regression analyses were done. FINDINGS: Ever
use of HEP (9.9%) was inversely associated with invasive breast cancer [odds
ratio (OR), 0.74; 95% confidence interval (CI), 0.63-0.87] in a dose-dependent
manner (OR, 0.96 per year of use; P = 0.03). Classes of HEP did not differ
significantly (P(heterogeneity) = 0.81). Risks for invasive ductal
(OR, 0.72; 95% CI, 0.60-0.87) and combined lobular/mixed/tubular tumors (OR, 0.76; 95% CI, 0.58-1.01) were similarly reduced
by any HEP use but not for in situ carcinomas (1.34; 95% CI, 0.86-2.09). There
were no substantial differences in associations of HEP use by estrogen receptor status (ER(+) OR, 0.74; 95% CI,
0.62-0.89; ER- OR, 0.68, 95% CI, 0.50-0.93) and progesterone receptor status of
the tumor. INTERPRETATION: Our findings support the
hypothesis that HEP use protects from invasive breast cancer in postmenopausal
women. Among conceivable modes of action, those independent of estrogen receptor-mediated pathways seem to be involved
(i.e., cytotoxicity, apoptosis).
Contraception. 2009
Aug;80(2):187-93. Epub 2009 Apr 22
Effects of oral
contraception with ethinylestradiol and drospirenone on oxidative stress in women 18-35 years old.
De Groote
D, d'Hauterive SP, Pintiaux A, Balteau B, Gerday C, Claesen J, Foidart JM.
PROBIOX SA, Campus
Universitaire du Sart-Tilman,
Avenue de l'hôpital, Tour GIGA, Bât.
B34, B-4000
BACKGROUND: Oral
contraceptives (OCs) with estrogens and progestins
may affect oxidative stress (OS) status. STUDY DESIGN: A group of 32 women
using oral contraceptives (OCU) containing 0.03 mg ethinylestradiol
and 3 mg drospirenone have been compared to a matched
control group of 30 noncontraception users (NCU).
Blood levels of antioxidants, trace elements and markers of lipid peroxidation were assessed by biochemical methods. A
microarray analysis of whole blood mRNA levels of 200 genes involved in
OS-dependant pathway was also performed. RESULTS: Levels of zinc, vitamin E and
antibodies to oxidized low-density lipoproteins (LDLs) were not significantly
different between the two groups. On the other hand, significant increases in
the mean levels of lipid peroxides (+176%, p<.001), oxidized LDLs (+145%,
p<.002), copper (+103%, p<.001), Cu/Zn ratio (+100%, p<.001) and a
significant decrease in the mean level of beta-carotene (-41%, p<.01) were
observed in the OCU compared to NCU. There was a highly significant positive
correlation between the lipid peroxide levels and the copper-to-zinc ratio.
From the 200 genes tested by microarray, one coding for HSP70 was significantly
up-regulated (log(2) fold change=+ 0.45, p<.02) and one coding for inducible
nitric oxide synthase significantly down-regulated
(log(2) fold change=-0.24, p<.05) in the OCU compared to the NCU.
CONCLUSIONS: The recently introduced combination of ethinylestradiol
and drospirenone induced the heightening of lipid peroxidation correlated with high levels of copper, a
situation that could be associated with increased cardiovascular risk.
Semana del 12 al 18 de Agosto de 2009
Arch Gynecol Obstet. 2009 Aug 14. [Epub ahead of print]
Severe menopausal symptoms in middle-aged women are associated to female
and male factors.
Chedraui P, Pérez-López
FR, Mendoza M,
Morales B,
Martinez MA, Salinas AM,
Hidalgo L.
Hospital Gineco-Obstétrico Enrique C.
Sotomayor, Guayaquil, Ecuador, pchedraui@jbgye.org.ec.
BACKGROUND: The
frequency and intensity of menopausal symptoms within a given population, as
assessed by several tools, may vary and depend on several factors, such as age,
menopausal status, chronic conditions and personal and partner
socio-demographic profile. OBJECTIVE: To determine the frequency and
intensity of menopausal symptoms and related risk factors among middle-aged
women. METHODS: In this cross-sectional study a total of 404 women aged 40 to
59 years, visiting inpatients at the Enrique C. Sotomayor
Gynecology and Obstetrics Hospital, Guayaquil,
Ecuador, were requested to fill out the menopause rating scale (MRS) and a
questionnaire containing personal and partner data. RESULTS: Mean age of
surveyed women (n = 404) was 48.2 +/- 5.7 years, 85.1% had 12 or less years of
schooling and 44.8% were postmenopausal. None was on hormonal therapy (HT) for
the menopause or psychotropic drugs. Regarding their partner, erectile
dysfunction was present in 23.8%, premature ejaculation in 21.2% and 43.5%
abused alcohol. The four most frequently found symptoms of those composing the
MRS were muscle and joint problems (80%), depressive mood (73.5%), physical and
mental exhaustion (71.3%) and irritability (68%). Mean total MRS score was 18 +/-
10.6 (median 17) and for subscales: 7.2 +/- 4.5 (somatic); 6.9 +/- 4.8
(psychological) and 3.9 +/- 3.4 (urogenital). Women
presented severe scores in 53, 36.1, 48.3 and 49.8% for total MRS and somatic,
psychological and urogenital subscales, respectively.
After adjusting for confounding factors, logistic regression analysis
determined that female higher parity and partner premature ejaculation
increased the risk for presenting severe total MRS scores (impaired female
quality of life), whereas women who had a positive perception of their health
status were at decreased risk. CONCLUSION: In this middle-aged series
psychological menopausal symptoms were the most frequent in which severity was
associated to parity and partner sexual dysfunction.
Int J Gynaecol
Obstet. 2009 Aug
8. [Epub ahead of print]
Assessment of bone mineral density should be considered earlier in perimenopausal women with vasomotor symptoms.
Tural A, Yoldemir T, Erenus M.
OBJECTIVE: To
investigate the relationship between vasomotor symptoms (hot flashes) and osteopenia or osteoporosis in perimenopausal
women. METHOD: In this cross-sectional study 79 perimenopausal
women aged between 45 and 55years and seen at the Gynecology
or Menopause Outpatient Clinic of Marmara University School of Medicine were
allotted to one of 2 groups according to the presence or absence of hot
flashes. The groups were then compared for bone mineral density (BMD) of the
lumbar vertebrae, as measured by dual energy X-ray absorptiometry.
RESULTS: The mean BMD measurement for vertebrae L2 to L4 was 0.32+/-0.19 for
the group with no hot flashes and -0.53+/-0.21 for the group with hot flashes
(P=0.007). In the former, 6.1% of the women and in the latter, 32.6% of the
women had a BMD value less than a 1.5 standard deviation from the mean
(P=0.005). CONCLUSION: Women with vasomotor symptoms are more prone to have osteopenia or osteoporosis.
N Engl J Med. 2009 Aug 11. [Epub ahead of
print]
Denosumab for Prevention of Fractures in
Postmenopausal Women with Osteoporosis.
Cummings
SR, Martin JS, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, et al.
California Pacific
Medical Center Research Institute and
BACKGROUND: Denosumab is a fully human monoclonal antibody to the
receptor activator of nuclear factor-kappaB ligand (RANKL) that blocks its binding to RANK, inhibiting
the development and activity of osteoclasts,
decreasing bone resorption, and increasing bone
density. Given its unique actions, denosumab may be
useful in the treatment of osteoporosis. METHODS: We enrolled 7868 women
between the ages of 60 and 90 years who had a bone mineral density T score of
less than -2.5 but not less than -4.0 at the lumbar spine or total hip.
Subjects were randomly assigned to receive either 60 mg of denosumab
or placebo subcutaneously every 6 months for 36 months. The primary end point
was new vertebral fracture. Secondary end points included nonvertebral
and hip fractures. RESULTS: As compared with placebo, denosumab
reduced the risk of new radiographic vertebral fracture, with a cumulative incidence
of 2.3% in the denosumab group, versus 7.2% in the
placebo group (risk ratio, 0.32; 95% confidence interval [CI], 0.26 to 0.41;
P<0.001) - a relative decrease of 68%. Denosumab
reduced the risk of hip fracture, with a cumulative incidence of 0.7% in the denosumab group, versus 1.2% in the placebo group (hazard
ratio, 0.60; 95% CI, 0.37 to 0.97; P=0.04) - a relative
decrease of 40%. Denosumab also reduced the risk of nonvertebral fracture, with a cumulative incidence of 6.5%
in the denosumab group, versus 8.0% in the placebo
group (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) - a relative decrease
of 20%. There was no increase in the risk of cancer, infection, cardiovascular
disease, delayed fracture healing, or hypocalcemia,
and there were no cases of osteonecrosis of the jaw
and no adverse reactions to the injection of denosumab.
CONCLUSIONS: Denosumab given subcutaneously twice
yearly for 36 months was associated with a reduction in the risk of vertebral, nonvertebral, and hip fractures in women with osteoporosis.
Circulation. 2009 Aug 10. [Epub
ahead of print]
Optimism, Cynical Hostility, and Incident Coronary Heart Disease and
Mortality in the Women's Health Initiative.
Tindle HA, Chang YF, Kuller LH, Manson JE, Robinson
JG, Rosal MC, Siegle GJ, Matthews
KA.
Brigham and
Women's Hospital and
BACKGROUND: -Trait
optimism (positive future expectations) and cynical, hostile attitudes toward
others have not been studied together in relation to incident coronary heart
disease (CHD) and mortality in postmenopausal women. Methods and
Results-Participants were 97 253 women (89 259 white, 7994 black) from the
Women's Health Initiative who were free of cancer and cardiovascular disease at
study entry. Optimism was assessed by the Life Orientation Test-Revised and
cynical hostility by the cynicism subscale of the Cook Medley Questionnaire.
Cox proportional hazard models produced adjusted hazard ratios (AHRs) for
incident CHD (myocardial infarction, angina, percutaneous
coronary angioplasty, or coronary artery bypass surgery) and total mortality
(CHD, cardiovascular disease, or cancer related) over approximately 8 years.
Optimists (top versus bottom quartile ["pessimists"]) had lower
age-adjusted rates (per 10 000) of CHD (43 versus 60) and total mortality (46
versus 63). The most cynical, hostile women (top versus bottom quartile) had
higher rates of CHD (56 versus 44) and total mortality (63 versus 46).
Optimists (versus pessimists) had a lower hazard of CHD (AHR 0.91, 95% CI 0.83
to 0.99), CHD-related mortality (AHR 0.70, 95% CI 0.55 to 0.90), cancer-related
mortality (blacks only; AHR 0.56, 95% CI 0.35 to 0.88), and total mortality
(AHR 0.86, 95% CI 0.79 to 0.93). Most (versus least) cynical, hostile women had
a higher hazard of cancer-related mortality (AHR 1.23, 95% CI 1.09 to 1.40) and
total mortality (AHR 1.16, 95% CI 1.07 to 1.27; this effect was pronounced in
blacks). Effects of optimism and cynical hostility were independent.
Conclusions-Optimism and cynical hostility are independently associated with
important health outcomes in black and white women. Future research should
examine whether interventions designed to change attitudes would lead to
altered risk.
Menopause. 2009 Aug 12. [Epub
ahead of print]
Osteoporosis treatment and atrial
fibrillation: alendronate versus raloxifene.
Huang WF, Tsai YW, Wen YW, Hsiao FY, Kuo KN, Tsai CR.
Institute of
Health and Social Welfare Policy,
OBJECTIVES:: Concerns
have been raised about bisphosphonate use and risk of
atrial fibrillation (AF) in women with osteoporosis.
This study compares the risk of AF and of flutter or acute myocardial
infarction (AMI) in women with osteoporosis taking alendronate
or raloxifene. METHODS:: Using
Bone. 2009 Aug 10. [Epub
ahead of print]
Long-term treatment of postmenopausal osteoporosis with strontium ranelate: results at 8 years.
Reginster JY, Bruyère O, Sawicki A, Roces-Varela A, Fardellone P, Roberts A, Devogelaer JP.
Department of
Public Health Sciences,
Objectives.
Strontium ranelate 2g/day has proven efficacy against
vertebral and nonvertebral fracture over 5 years in
postmenopausal osteoporosis, though many women require longer-term treatment.
This article describes the efficacy, safety, and tolerability of this agent
over 8 years. Methods. Postmenopausal osteoporotic women having participated in
the 5-year efficacy trials SOTI and TROPOS were invited to enter a 3-year
open-label extension study. The results presented here focus on patients who
received strontium ranelate for 8 years. Results. At
the extension baseline, the population treated for 8 years (n=879; 79.1+/-5.6
years) had femoral neck T-score of -2.61+/-0.71. The cumulative incidences of
new vertebral and nonvertebral fractures (13.7% and
12.0% respectively) over years 6 to 8 were non statistically different from the
cumulative incidences in the first 3 years of the original studies (11.5% and
9.6%). Lumbar spine, femoral neck, and total hip Bone Mineral Density (BMD)
increased throughout the 8-year period. Annual relative change in BMD was
significant at every visit, except the 8-year visit for femoral neck and total
hip BMD. Strontium ranelate was safe and well
tolerated over 8 years. Conclusions. Long-term treatment with strontium ranelate 2g/day in postmenopausal osteoporotic women leads
to continued increases in BMD at all sites. The data also provide some evidence
for a sustained antifracture efficacy.
Menopause. 2009 Aug 11. [Epub
ahead of print]
Daily vasomotor symptoms, sleep problems, and mood: using daily data to
evaluate the domino hypothesis in middle-aged women.
Burleson
MH, Todd M, Trevathan WR.
Objetive: The
aim of this study was to investigate the relationships among daily reports of
vasomotor symptoms (hot flashes and/or sweats), same-day sleep problems, and
next-day mood reports in middle-aged women. METHODS: Fifty-five healthy
middle-aged women were recruited to keep daily records for up to 5 years or
until menopause. For each participant, the first 252 days of contiguous data
with the highest weekly frequency of vasomotor symptoms was selected for the
current analyses. Multilevel structural equation modeling
was used to test whether changes in daily vasomotor symptom occurrence
predicted changes in occurrence of same-day sleep problems and changes in
next-day positive and negative mood ratings and whether sleep problems mediated
any predictive effect of symptoms on next-day mood. RESULTS: Controlling for
initial depression, daily vasomotor symptoms predicted same-day sleep problems
(b = 0.59, P < 0.001) and next-day positive mood (b = -0.07, P < 0.01),
although significant direct relationships between vasomotor symptoms and mood
were found primarily in women with initial depression scores in the low to
moderate range. Sleep problems predicted next-day positive (b = -0.08, P <
0.01) and negative (b = 0.10, P < 0.001) mood more robustly than vasomotor
symptoms did. CONCLUSIONS: Sleep problems predicted worse mood on the following
day and accounted for only a small portion of the relationship between
vasomotor symptoms and mood. These findings suggest that any effect of
vasomotor symptoms on mood may occur largely through a mechanism other than
sleep disruption.
Menopause. 2009 Aug 11. [Epub
ahead of print]
A randomized controlled study of taper-down or abrupt discontinuation of
hormone therapy in women treated for vasomotor symptoms.
Department of
Women's and Children's Health,
Objetive: The
aim of this study was to investigate whether tapering down of combined estrogen plus progestogen therapy
(EPT) reduced the recurrence of hot flashes and resumption of therapy compared
with abrupt discontinuation. A secondary aim was to evaluate whether
health-related quality of life (HRQoL) was affected
after discontinuation of EPT and to investigate the possible factors predicting
resumption of EPT. Methods: Eighty-one postmenopausal women undergoing EPT
because of hot flashes were randomized to tapering down or abrupt
discontinuation of EPT. Vasomotor symptoms were recorded in self-registered
diaries, and resumption of hormone therapy (HT) was asked for at every
follow-up. The Psychological General Well-being Index was used to assess HRQoL. Results: Neither the number nor the severity of hot
flashes or HRQoL or frequency of resumption of HT
differed between the two modes of discontinuation of EPT during up to 12 months
of follow-up. About every other woman had resumed HT within 1 year. Women who
resumed HT after 4 or 12 months reported more deteriorated HRQoL
and more severe hot flashes after discontinuation of therapy than did women who
did not resume HT. Conclusions Women
who initiate EPT because of hot flashes may experience recurrence of vasomotor
symptoms and impaired HRQoL after discontinuation of
EPT regardless of the discontinuation method used, abrupt or taper down.
Because, in addition to severity of flashes, decreased well-being was the main
predictor of the risk to resume HT, it seems important to also discuss quality
of life in parallel with efforts to discontinue HT.
Climacteric. 2009 Aug 11:1-14. [Epub
ahead of print]
The effects of hormone replacement therapy on myocardial performance in
early postmenopausal women.
Duzenli MA, Ozdemir K, Sokmen A, Gezginc K, Soylu A, Celik C, Altunkeser BB, Tokac M.
Objectives The
results of the studies in which the effect HRT on cardiac function have been
evaluated are rather disputable. In these studies, cardiac function was
evaluated with conventional echocardiographic
methods. This study was planned in order to investigate the effects of HRT on
myocardial velocities and myocardial performance index (MPI) in healthy early
postmenopausal women. Method In a prospective, controlled study, 60 healthy
postmenopausal women were assigned to two groups (32 in the HRT group and 28 in
the control group). After conventional echocardiographic
parameters were measured, tissue Doppler echocardiography recordings were
obtained from the mitral and tricuspid annulus. Systolic myocardial velocity (Sm), early and late diastolic myocardial velocities (Em and Am) and time intervals were measured and MPI was
calculated. Then the symptom-limited exercise stress test using the Bruce
protocol was performed. After 3 and 6 months of HRT (oral 0.625 mg conjugated estrogen + 2.5 mg medroxyprogesterone
acetate/day), the same examinations were repeated. The effects of HRT on
myocardial velocities, MPI and exercise time were evaluated at the 3rd and 6th
months. Results The parameters of the control group remained statistically unchanged
during the study. HRT did not have any effect on segmental and mean left
ventricular (
Eur J Endocrinol. 2009 Aug 11. [Epub ahead of print]
Hyperthyroid Levels of TSH correlate with low bone mineral density: The
HUNT 2 -Study.
Svare A, Nilsen T, Bjøro T, Forsmo S, Schei B, Langhammer A.
Objective: To
study the relation between TSH and forearm bone mineral density (BMD) in a
general female population. Design: Cross sectional, population-based study.
Methods: In a substudy of the Nord-Trøndelag Health Study (HUNT 2), 5,778 women without and
944 with self-reported thyroid disease aged >/=40 years had their serum TSH
and distal and ultra distal forearm BMD measured. In range-based categories of TSH,
excluding women with previous thyroid disease, a general linear model was
used to calculate adjusted mean BMD, and a logistic regression model to compute
adjusted odds ratio for osteopenia and osteoporosis.
Corresponding models were used to compare BMD in women with self-reported
hypothyroidism or hyperthyroidism to euthyroid women.
Results: In women without self-reported thyroid disease, those with TSH <0.5
mU/l had 10.7 mg/cm(2) (95% CI 0.2 - 21.1) lower
distal and 9.1 mg/cm(2) (95% CI -0.7 - 18.9) lower ultra distal BMD than women
in the reference category (TSH 0.50-1.49 mU/l). No
differences were found between the categories with TSH >/=0.50 mU/l. Compared to self-reported euthyroid
women, self-reported hyperthyroid women had increased odds for osteoporosis
both distally (OR 1.35, 95% CI 1.00 - 1.82) and ultra distally (OR 1.48, 95% CI
1.10 - 1.99). Conclusion: Women with the lowest TSH (<0.5 mU/l) had lower forearm BMD than the reference category. No
differences were observed between the TSH categories >/=0.50 mU/l. The prevalence of osteoporosis was higher in women
who reported hyperthyroidism than in women without self-reported thyroid
disease.
Semana del 19 al 25 de Agosto de 2009
Methods Inf Med. 2009 Aug 20;48(5). [Epub ahead of print]
Physical Activity and Postmenopausal Breast Cancer.
Schmidt ME, Chang-Claude J, Slanger T, Obi N, Flesch-Janys D, Steindorf K.
PD Dr. Karen Steindorf, Unit of Environmental Epidemiology, German
Cancer Research Center, Im Neuenheimer Feld 280, 69120
Heidelberg, Germany.
Objectives:
Epidemiological evidence suggests an inverse association between physical
activity (PA) and postmenopausal breast cancer risk. Breast cancer is a
heterogeneous disease, influenced by reproductive factors, lifestyle pattern,
and predispositions. We investigated whether these risk factors modify the
effect of PA on breast cancer risk. Methods: We analyzed data from 2004
hormone-receptor-positive postmenopausal breast cancer cases and 6569 controls
from the population-based MARIE study conducted 2002-2005 in
Clin Rheumatol. 2009 Aug 14. [Epub ahead of print]
Relationship between historical height loss and vertebral fractures in
postmenopausal women.
Bennani L, Allali F, Rostom S, Hmamouchi I, Khazzani H, El Mansouri L, Ichchou L, Abourazzak FZ, Abouqal R, Hajjaj-Hassouni N.
Laboratory of
Information and Research on Bone Diseases (LIRPOS), Department of Rheumatology,
El Ayachi hospital, University Hospital of
Rabat-Sale, Rabat, Morocco, loubnabennani29@yahoo.fr.
The aim of this
study was to evaluate the relationship between historical height loss (HHL) and
prevalent vertebral fractures (VF) in postmenopausal Moroccan women and to
estimate its accuracy as a clinical test for detecting VF. Two hundred
eighty-eight postmenopausal women were studied. All subjects had bone density
measurements and spinal radiographs. Vertebral bodies (T4-L4) were graded using
the semi-quantitative method of Genant. HHL was
calculated as the difference between a patient's tallest recalled height and
the current measured height. The mean age was 58.4 +/- 7.8 years. Thirty-one
percent of patients were osteoporotic, and 46.5% had VF. Patients with VF had
lost more height than those without VF (median, 2.0 cm (0.26-3.3) vs 0.96 cm (0.33-2.4), p < 0.05). In univariate
analysis, HHL was positively correlated to both number and grade of prevalent
VF (p < 0.05). The area under the receiver operating characteristics curve for
the ability of HHL to detect VF was 0.60 (95% confidence interval (CI), 0.52,
0.69). Our HHL threshold for detecting VF was >1.5 cm, its sensitivity was
58%, and its specificity was 61%. The positive predictive value was 53%, and
the negative predictive value was 65%. With HHL >1.5 cm, positive likelihood
ratio was 1.49 with 95% CI, 1.07, 2.06. Our results demonstrate significant
positive associations between HHL, VF, number of VF, and grade of VF. However,
this relationship is not clinically pertinent. Consequently, HHL cannot be used
as a reliable clinical test for detecting VF in postmenopausal Moroccan women.
Spine (Phila Pa 1976). 2009 Aug 15;34(18):1984-9.
The relationship between back pain and future vertebral fracture in
postmenopausal women.
Kuroda T, Shiraki M, Tanaka S, Shiraki Y, Narusawa K, Nakamura T.
Department of Gynecology and Obstetrics,
STUDY DESIGN:
Cross sectional and prospective observational study in Japanese postmenopausal
women. OBJECTIVE: The aim of the study was 2-fold. The first was to investigate
what kind of comorbidities could be found in
conjunction with back pain in Japanese postmenopausal women. The second was to
investigate whether significant relationship between baseline back pain and
future fracture exists or not. SUMMARY OF BACKGROUND DATA: Back pain has been
reported to be associated with vertebral degeneration or vertebral fracture.
However, there has been no available data that indicates the relationship
between back pain and future fracture risks. METHODS: The subjects who visited
their practitioner were examined for their prevalent back pain or pains in
other site. Bone mineral density, body height, body weight, and serum parameter
were measured at baseline, and comorbidities were
investigated by interview. Fragility fractures were also assessed at baseline
and then followed up with 1- to 2-year intervals. The correlation between back
pain and baseline characteristics was investigated by logistic regression
analysis. The hazard ratio of back pain to future vertebral fracture was
estimated by multivariate Cox regression analysis. RESULTS: A total of 899
postmenopausal ambulatory women (62.5 +/- 10.3 years old) were enrolled and 81
subjects were dropped out from the study within 1 year. The remaining 818
postmenopausal women (62.1 +/- 10.3 years) were followed-up for 5.7 +/- 3.5
years. Compared to the group without pain, the group with back pain had
significantly higher age, lower bone mineral densities at lumbar spine and hip,
and higher number of prevalent vertebral fractures. The back pain was
significantly associated with rheumatic arthritis (odds ratio [OR]: 2.01, P
< 0.05), prevalent vertebral fracture (OR: 4.60, P < 0.001) and
osteoporosis (OR: 2.14, P < 0.001). A total of 189 future fractures were
observed, of which the most frequent was vertebral fractures (78.3%). The fact
that baseline back pain was a significant risk factor for time-dependent
vertebral fractures (hazard ratio: 1.62, 95% confidence interval: 1.16-2.27, P
= 0.005) was demonstrated by the Cox hazards model after adjusting for
traditional risk factors, such as age, bone mineral density, and prevalence of
vertebral fractures. CONCLUSION: The data obtained in this study indicated that
the back pain is significantly associated with osteoporosis and rheumatoid
arthritis and that it can be useful predictor for future vertebral fracture
risk in Japanese postmenopausal women in clinical settings.
Obesity (Silver Spring). 2009 Aug 20. [Epub ahead of print]
Testosterone and Visceral Fat in Midlife Women: The Study of Women's Health Across the Nation (SWAN) Fat Patterning
Study.
Janssen I, Powell LH, Kazlauskaite R, Dugan SA.
Department of
Preventive Medicine,
Visceral fat (VF)
increases with the menopause and is an independent predictor of the metabolic
syndrome, diabetes, and cardiovascular disease (CVD) in women. Little is known
about how hormonal changes during the menopausal transition are related to the
increase in VF. We aimed to determine the relationship between bioavailable testosterone and VF in middle-aged women at
various stages of the menopausal transition and whether this relationship is
independent of age and other CVD risk factors. The Study of Women's Health
Across the Nation (SWAN) is a longitudinal, community-based study. This report
uses baseline data from a population-based longitudinal ancillary study at the
Stroke. 2009 Aug 20. [Epub ahead of print]
Body Mass Index and Stroke Mortality by Smoking and Age at Menopause
Among Korean Postmenopausal Women.
Yi SW, Odongua N, Nam CM, Sull JW, Ohrr H.
From the
Department of Preventive Medicine and Public Health, Kwandong
University College of Medicine, Gangneung, Korea; the
Department of Preventive Medicine, College of Medicine, and Institute for
Health Promotion, Graduate School of Public Health, Yonsei
University, Seoul, Korea; the Department of Public Health, Graduate School of Yonsei University, Seoul, Korea; and Institute for Health
Promotion, Graduate School of Public Health, Yonsei
University, Seoul, Korea.
BACKGROUND AND
PURPOSE: The association between body mass index and mortality caused by
subtypes of stroke among postmenopausal women in terms of smoking status and
age at menopause remains controversial. METHODS: The data were derived from a
cohort study of 3321 with 17.8 years of follow-up (1985 to 2002). Hazard ratios
(HRs) and 95% CIs for strokes as related to body mass index were estimated by
Cox proportional hazard models adjusted for age, hypertension, smoking,
drinking, occupation, education, self-reported health, and age at menopause. A
stratified analysis was conducted by age at menopause and smoking status.
RESULTS: The obese group (body mass index >/=27.5 kg/m(2)) had higher risks
of total stroke mortality (HR, 1.59; 95% CI, 1.05 to 2.42) and hemorrhagic
stroke mortality (HR, 2.91; 95% CI, 1.37 to 6.19) than the normal weight group
(18.5</= body mass index <23.0). Among ever smokers, the obese group
showed significantly increased risks of total stroke mortality (HR, 2.33; 95%
CI, 1.00 to 5.43) and ischemic stroke mortality (HR, 7.21; 95% CI, 1.18 to
44.3). Obesity had more effect on stroke mortality among women who experienced
menopause at age <50 than women with age >/=50. For the obese group of
the former, the HR of total stroke was 2.04 (95% CI, 1.25 to 3.34) and that of
hemorrhagic stroke 6.46 (95% CI, 2.42 to 17.25). CONCLUSIONS: In this
prospective study, obesity raised the risks of total stroke mortality and
hemorrhagic stroke mortality among Korean menopausal women. It was more evident
with women who experienced menopause at age <50. The obese group of ever
smokers was at an increased risk of ischemic stroke mortality.
Semana del 26 de Agosto al 1 de Septiembre de 2009
Ir J Med Sci. 2009 Aug 28. [Epub ahead of print]
The effect of intramuscular vitamin D (cholecalciferol) on serum 25OH vitamin D levels in older
female acute hospital admissions.
Nugent C, Roche K, Wilson S, Fitzgibbon
M, Griffin D, Nichaidhin N, Mulkerrin E.
Department of Medicine for the Elderly,
INTRODUCTION:
Many studies have demonstrated the prevalence of vitamin D insufficiency in the
older population. OBJECTIVE: This study sought to determine whether
supplementation with intramuscular vitamin D improved 25OH vitamin D levels
significantly. SUBJECTS: Ninety female inpatients aged over 65 years were
assigned to receive 300,000 IU of intramuscular vitamin D3 (cholecalciferol)
or no intervention. METHODS: Baseline 25OH vitamin D and intact parathyroid
hormone (iPTH) levels were taken and repeated 3
months after supplementation. RESULTS: Patients who received treatment showed a
significant improvement in 25OH vitamin D levels, from 25.5 to 81 nmol/L with 11% remaining deficient. No patient became hypercalcaemic after treatment. CONCLUSIONS: Vitamin D
deficiency is common throughout all age groups in the Irish population and
particularly the older female population who have increased risk of
osteoporosis and fractures. Intramuscular vitamin D significantly improves 25OH
vitamin D levels compared to no treatment and may combat non-compliance with
oral medication.
Menopause. 2009 Aug 26. [Epub
ahead of print]
"Persistence" improves the 60-day
amenorrhea marker of entry to late-stage menopausal transition for women aged
40 to 44 years.
Taffe JR, Cain KC, Mitchell
ES, Woods NF, Crawford
SL, Harlow SD.
From
the 1Monash University Melbourne, Australia; 2University of Washington,
Seattle, WA; 3University of Massachusetts, Boston, MA; and 4University of
Michigan, Ann Arbor, MI.
OBJECTIVE::
The ReSTAGE collaboration evaluated four menstrual
markers of entry to late-stage menopausal transition. The aim of this study was
to assess the additional usefulness of "persistence" in relation to a
clinically accessible menstrual marker of late menopausal transition, taking
age into account. METHODS:: In this study, a secondary analysis of menstrual
calendar data in two ReSTAGE-collaborating studies
with comparatively low age at beginning of menstrual calendar observation was
performed. RESULTS:: Sixty days of amenorrhea is as useful for predicting time
to the final menstrual period as the currently accepted 90-day marker for women
older than 45 years. For those aged between 40 and 44 years, recurrence of the
60-day marker within the next 10 cycles is a better indicator than a single
occurrence of the 60-day marker or the 90-day marker. CONCLUSIONS:: Sixty-day
amenorrhea is as reliable a marker of late menopausal transition as the
traditional 90-day marker for women older than 45 years. For those aged 40 to
44 years, keeping menstrual records to check for a recurrence of the 60-day
marker will be useful.
Menopause. 2009 Aug 26. [Epub
ahead of print]
Quality of life and psychosocial health in
postmenopausal women achieving public health guidelines for physical activity.
Vallance JK, Murray TC, Johnson ST, Elavsky S.
From
the 1Centre for Nursing and Health Studies, Athabasca University, Athabasca;
2Faculty of Physical Activity and Recreation, University of Alberta, Edmonton,
Alberta, Canada; and 3Department of Kinesiology, Pennsylvania State University,
University Park, PA.
OBJECTIVE::
The aim of this study was to determine if there are differences in health-related
quality of life (HRQoL) and psychosocial health
between postmenopausal women who meet public health physical activity (PA)
guidelines versus those who do not (ie, self-report)
and those women who achieve at least 7,500 steps . day versus those who do not
(ie, via objective monitor). METHODS:: Postmenopausal
women (n = 297) residing in
Maturitas. 2009 Aug 24. [Epub
ahead of print]
Hormone therapy, mammographic density, and
breast cancer risk.
Campbell
Family Institute for Breast Cancer Research, Ontario Cancer Institute,
Percent
mammographic density (PMD) is a strong independent risk factor for breast
cancer. The effects of age, parity and menopause on PMD are consistent with it
being a marker of susceptibility to breast cancer. In this review, we describe
the association of PMD with breast cancer, the biological plausibility of this
association, and discuss the extent to which PMD meets the criteria for a
surrogate marker for the effects of exogenous hormones on risk of breast
cancer. Combined hormone therapy is associated with a small increase in both
PMD and the risk of breast cancer. However there is evidence that the
associations of blood estradiol levels and HRT with
breast cancer risk are independent of the association of PMD with risk,
suggesting that different biological pathways may be involved. Tamoxifen, an anti-estrogenic drug, reduces both the risk
of breast cancer and PMD, but the potential mediation of the effects of
anti-estrogens on breast cancer risk by their effects on PMD has not yet been
examined. Given the evidence that estradiol and PMD
are independently associated with breast cancer risk, it seems unlikely that an
effect of these agents on PMD mediates their effects on risk. We thus find that
the available evidence is insufficient to conclude that PMD can be used as a
surrogate marker for the effect of exogenous hormones on breast cancer. Further
research to examine the potential role of PMD as a mediator of the effects of
other risk factors is required.
Maturitas. 2009 Aug 24. [Epub
ahead of print]
Risks of osteoporosis associated with
breast cancer treatment: The need to access to preventive treatment.
Rozenberg S, Carly B, Liebens F, Antoine C.
Department
of Ob-Gyn, CHU ST PIERRE, Université
Libre de Bruxelles, Rue
Haute 290, Brussels 1000, Belgium.
The
results of available clinical studies suggest that breast cancer treatment
significantly affect bone turnover, BMD and fracture risk. This is for instance
the case for all third-generation aromatase
inhibitors. For these reasons it is recommended that breast cancer patients
exercise regularly and take daily calcium (1500mg) and vitamin D (800UI)
supplements. Most experts recommend that all women starting medical castration
or aromatase inhibitor therapy should be assessed for
their risk of osteoporosis and undergo bone mineral density (BMD) measurement
by dual-energy X-ray absorptiometry (DEXA). Patients
with pre-existing osteopenia and osteoporosis should
be evaluated for conditions which worsen skeletal health, such as vitamin D
deficiency, hyperparathyroidism, hyperthyroidism and hypercalcuria.
If these patients have a BMD score of -2.5 or lower, a low BMD (T-score between
-1 and -2.5) and additional risk factors for osteoporosis or fragility
fractures, bisphosphonate therapy should be
considered. The optimal duration of bisphosphonate
therapy is unknown. It should probably be given for as long as aromatase inhibitor therapy is continued. In addition, bisphosphonate therapy may also reduce the risk of bone
metastases. This approach seems to be cost effective based on an economic
evaluation model.
Metabolism. 2009 Aug 24. [Epub
ahead of print]
Metabolically healthy but obese
individuals: relationship with hepatic enzymes.
Messier V, Karelis AD, Robillard ME, Bellefeuille P, Brochu M, Lavoie JM, Rabasa-Lhoret R.
Department
of Nutrition, Université de Montréal,
The
purpose of this study was to investigate the level of plasma hepatic enzymes in
obese women displaying the metabolically healthy but obese (MHO) phenotype. We
studied 104 obese, sedentary, postmenopausal women. Subjects were classified as
MHO or at risk based on insulin sensitivity as assessed with the oral glucose
tolerance test-derived Matsuda index. Subjects were divided into quartiles
according to insulin sensitivity values. Subjects in the upper quartile were
categorized as MHO, whereas subjects in the lower 3 quartiles represented
at-risk subjects. Outcome measures were hepatic enzymes (aspartate
aminotransferase [AST], alanine
aminotransferase [ALT], alkaline phosphatase,
and gamma-glutamyltransferase [GGT]], high-density
lipoprotein cholesterol, triglycerides, triglycerides to high-density lipoprotein
cholesterol ratio, apolipoprotein B, fatty liver
index, body composition (dual-energy x-ray absorptiometry),
and visceral adipose tissue (computed tomography). The MHO individuals had
significantly lower concentrations of ALT, AST, and GGT as well as a lower
fatty liver index compared with at-risk subjects (P < .05). In addition,
lean body mass index and visceral adipose tissue were significantly lower in
MHO individuals (P < .05). Moreover, stepwise regression analysis showed
that ALT explained 17.9% of the variation in insulin sensitivity in our cohort,
which accounted for the greatest source of unique variance. Results of the
present study indicate that postmenopausal women displaying the MHO phenotype
present favorable levels of ALT, AST, and GGT. Lower concentrations of hepatic
enzymes, in particular, lower circulating ALT levels, in MHO individuals may
reflect lower hepatic insulin resistance and lower liver fat content; and this
could be involved, at least in part, in the protective profile of MHO
individuals.
Metabolism. 2009 Aug 25. [Epub
ahead of print]
Changes in C-reactive protein from low-fat
diet and/or physical activity in men and women with and without metabolic
syndrome.
Camhi SM, Stefanick ML, Ridker PM, Young DR.
Population
Science, Pennington Biomedical
Change
in high-sensitivity C-reactive protein (CRP) from low-fat diet (diet) and
physical activity (PA) interventions is relatively unknown for adults with
metabolic syndrome. The objective of the study was to assess CRP change (DeltaCRP) with diet and/or PA in men and women with and
without metabolic syndrome. Men (n = 149) and postmenopausal women (n = 125)
with elevated low-density lipoprotein cholesterol and low high-density
lipoprotein cholesterol were recruited into a 1-year randomized controlled
trial. Treatment groups were as follows: control, diet (reduced total fat,
saturated fat, and cholesterol intake), PA (45-60 minutes at 60%-85% maximum
heart rate), or diet + PA. Weight loss was not an intervention focus. Metabolic
syndrome was defined using the American Heart Association/National Heart, Lung,
and Blood Institute criteria. Stored plasma samples were analyzed for CRP.
Change in CRP was compared between treatments, within sex and metabolic
syndrome status, using analysis of covariance, including covariates for
baseline CRP and body fat change. For women with metabolic syndrome (n = 39), DeltaCRP was greater in diet vs
control (-1.2 +/- 0.4, P = .009), diet + PA vs
control (-1.3 +/- 0.4, P = .006), and diet + PA vs PA
(-1.1 +/- 0.4, P = .02). Women with metabolic syndrome receiving the diet
component (diet or diet + PA) had greater DeltaCRP
compared with those who did not (control or PA) (P = .001). Change in CRP was
not significantly different between intervention groups in men overall, women
overall, men with (n = 47) or without metabolic syndrome (n = 102), or women
without metabolic syndrome (n = 86). Low-fat diet may be the most effective
treatment for reducing CRP in women with metabolic syndrome.
PLoS Med. 2009 Aug;6(8):e1000135.
Epub 2009 Aug 25.
Decreased bone mineral density in adults
born with very low birth weight: a cohort study.
Hovi P, Andersson S, Järvenpää AL, Eriksson
JG, Strang-Karlsson S, Kajantie E, Mäkitie O.
Hospital
for Children and Adolescents, Institute of Clinical Medicine,
BACKGROUND:
Very-low-birth-weight (VLBW, <1,500 g) infants have compromised bone mass
accrual during childhood, but it is unclear whether this results in subnormal
peak bone mass and increased risk of impaired skeletal health in adulthood. We
hypothesized that VLBW is associated with reduced bone mineral density (BMD) in
adulthood. METHODS AND FINDINGS: The Helsinki Study of Very Low Birth Weight
Adults is a multidisciplinary cohort study representative of all VLBW births
within the larger
J Clin Oncol. 2009 Aug 24. [Epub
ahead of print]
Use of Hormone Replacement Therapy and the
Risk of Colorectal Cancer.
Rennert G, Rennert HS, Pinchev M, Lavie O, Gruber SB.
Department
of Community Medicine and Epidemiology, Carmel Medical Center; Bruce Rappaport Faculty of Medicine, Technion-Israel
Institute of Technology; Clalit Health Services
National Cancer Control Center; Gyneco-oncology Unit,
Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel.
PURPOSE:
Estrogen/progestin replacement therapy is prescribed to women in menopause for
purposes of postmenopausal symptom control or prevention of hormone
deficiency-related diseases such as osteoporosis. Such treatments have formerly
been shown to be associated with lower colorectal cancer risk in an as yet
unknown mechanism. PATIENTS AND METHODS: The Molecular Epidemiology of
Colorectal Cancer study was a population-based case-control study in northern