Selección de Resúmenes
de Menopausia
Septiembre de
2008
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de Chile
Semana del 27 de Agosto al 02 de Septiembre 2008
Menopause. 2008 Aug 26. [Epub ahead of
print]
Long-term risk of depressive and anxiety symptoms
after early bilateral oophorectomy.
Rocca WA, Grossardt BR, Geda YE, Gostout BS, Bower JH, Maraganore DM, de Andrade M,
From the Divisions of 1Epidemiology and 2Biostatistics, Department of
Health Sciences Research; Departments of 3Psychiatry and Psychology,
4Obstetrics and Gynecology, and 5Neurology, College
of Medicine, Mayo Clinic, Rochester, MN.
OBJECTIVE:: We studied the long-term risk of depressive and anxiety
symptoms in women who underwent bilateral oophorectomy
before menopause. DESIGN:: We conducted a cohort study
among all women residing in
Menopause. 2008 Aug 21. [Epub
ahead of print]
Effect
of progestogen and progestogen
type on hemostasis measures in postmenopausal women:
the Postmenopausal Estrogen/Progestin Intervention
(PEPI) Study.
Smith NL, Wiley JR, Legault C, Rice KM, Heckbert SR, Psaty BM, Tracy RP, Cushman M.
From
the Departments of 1Epidemiology, 2Medicine, 3Biostatistics, and 4Health
Services, University of Washington, Seattle, WA; 5Seattle Epidemiologic
Research and Information Center of the Department of
Veterans Affairs Office of Research and Development, Seattle, WA; 6Department
of Public Health Sciences, Wake Forest University, Winston-Salem, NC; and
7Departments of Pathology and Laboratory Medicine, University of Vermont,
Burlington, VT.
OBJECTIVE:: The contribution of progestogen
therapy or progestogen type to risks and benefits of estrogen treatment is inadequately characterized. We
examined the effect of conjugated equine estrogens (CEE) with and without
concomitant progestogen treatments on changes in hemostasis measures among Postmenopausal Estrogen/Progestin Intervention participants. DESIGN:: Postmenopausal Estrogen/Progestin
Intervention was a clinical trial that randomized 875 postmenopausal women to
one of five arms: placebo, CEE alone, CEE with cyclic micronized progesterone
(MP), CEE with cyclic medroxyprogesterone acetate (MPA),
and CEE with continuous MPA. Twelve hemostasis assays
were measured in a substudy at baseline and 12 and 36
months. Using 12- and 36-month changes in hemostasis
measures, we calculated change ratios for two comparisons of active treatments:
CEE+MPA versus CEE and CEE+MPA versus CEE+MP. RESULTS::
Hemostasis measures were available for 288 women.
Compared with women assigned to CEE alone, 12-month increases in factor VIIc and protein C among women assigned to CEE+MPA were
relatively smaller (ratios: 0.94 [95% CI: 0.89-0.98] and 0.96 [95% CI:
0.92-1.00]), respectively. Compared with women assigned to CEE+MP, women
assigned to CEE+MPA had smaller increases in factor VIIc
and larger decreases in plasminogen activator
inhibitor-1 antigen at 12 months (ratios: 0.94 [95% CI: 0.90-0.98] and 0.70
[95% CI: 0.53-0.93], respectively). Thirty-six month ratios were similar to
these. Women assigned to CEE+MPA had smaller increases in protein C than those
assigned CEE+MP at 36 months only (ratio: 0.95 [95% CI: 0.91-0.99]). No other
associations were significant. CONCLUSIONS:: We found
modest yet significant differences in hemostasis
measure changes when comparing progestogen use and progestogen type in postmenopausal women using CEE.
Cancer Epidemiol
Biomarkers Prev. 2008 Aug 25. [Epub
ahead of print]
Estrogen plus Progestin and
Risk of Benign Proliferative Breast Disease.
Rohan TE, Negassa A, Chlebowski RT, Lasser NL, McTiernan A, Schenken RS, Ginsberg M, Wassertheil-Smoller S, Page DL.
Albert
Einstein College of Medicine, Bronx, New York; Harbor-UCLA
Medical Center, Torrance, California; New Jersey
Medical School, Newark, New Jersey; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Texas Health
Science Center, San Antonio, Texas; and Vanderbilt
University Medical School, Nashville, Tennessee.
Women
with benign proliferative breast disease are at increased risk of subsequent
breast cancer. Estrogens and progesterone exert proliferative effects on
mammary epithelium, and combined hormone replacement therapy has been
associated with increased breast cancer risk. We tested the effect of
conjugated equine estrogen plus progestin on the risk
of benign proliferative breast disease in the Women's Health Initiative (WHI)
randomized controlled trial. In the WHI trial of estrogen
plus progestin, 16,608 postmenopausal women were randomly assigned either to
0.625 mg/day of conjugated equine estrogen plus 2.5
mg/day of medroxyprogesterone acetate or to placebo.
Baseline and annual breast exams and mammograms were required. The trial was
terminated early (average follow-up, 5.5 years). We identified women who had
had a biopsy for benign breast disease, and subjected histologic
sections from the biopsies to standardized review. Overall, 178 incident cases
of benign proliferative breast disease were ascertained in the estrogen plus progestin group and 99 in the placebo group.
The use of estrogen plus progestin was associated
with a 74% increase in the risk of benign proliferative breast disease [hazard
ratio, 1.74; 95% confidence interval (CI), 1.35-2.25]. For benign proliferative
breast disease without atypia the hazard ratio was
2.00 (95% CI, 1.50-2.66), while for atypical hyperplasia it was 0.76 (95% CI,
0.38-1.52). The risk varied little by levels of baseline characteristics. The
results of this study suggest that the use of estrogen
plus progestin may increase the risk of benign proliferative breast disease.
Curr Osteoporos Rep. 2008 Sep;6(3):95-9.
Evaluation and correction of low vitamin D status.
Low
vitamin D status, which is endemic due to inadequate oral intake combined with
sun avoidance, contributes to musculoskeletal and other pathologies. Although
controversial, it is increasingly recommended that serum 25-hydroxyvitamin D
(25D) concentrations less than 30 ng/mL be considered suboptimal. Clinicians should
appreciate that 25(OH)D measurements, like all
quantitative laboratory tests, are subject to assay and biologic variability.
Additionally, international standardized calibrators do not exist for 25(OH)D measurement. As such, a single 25(OH)D
value of "30 ng/mL"
may have substantial variability surrounding it, thereby making 25(OH)D levels
of approximately 35 to 40 ng/mL
a reasonable therapeutic goal to assure vitamin D adequacy. Achieving such
levels often requires vitamin D supplementation. Vitamin D3 (cholecalciferol) or D2 (ergocalciferol)
may be used; whether vitamin D3 is more potent than vitamin D2 in maintaining
25(OH)D is controversial.
HSS J. 2006 Sep;2(2):130-5.
How much
calcium is in your drinking water? A survey of calcium concentrations in
bottled and tap water and their significance for medical treatment and drug
administration.
Morr S, Cuartas E, Alwattar B, Lane JM.
Hospital for Special Surgery, New York, NY, USA.
INTRODUCTION:
Different forms of water vary in calcium content. High divalent ion (i.e., Ca(2+), Mg(2+), etc.) concentration is deleterious to the
absorption and efficacy of the bisphosphonate group
of drugs in osteoporosis treatment. Water with high calcium concentration may
also present an alternate pathway of calcium administration. In either case,
knowing the actual concentration is critical. HYPOTHESIS: The current paper is
a surveillance study. We hypothesize that there is considerable variation in
the calcium concentrations in the various water sources: tap water from US and
Canadian cities of different regions and purified, spring, and mineral bottled
waters. In addition, we hypothesize that the water filter removes a significant
amount of minerals including calcium from the water. METHODOLOGY: Calcium
concentrations in various city tap waters, as well as an assorted number of
bottled waters, were determined through the direct
inspection of scientific data. The effect of filtering was also determined by
mineral analysis of mineral water directly before and after filtration. RESULT:
The calcium concentration of water varies from 1 to 135 mg/L across the
J Clin Endocrinol Metab. 2008 Aug 26. [Epub ahead of print]
Relations
between endogenous androgens and estrogens in postmenopausal women with
suspected ischemic heart disease.
Braunstein GD, Bairey Merz
CN, Johnson BD, Stanczyk FZ, Bittner V, Berga SL, Shaw L, Hodgson TK, Paul-Labrador M, Azziz R.
Cedars-Sinai
Medical Center, Los Angeles, CA; University of
Pittsburgh, Pittsburgh, PA; University of Southern California, Los Angeles, CA;
University of Alabama at Birmingham, Birmingham, AL; Emory University School of
Medicine, Atlanta, GA.
Context:
Since androgens are obligatory precursors of estrogens, it is reasonable to
assume that their serum concentrations would exhibit positive correlations. If
so, then epidemiologic studies that examine the association between androgens
and pathologic processes should adjust the results for the independent effect
of estrogens. Objective: To examine the interrelationships among testosterone
(T), androstenedione (A), estradiol
(E2), estrone (E1), and sex hormone-binding globulin
(SHBG) in postmenopausal women. Design: Cross-sectional study of women
participating in the NHBLI-sponsored Women's Ischemia Syndrome Evaluation
(WISE) study. Setting: Four academic medical centers.
Patients: A total of 284 postmenopausal women with chest pain symptoms or
suspected myocardial ischemia. Main Outcome Measures: Post-hoc analysis of the
relationships among sex steroid hormones with insulin resistance, body mass
index (BMI) and presence or absence of coronary artery disease as determined by
coronary angiography. Results: BMI was significantly associated with insulin
resistance, total E2, free E2, bioavailable E2, and
free T. Highly significant correlations were found for total T, free T, and A
with total E2, free E2, bioavailable E2 and E1, and
persisted after adjustment for BMI and insulin resistance. A significant
relationship was present between total and free T and the presence of coronary
artery disease after adjustment for the effect of E2. Conclusions: Serum levels
of androgens and estrogens track closely in postmenopausal women referred for
coronary angiography for suspected myocardial ischemia. Epidemiologic studies
that relate sex steroid hormones to physiological or pathological processes
need to control for the independent effect of both estrogens and androgens.
J Cell Physiol. 2008 Aug
25. [Epub ahead of print]
Low dose
beta-blocker prevents ovariectomy-induced bone loss
in rats without affecting heart functions.
Bonnet N, Benhamou CL, Malaval L, Goncalves C, Vico L, Eder V, Pichon C, Courteix D.
INSERM U658,
CTI (Caractérisation du tissu osseux par imagerie, techniques et applications),
Université d'Orléans, Orleans, France.
Findings
from animal studies have suggested that bone remodeling
is under beta-adrenergic control. However, the level of adrenergic inhibition
required to achieve the most favorable effects on the
skeleton remains unknown. To address this question, we compared the effects of
low (0.1 mg/Kg/day), medium (5 mg/Kg/day) or high (20 mg/Kg/day) doses of propranolol given 5 days per week for 10 weeks in ovariectomized (OVX) rats. Characteristics of bone microarchitecture, biomechanical properties and bone
turnover were investigated, whilst heart functions were assessed by
echocardiography and catheterization of the left ventricle. We first confirmed
the expression of Adrbeta2R and the absence of Adrbeta1R on osteoblasts
by PCR and confocal microscopy. We then showed that
low dose propranolol prevented OVX induced bone loss
by increasing bone formation (+30% of MAR vs. placebo, P = 0.01) and decreasing
bone resorption (-52% of osteoclast
surface on bone surface vs. placebo, P = 0.01). Consequently, rats receiving
0.1 mg/kg/day propranolol displayed higher stress
(+27%), intrinsic energy (+28.7%) and Young's Modulus in compression versus
placebo (all, P < 0.05). No significant effects on heart hemodynamic
parameters were found in rats receiving this dose. In contrast, medium and high
doses of propranolol had a negative effect on heart
functions but no significant protective effects on bone mass in ovariectomized rats. These results, consistent with the
dominant nature of the high bone mass phenotype and normal heart function of
Adrbeta2R-deficient mice, suggest that low doses of beta-blockers may have a
therapeutic utility in the treatment of osteoporosis with high selectivity for
bone tissues.
Menopause. 2008 Aug
22. [Epub ahead of print]
Changes
in skin topography during hormone therapy.
Kaatz M, Elsner P, Koehler MJ.
From
the Department of Dermatology and Allergology,
The
influence of female sex hormones on skin aging has repeatedly been investigated
with contradictory results. In our study, the skin roughness of eight women
receiving hormone therapy decreased significantly by approximately 15% in 12
months. Our results provide new evidence of the antiaging
effect of female sex hormones.
Menopause. 2008 Aug
22. [Epub ahead of print]
Newer
antidepressants for hot flashes-should their efficacy still be up for debate?
Loprinzi CL, Barton DL, Sloan JA, Novotny PJ, Wolf S.
From
the Departments of 1Oncology and 2Biostatistics, Mayo Clinic,
OBJECTIVE::
Newer antidepressants have been shown in clinical trials to reduce hot flashes,
although not as well as do hormones. Nonetheless, a recently published
meta-analysis and subsequent editorial raised doubts with regard to the utility
of newer antidepressants for treating hot flashes. Concerns about the lack of
efficacy of newer antidepressants on hot flashes were based in large part on
results of two placebo-controlled, double-blind trials, one evaluating venlafaxine and the other individually evaluating both fluoxetine and citalopram. These
two studies have repeatedly been put forward as evidence that newer
antidepressants are not definitively proven to reduce hot flashes. DESIGN:: Raw
data from these two randomized, placebo-controlled trials evaluating
second-generation antidepressants for hot flashes were obtained. These data and
subsequent study conclusions are evaluated and discussed in the context of
other published trial data regarding the use of newer antidepressants for
treating hot flashes. RESULTS:: Examination of the raw data from these two
trials revealed that neither employed a baseline period of hot flash
determination against which to calculate changes over time from baseline.
CONCLUSIONS:: Recognition that these two trials cannot be used to look at hot
flash frequency or score changes from baseline limits their ability to inform
the efficacy literature about the use of newer antidepressants for hot flash
reduction.
Semana del 03 al 09 de Septiembre 2008
Menopause. 2008 Aug 26. [Epub ahead of print]
Long-term risk of depressive
and anxiety symptoms after early bilateral oophorectomy.
Rocca WA, Grossardt BR, Geda YE, Gostout BS, Bower JH, Maraganore DM, de Andrade
M,
From the Divisions
of 1Epidemiology and 2Biostatistics, Department of Health Sciences Research; Departments
of 3Psychiatry and Psychology, 4Obstetrics and Gynecology,
and 5Neurology,
OBJECTIVE:: We
studied the long-term risk of depressive and anxiety symptoms in women who
underwent bilateral oophorectomy before menopause.
DESIGN:: We conducted a cohort study among all women residing in
Menopause. 2008 Aug 21. [Epub ahead of print]
Effect of progestogen and progestogen type
on hemostasis measures in postmenopausal women: the
Postmenopausal Estrogen/Progestin Intervention (PEPI)
Study.
Smith NL, Wiley JR, Legault C, Rice KM, Heckbert SR, Psaty BM, Tracy RP, Cushman M.
From the
Departments of 1Epidemiology, 2Medicine, 3Biostatistics, and 4Health Services,
University of Washington, Seattle, WA; 5Seattle Epidemiologic Research and
Information Center of the Department of Veterans
Affairs Office of Research and Development, Seattle, WA; 6Department of Public
Health Sciences, Wake Forest University, Winston-Salem, NC; and 7Departments of
Pathology and Laboratory Medicine, University of Vermont, Burlington, VT.
OBJECTIVE:: The
contribution of progestogen therapy or progestogen type to risks and benefits of estrogen treatment is inadequately characterized. We
examined the effect of conjugated equine estrogens (CEE) with and without
concomitant progestogen treatments on changes in hemostasis measures among Postmenopausal Estrogen/Progestin Intervention participants. DESIGN::
Postmenopausal Estrogen/Progestin Intervention was a
clinical trial that randomized 875 postmenopausal women to one of five arms:
placebo, CEE alone, CEE with cyclic micronized progesterone (MP), CEE with
cyclic medroxyprogesterone acetate (MPA), and CEE
with continuous MPA. Twelve hemostasis assays were
measured in a substudy at baseline and 12 and 36
months. Using 12- and 36-month changes in hemostasis
measures, we calculated change ratios for two comparisons of active treatments:
CEE+MPA versus CEE and CEE+MPA versus CEE+MP. RESULTS:: Hemostasis
measures were available for 288 women. Compared with women assigned to CEE
alone, 12-month increases in factor VIIc and protein
C among women assigned to CEE+MPA were relatively smaller (ratios: 0.94 [95%
CI: 0.89-0.98] and 0.96 [95% CI: 0.92-1.00]), respectively. Compared with women
assigned to CEE+MP, women assigned to CEE+MPA had smaller increases in factor VIIc and larger decreases in plasminogen
activator inhibitor-1 antigen at 12 months (ratios: 0.94 [95% CI: 0.90-0.98]
and 0.70 [95% CI: 0.53-0.93], respectively). Thirty-six month ratios were
similar to these. Women assigned to CEE+MPA had smaller increases in protein C
than those assigned CEE+MP at 36 months only (ratio: 0.95 [95% CI: 0.91-0.99]).
No other associations were significant. CONCLUSIONS:: We found modest yet
significant differences in hemostasis measure changes
when comparing progestogen use and progestogen type in postmenopausal women using CEE.
Cancer Epidemiol
Biomarkers Prev. 2008 Aug 25. [Epub ahead of print]
Estrogen plus
Progestin and Risk of Benign Proliferative Breast Disease.
Rohan TE, Negassa A, Chlebowski RT, Lasser NL, McTiernan A, Schenken RS, Ginsberg M, Wassertheil-Smoller S, Page DL.
Albert Einstein
College of Medicine, Bronx, New York; Harbor-UCLA
Medical Center, Torrance, California; New Jersey
Medical School, Newark, New Jersey; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Texas Health
Science Center, San Antonio, Texas; and Vanderbilt
University Medical School, Nashville, Tennessee.
Women with benign
proliferative breast disease are at increased risk of subsequent breast cancer.
Estrogens and progesterone exert proliferative effects on mammary epithelium,
and combined hormone replacement therapy has been associated with increased
breast cancer risk. We tested the effect of conjugated equine estrogen plus progestin on the risk of benign proliferative
breast disease in the Women's Health Initiative (WHI) randomized controlled
trial. In the WHI trial of estrogen plus progestin,
16,608 postmenopausal women were randomly assigned either to 0.625 mg/day of
conjugated equine estrogen plus 2.5 mg/day of medroxyprogesterone acetate or to placebo. Baseline and
annual breast exams and mammograms were required. The trial was terminated
early (average follow-up, 5.5 years). We identified women who had had a biopsy
for benign breast disease, and subjected histologic
sections from the biopsies to standardized review. Overall, 178 incident cases
of benign proliferative breast disease were ascertained in the estrogen plus progestin group and 99 in the placebo group.
The use of estrogen plus progestin was associated
with a 74% increase in the risk of benign proliferative breast disease [hazard
ratio, 1.74; 95% confidence interval (CI), 1.35-2.25]. For benign proliferative
breast disease without atypia the hazard ratio was
2.00 (95% CI, 1.50-2.66), while for atypical hyperplasia it was 0.76 (95% CI,
0.38-1.52). The risk varied little by levels of baseline characteristics. The
results of this study suggest that the use of estrogen
plus progestin may increase the risk of benign proliferative breast disease.
Curr Osteoporos
Rep. 2008 Sep;6(3):95-9.
Evaluation and
correction of low vitamin D status.
Low vitamin D
status, which is endemic due to inadequate oral intake combined with sun
avoidance, contributes to musculoskeletal and other pathologies. Although
controversial, it is increasingly recommended that serum 25-hydroxyvitamin D
(25D) concentrations less than 30 ng/mL be considered suboptimal. Clinicians should appreciate
that 25(OH)D measurements, like all quantitative laboratory tests, are subject
to assay and biologic variability. Additionally, international standardized
calibrators do not exist for 25(OH)D measurement. As such, a single 25(OH)D
value of "30 ng/mL"
may have substantial variability surrounding it, thereby making 25(OH)D levels
of approximately 35 to 40 ng/mL
a reasonable therapeutic goal to assure vitamin D adequacy. Achieving such
levels often requires vitamin D supplementation. Vitamin D3 (cholecalciferol) or D2 (ergocalciferol)
may be used; whether vitamin D3 is more potent than vitamin D2 in maintaining
25(OH)D is controversial.
HSS J. 2006 Sep;2(2):130-5.
How much calcium is
in your drinking water? A survey of calcium concentrations in bottled and tap water
and their significance for medical treatment and drug administration.
Morr S, Cuartas E, Alwattar B, Lane JM.
Hospital for
Special Surgery,
INTRODUCTION: Different
forms of water vary in calcium content. High divalent ion (i.e., Ca(2+),
Mg(2+), etc.) concentration is deleterious to the absorption and efficacy of
the bisphosphonate group of drugs in osteoporosis
treatment. Water with high calcium concentration may also present an alternate
pathway of calcium administration. In either case, knowing the actual
concentration is critical. HYPOTHESIS: The current paper is a surveillance
study. We hypothesize that there is considerable variation in the calcium concentrations
in the various water sources: tap water from US and Canadian cities of
different regions and purified, spring, and mineral bottled waters. In
addition, we hypothesize that the water filter removes a significant amount of
minerals including calcium from the water. METHODOLOGY: Calcium concentrations
in various city tap waters, as well as an assorted number of bottled waters,
were determined through the direct inspection of scientific data. The effect of
filtering was also determined by mineral analysis of mineral water directly
before and after filtration. RESULT: The calcium concentration of water varies
from 1 to 135 mg/L across the
J
Clin Endocrinol Metab. 2008 Aug
26. [Epub ahead of print]
Relations between
endogenous androgens and estrogens in postmenopausal women with suspected ischemic
heart disease.
Braunstein GD, Bairey Merz CN, Johnson BD, Stanczyk FZ, Bittner V, Berga SL, Shaw L, Hodgson TK, Paul-Labrador
M, Azziz R.
Cedars-Sinai
Medical Center, Los Angeles, CA; University of
Pittsburgh, Pittsburgh, PA; University of Southern California, Los Angeles, CA;
University of Alabama at Birmingham, Birmingham, AL; Emory University School of
Medicine, Atlanta, GA.
Context: Since
androgens are obligatory precursors of estrogens, it is reasonable to assume
that their serum concentrations would exhibit positive correlations. If so,
then epidemiologic studies that examine the association between androgens and
pathologic processes should adjust the results for the independent effect of
estrogens. Objective: To examine the interrelationships among testosterone (T),
androstenedione (A), estradiol
(E2), estrone (E1), and sex hormone-binding globulin
(SHBG) in postmenopausal women. Design: Cross-sectional study of women
participating in the NHBLI-sponsored Women's Ischemia Syndrome Evaluation
(WISE) study. Setting: Four academic medical centers.
Patients: A total of 284 postmenopausal women with chest pain symptoms or
suspected myocardial ischemia. Main Outcome Measures: Post-hoc analysis of the
relationships among sex steroid hormones with insulin resistance, body mass
index (BMI) and presence or absence of coronary artery disease as determined by
coronary angiography. Results: BMI was significantly associated with insulin
resistance, total E2, free E2, bioavailable E2, and
free T. Highly significant correlations were found for total T, free T, and A
with total E2, free E2, bioavailable E2 and E1, and
persisted after adjustment for BMI and insulin resistance. A significant
relationship was present between total and free T and the presence of coronary
artery disease after adjustment for the effect of E2. Conclusions: Serum levels
of androgens and estrogens track closely in postmenopausal women referred for
coronary angiography for suspected myocardial ischemia. Epidemiologic studies
that relate sex steroid hormones to physiological or pathological processes
need to control for the independent effect of both estrogens and androgens.
J Cell Physiol. 2008 Aug
25. [Epub ahead of print]
Low dose
beta-blocker prevents ovariectomy-induced bone loss
in rats without affecting heart functions.
Bonnet N, Benhamou CL, Malaval L, Goncalves C, Vico L, Eder V, Pichon C, Courteix D.
INSERM U658, CTI (Caractérisation du
tissu osseux par imagerie, techniques et applications), Université d'Orléans, Orleans, France.
Findings from
animal studies have suggested that bone remodeling is
under beta-adrenergic control. However, the level of adrenergic inhibition
required to achieve the most favorable effects on the
skeleton remains unknown. To address this question, we compared the effects of
low (0.1 mg/Kg/day), medium (5 mg/Kg/day) or high (20 mg/Kg/day) doses of propranolol given 5 days per week for 10 weeks in ovariectomized (OVX) rats. Characteristics of bone microarchitecture, biomechanical properties and bone
turnover were investigated, whilst heart functions were assessed by
echocardiography and catheterization of the left ventricle. We first confirmed
the expression of Adrbeta2R and the absence of Adrbeta1R on osteoblasts
by PCR and confocal microscopy. We then showed that
low dose propranolol prevented OVX induced bone loss
by increasing bone formation (+30% of MAR vs. placebo, P = 0.01) and decreasing
bone resorption (-52% of osteoclast
surface on bone surface vs. placebo, P = 0.01). Consequently, rats receiving
0.1 mg/kg/day propranolol displayed higher stress
(+27%), intrinsic energy (+28.7%) and Young's Modulus in compression versus
placebo (all, P < 0.05). No significant effects on heart hemodynamic
parameters were found in rats receiving this dose. In contrast, medium and high
doses of propranolol had a negative effect on heart
functions but no significant protective effects on bone mass in ovariectomized rats. These results, consistent with the
dominant nature of the high bone mass phenotype and normal heart function of
Adrbeta2R-deficient mice, suggest that low doses of beta-blockers may have a
therapeutic utility in the treatment of osteoporosis with high selectivity for
bone tissues.
Menopause. 2008 Aug
22. [Epub ahead of print]
Changes in skin
topography during hormone therapy.
Kaatz M, Elsner P, Koehler MJ.
From the
Department of Dermatology and Allergology,
The influence of
female sex hormones on skin aging has repeatedly been investigated with
contradictory results. In our study, the skin roughness of eight women
receiving hormone therapy decreased significantly by approximately 15% in 12
months. Our results provide new evidence of the antiaging
effect of female sex hormones.
Menopause. 2008 Aug
22. [Epub ahead of print]
Newer
antidepressants for hot flashes-should their efficacy still be up for debate?
Loprinzi CL, Barton DL, Sloan JA, Novotny PJ, Wolf S.
From the
Departments of 1Oncology and 2Biostatistics, Mayo Clinic,
OBJECTIVE:: Newer
antidepressants have been shown in clinical trials to reduce hot flashes,
although not as well as do hormones. Nonetheless, a recently published
meta-analysis and subsequent editorial raised doubts with regard to the utility
of newer antidepressants for treating hot flashes. Concerns about the lack of
efficacy of newer antidepressants on hot flashes were based in large part on
results of two placebo-controlled, double-blind trials, one evaluating venlafaxine and the other individually evaluating both fluoxetine and citalopram. These
two studies have repeatedly been put forward as evidence that newer
antidepressants are not definitively proven to reduce hot flashes. DESIGN:: Raw
data from these two randomized, placebo-controlled trials evaluating
second-generation antidepressants for hot flashes were obtained. These data and
subsequent study conclusions are evaluated and discussed in the context of
other published trial data regarding the use of newer antidepressants for
treating hot flashes. RESULTS:: Examination of the raw data from these two
trials revealed that neither employed a baseline period of hot flash
determination against which to calculate changes over time from baseline.
CONCLUSIONS:: Recognition that these two trials cannot be used to look at hot flash
frequency or score changes from baseline limits their ability to inform the
efficacy literature about the use of newer antidepressants for hot flash
reduction.
Semana del 10 al 16 de Septiembre 2008
Menopause. 2008 Sep 4. [Epub
ahead of print]
A proposed classification system for menstrual cycles in the menopause
transition based on changes in serum hormone profiles.
Robertson
DM, Hale GE, Fraser IS, Hughes CL, Burger HG.
From the 1Prince
Henry's Institute, Monash Medical Centre, Clayton,
Victoria, Australia; 2Department of Obstetrics and Gynaecology, University of
Sydney, NSW, Australia; and 3Quintiles Inc., Research Triangle Park, NC.
OBJECTIVE:: To
characterize menstrual cycles in women in late reproductive age and the
menopause transition, based on changes in serum hormone levels. DESIGN:: Serum
levels of estradiol, progesterone,
follicle-stimulating hormone (FSH), luteinizing hormone, inhibin
A, inhibin B, and antimüllerian
hormone, as previously reported as mean data grouped according to the Stages of
Reproductive Aging Workshop proposals, were analyzed in 55 women aged 45 to 55
and compared with those in 21 women aged 21 to 35. RESULTS:: The ovulatory cycles in the older women were divided into three
types. Type 1 cycles (n = 14, 33%) were those with hormone concentrations
similar to the women aged 21 to 35 except for 20-fold lower antimüllerian
hormone levels. Type 2 cycles (n = 24; 53%) had increased FSH, decreased inhibin B, and increased FSH-to-inhibin
B ratios but normal estradiol and progesterone
levels. Type 3 cycles had the same characteristics as type 2 cycles (n = 5;
12%) in addition to lower luteal phase progesterone
and increased luteinizing hormone. CONCLUSIONS:: The changes in hormone levels
indicated in cycle types 1 to 3 closely reflect the changes in
ovarian-pituitary activity as menopause approaches and are likely to be
directly attributable to a decrease in ovarian follicle reserve. The findings
suggest that FSH-to-inhibin B ratios and antimüllerian hormone are distinct early indicators of the
menopause transition and are likely to be useful biomarkers of impending
menopause. Furthermore, this classification may provide an improved basis for
the study of reproductive endocrine disorders associated with the menopause
transition.
Maturitas. 2008 Sep 3. [Epub ahead of print]
Effects of estradiol on the cognitive function
of postmenopausal women.
Marinho RM, Soares JM Jr, Santiago RC, Maganhin CC, Machado F, de Miranda Cota AM, Baracat EC.
Federal University of Sâo Paulo and Faculdade de Ciências Médicas de
Minas Gerais, Brazil.
OBJECTIVE: To
analyze the effect of estrogen on the cognitive
function of postmenopausal women through psychometric tests. METHODS:
Seventy-four postmenopausal women were divided into two groups: (G1) estrogen group (n=34), treated with 2mg 17 beta-estradiol; (G2) placebo group (n=31), treated with inactive
substance. All the participants were submitted, before and after treatment, to
psychometric tests, Greene's Scale of Climacteric Symptoms and the Hamilton
Scale for depression. Statistical analysis was performed using the Mann-Whitney
test and Student's t-test. In order to evaluate the degree of improvement of
symptoms or depression after estrogen treatment,
Spearman's correlation coefficient was calculated. RESULTS: A few psychometric
tests (immediate and late recall of story, Trailmaking
A and B, FAS, Stroop, Bells tests) showed
post-intervention improvement, but these were not significant when compared to
the placebo group's data. The estrogen group's climacteric
symptoms were mitigated in comparison to placebo's, but there was no
significant difference between the two groups on the Hamilton Scale. Reduction
in climacteric symptoms was associated with improvement in executive function
performance as evaluated by the Stroop test.
CONCLUSION: Our results suggest estrogen improves the
cognitive function, possibly due to a decrease in vasomotor symptoms.
Maturitas. 2008 Sep 4. [Epub ahead of print]
Could transdermal estradiol
+ progesterone be a safer postmenopausal HRT? A review.
L'hermite M, Simoncini T, Fuller S, Genazzani AR.
Department of Gynecology and Obstetrics, Université
Libre de Bruxelles,
Hormone
replacement therapy (HRT) in young postmenopausal women is a safe and effective
tool to counteract climacteric symptoms and to prevent long-term degenerative
diseases, such as osteoporotic fractures, cardiovascular disease, diabetes
mellitus and possibly cognitive impairment. The different types of HRT offer to
many extent comparable efficacies on symptoms control; however, the expert
selection of specific compounds, doses or routes of administration can provide
significant clinical advantages. This paper reviews the role of the non-oral
route of administration of sex steroids in the clinical management of
postmenopausal women. Non-orally administered estrogens, minimizing the hepatic
induction of clotting factors and others proteins associated with the
first-pass effect, are associated with potential advantages on the
cardiovascular system. In particular, the risk of developing deep vein
thrombosis or pulmonary thromboembolism is negligible
in comparison to that associated with oral estrogens. In addition, recent
indications suggest potential advantages for blood pressure control with
non-oral estrogens. To the same extent, a growing literature suggests that the progestins used in association with estrogens may not be
equivalent. Recent evidence indeed shows that natural progesterone displays a favorable action on the vessels and on the brain, while
this might not be true for some synthetic progestins.
Compelling indications also exist that differences might also be present for
the risk of developing breast cancer, with recent trials indicating that the
association of natural progesterone with estrogens confers less or even no risk
of breast cancer as opposed to the use of other synthetic progestins.
In conclusion, while all types of hormone replacement therapies are safe and effective
and confer significant benefits in the long-term when initiated in young
postmenopausal women, in specific clinical settings the choice of the transdermal route of administration of estrogens and the
use of natural progesterone might offer significant benefits and added safety.
J Endocrinol
Invest. 2008 Jul;31(7):597-601.
Sex hormone binding globulin levels across the adult lifespan in women -
The role of body mass index and fasting insulin.
Maggio M, Lauretani F, Basaria S, Ceda GP, Bandinelli S, Metter EJ, Bos AJ, Ruggiero C, et al. Internal Medicine
and Biomedical Sciences, Section of Geriatrics,
SHBG is a major
carrier of androgens. In men, SHBG levels increase with age, while in women
data are scant. There is evidence that body mass index (BMI) and fasting
insulin influence SHBG concentration. Since low SHBG levels are predictors of
insulin resistance and diabetes, understanding the relationship of SHBG with
age, insulin, and BMI is important to gain insight into the role of SHBG as a
cardiovascular risk factor in women. Differences in SHBG across adult life span
and their relationship with insulin and BMI were evaluated in a representative
cohort of 616 Italian women free of diabetes and not on hormone replacement therapy
enrolled in the InCHIANTI Study. The relationship of
SHBG with age, BMI, and fasting insulin levels was analyzed using linear
regression and by loess smoother. Serum SHBG levels showed a U-shaped
trajectory with age, declining from the 2nd to the 6th decade of life and
increasing after the 6th decade (p<0.0001). Age-related trends for BMI and
fasting insulin mirrored the trend observed for SHBG. After adjusting for
fasting insulin, the relationship between log (SHBG) and age square was
attenuated (beta coefficient from 0.00044 to 0.00039) and was further reduced
after adjustment for BMI (from 0.00039 to 0.00028). SHBG levels show an
age-related U-shaped trajectory. These changes mirror the age-related changes
in BMI and fasting insulin, suggesting that BMI and insulin negatively
influence SHBG concentration.
Neuroepidemiology. 2008 Sep
11;31(3):167-173. [Epub ahead of print]
Functional Decline in Cognitive Impairment - The Relationship between
Physical and Cognitive Function.
Auyeung TW, Kwok T, Lee J, Leung PC, Leung J, Woo J.
Background: Physical
function decline is associated with dementia, which might either be mediated by
the coexisting sarcopenia or directly related to the
impaired cognition. Our objectives are to examine the relationship between
cognitive function and performance-based physical function and to test the
hypothesis that cognitive function is related to poor physical function
independent of muscle mass. Methods: We measured muscle strength,
performance-based physical function and muscle mass using dual-energy X-ray absorptiometry and cognitive function using the cognitive
part of the Community Screening Instrument of Dementia (CSI-D) in 4,000
community-dwelling Chinese elderly aged >65 years. A CSI-D cognitive score
of >28.40 was considered as cognitively impaired. The effect of cognitive
impairment on muscle strength and physical function was analyzed by
multivariate analysis with adjustment for age, appendicular
skeletal mass (ASM), the Physical Activity Scale for the Elderly (PASE) and
other comorbidities. Results: In both genders, the
cognitively impaired (CSI-D cognitive score >28.40) group had a weaker grip
strength (-5.10 kg, p < 0.001 in men; -1.08 kg in women, p < 0.001) and
performed worse in the two physical function tests (in men, 6-meter walk speed,
-0.13 m/s, p < 0.001, chair stand test, 1.42 s, p < 0.001; in women,
6-meter walk speed, -0.08 m/s, p < 0.001, chair stand test, 1.48 s, p <
0.001). After adjustment for age, ASM, PASE and other comorbidities,
significant differences in grip strength (-2.60 kg, p < 0.001 in men; -0.49
kg, p = 0.011 in women) and the two physical function tests persisted between
the cognitively impaired and nonimpaired group (in
men, 6-meter walk speed, -0.072 m/s, p < 0.001, chair stand test, 0.80 s, p
= 0.045; in women, 6-meter walk speed, -0.049 m/s, p < 0.001, chair stand
test, 0.98 s, p < 0.001). Conclusions: Poor physical function and muscle
strength coexisted with cognitive impairment. This relationship was independent
of muscle mass. It is likely therefore that the functional decline in dementia
might be related directly to factors resulting in cognitive impairment
independently of the coexisting sarcopenia.
Curr Diab
Rep. 2008 Oct;8(5):393-8.
Diabetes and the vitamin D connection.
Department of
Medicine, Section of Endocrinology, Nutrition, and Diabetes, Boston University
School of Medicine, 715 Albany Street, M-1013, Boston, MA 02118, USA.
mfholick@bu.edu
Vitamin D
deficiency, which is common in children and adults, causes rickets, osteomalacia, and osteoporosis. Most organs and immune
cells have a vitamin D receptor, and some also have the capacity to metabolize
25-hydroxyvitamin D to 1,25-dihydroxyvitamin D. 1,25-Dihydroxyvitamin D is a
potent immunomodulator that also enhances the production
and secretion of several hormones, including insulin. Vitamin D deficiency has
been associated with increased risk of type 1 diabetes. Glycemic
control and insulin resistance are improved when vitamin D deficiency is
corrected and calcium supplementation is adequate. 25-Hydroxyvitamin D (measure
of vitamin D status) of less than 20 ng/mL is vitamin D deficiency and 21 to 29 ng/mL is insufficiency. Children and adults need at least 1000
IU of vitamin D per day to prevent deficiency when there is inadequate sun
exposure.
Climacteric. 2008
Oct;11(5):422-8.
Restless legs syndrome among women: prevalence, co-morbidity and
possible relationship to menopause.
Wesstrom J, Nilsson S, Sundstrom-Poromaa I, Ulfberg J.
Department of
Women's and Children's Health,
Objectives Restless
legs syndrome (RLS) is a common neurological movement disorder with a female
preponderance and an increasing prevalence with age. During the menopausal
transition, sleep is affected. Prior studies suggest that female hormones are
associated with the clinical manifestation of RLS. Methods A random sample of
5000 women aged 18-64 years was selected from the general Swedish population.
They were sent questions on RLS, general health, sleep problems, reproductive
health and menopausal state. Results The response rate was 70.3%; 15.7% of the
women were diagnosed with RLS. Prevalence increased with age. RLS subjects more
often had symptoms of affected sleep and depressed mood. Co-morbidity with
heart disease was more common among RLS subjects, whereas hypertension and
diabetes mellitus were not. There was a strong association between vasomotor
symptoms and RLS but no statistical relationship between use of hormone
replacement therapy, postmenopausal state and RLS. Conclusion The prevalence of
RLS among Swedish women is high. RLS sufferers more often suffered from
depression and heart disease, whereas no such associations were noted for
diabetes or hypertension. We found an increased prevalence of RLS among women
with vasomotor symptoms (night sweats) during the m
Climacteric. 2008
Oct;11(5):416-21.
Characteristics of external genitalia in pre- and postmenopausal women.
Basaran M, Kosif R, Bayar U, Civelek B.
Department of
Obstetrics and Gynecology.
Objective To
determine those objective measurements that characterize the differences
between the external genital organs of pre- and postmenopausal women. Methods
During the study period, 50 premenopausal and 50 postmenopausal patients were
recruited. Only women who were admitted for routine control examinations were consecutively
included in the study. Exclusion criteria were previous history of pelvic
surgery including external and internal genital organs, presence of diseases
that may change the anatomy of external genital organs, Mullerian
anomalies, previous vaginal birth with mediolateral
episiotomy, and use of hormone replacement therapy. The following measurements
were performed: length and width of clitoris, labium majus,
and labium minus, the distance between the clitoris and urethra, perineal length, and length of vagina. Results The length
of the vagina and the width of the labium minus were significantly different
between the two groups. Mean vaginal length was significantly longer in
premenopausal women compared to postmenopausal women (90.3 +/- 14.8 mm vs. 82.3
+/- 11.2 mm, respectively). The labia minora were
wider in premenopausal women than in postmenopausal women (17.9 +/- 4.1 mm vs.
15.4 +/- 4.7 mm). Conclusions Characterization of the anatomical changes and
relationships of external genitalia in postmenopausal women is important for
functional and perioperative evaluation. In addition
to reconstructive surgical procedures, determination of the objective
measurements of anatomical landmarks in postmenopausal external genitalia might
also be useful for assessing the results of treatment of 'atrophic' changes in
women.
Climacteric. 2008
Oct;11(5):383-9.
Relation between body mass index and endothelium-dependent
vasodilatation in healthy postmenopausal women.
Cagnacci A, Cannoletta M, Arangino S, Generali M, Ferrari S, Volpe A.
Department of
Obstetrics, Gynecology and Pediatrics,
Gynecology Unit, Policlinico
of
Objective To
evaluate whether endothelium-dependent vasodilatation is related to
anthropometric parameters in 105 healthy postmenopausal women 47-68 years of
age. Methods Flow-dependent, endothelium-dependent vasodilatation was
considered as the maximal dilatation following deflation of a cuff placed on
the forearm and inflated to supra-systolic blood pressure values for 4 min.
Endothelium-independent vasodilatation was considered as the maximal dilatation
induced by sublingual nitroglycerine (400 mug).
Results Among parameters such as height, weight, body mass index (BMI), waist,
hip, waist/hip ratio, lipids, glucose or insulin, only BMI, an indirect index
of adiposity, was independently and directly related to baseline brachial
artery diameter (b = 0.042, r = 0.269, p = 0.0055) and flow-mediated
endothelium-dependent vasodilatation either expressed as net (b = 0.034, r =
0.315, p = 0.001) or percentage (b = 0.376, r = 0.202, p = 0.039) change.
Stratification for BMI categories showed that women with BMI < 22 kg/m(2)
had an endothelium-dependent vasodilatation, significantly lower than that of
women with BMI >/= 30 kg/m(2) (0.711 +/- 0.076 mm vs. 1.107 +/- 0.141 mm; p
= 0.0114). BMI was not related to endothelium-independent vasodilatation.
Conclusions Present results show that, in healthy postmenopausal women, endothelium-dependent
vasodilatation is related to BMI, arteries of slender women dilating less than
those of their heavier counterparts. A low BMI does not appear to be beneficial
for artery vasodilatation in healthy postmenopausal women.
Climacteric. 2008
Oct;11(5):355-63.
Oral contraceptives, hormone therapy and cardiovascular risk.
Emeritus Professor
of Epidemiology,
Background Soon
after combined estrogen/progestogen
oral contraceptives (COCs) were introduced in the 1950s, it was established
that they cause venous thromboembolism (VTE), that
the risk is related to estrogen dose, and that COCs
also increase the risk of myocardial infarction among female smokers over age
35. Stroke risk is also increased. Early studies of supplemental hormone
therapy were inconclusive. Objective To consider new findings. New findings on
oral contraceptives Genetic predisposition to VTE has been established with the
discovery of
Menopause. 2008 Sep 4. [Epub ahead of print]
Prevalence of symptoms in relation to androgen concentrations in women
using estrogen plus progestogen
and women using estrogen alone.
Spetz AC, Fredriksson MG, Lidfeldt J, Samsioe GN.
Department of
Clinical Sciences,
OBJECTIVE:: Women
using estrogen plus progestogen
therapy sometimes report difficult to describe symptoms, eg,
changes in libido, mood, and memory, that may be related to decreased
androgens. To evaluate the prevalence of such symptoms and relate these
symptoms to androgen levels in women using estrogen
plus progestogen therapy, data from the Women's Health
in the Lund Area Study were analyzed. DESIGN:: A total of 2,816 women using estrogen plus progestogen therapy
were asked to complete a questionnaire consisting of questions concerning
sexual well-being and different aspects of quality of life. Serum
concentrations of testosterone, androstendione, sex
hormone-binding globulin, and estradiol were
measured. RESULTS:: A total of 2,048 questionnaires were eligible for
evaluation. Almost 40% of the women reported decreased libido. Approximately
70% were satisfied with their current sex life. Eight percent reported that
intercourse was unpleasant because of vaginal dryness. No evident associations
were found between libido and serum hormone concentrations. The most positive
effects of estrogen plus progestogen
therapy concerning memory and urinary tract and vaginal complaints were found
in women with the highest and/or moderate testosterone levels (P < 0.05).
CONCLUSIONS:: We found no strong association between symptoms related to sexual
well-being or quality of life and androgen concentrations in this study. Estrogen plus progestogen therapy
did not seem to affect symptoms that might be related to low levels of
androgens in the group of climacteric women whom we studied.
Menopause. 2008
Sep-Oct;15(5):958-62.
The relationship of self-reported sleep disturbance, mood, and menopause
in a community study.
Cheng MH, Hsu CY, Wang SJ, Lee SJ, Wang PH, Fuh JL.
Department of
Obstetrics and Gynecology,
OBJECTIVE: The aim
of this study was to assess the relationship between sleep disturbance, mood, menopausal
status, and vasomotor symptoms in middle-aged women in Kinmen.
DESIGN: A community-based sample of 1,113 Taiwanese women aged 43 to 57 years
who were living on the
Semana del 17 al 23 de Septiembre 2008
Ann Intern Med. 2008 Sep 16;149(6):404-15.
Pharmacologic treatment of low bone density or osteoporosis to prevent
fractures: a clinical practice guideline from the American College of
Physicians.
Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK; Clinical
Efficacy Assessment Subcommittee of the American College of Physicians.
American College of
Physicians, Philadelphia, Pennsylvania 19106, USA. aqaseem@acponline.org
DESCRIPTION: The American
College of Physicians (ACP) developed this guideline to present the available
evidence on various pharmacologic treatments to prevent fractures in men and
women with low bone density or osteoporosis. METHODS: Published literature on
this topic was identified by using MEDLINE (1966 to December 2006), the ACP
Journal Club database, the Cochrane Central Register of Controlled Trials (no
date limits), the Cochrane Database of Systematic Reviews (no date limits), Web
sites of the United Kingdom National Institute of Health and Clinical
Excellence (no date limits), and the United Kingdom Health Technology
Assessment Program (January 1998 to December 2006). Searches were limited to
English-language publications and human studies. Keywords for search included
terms for osteoporosis, osteopenia, low bone density,
and the drugs listed in the key questions. This guideline grades the evidence
and recommendations according to the ACP's clinical practice guidelines grading
system. RECOMMENDATION 1: ACP recommends that clinicians offer pharmacologic
treatment to men and women who have known osteoporosis and to those who have
experienced fragility fractures (Grade: strong recommendation; high-quality
evidence). RECOMMENDATION 2: ACP recommends that clinicians consider
pharmacologic treatment for men and women who are at risk for developing
osteoporosis (Grade: weak recommendation; moderate-quality evidence).
RECOMMENDATION 3: ACP recommends that clinicians choose among pharmacologic
treatment options for osteoporosis in men and women on the basis of an
assessment of risk and benefits in individual patients (Grade: strong
recommendation; moderate-quality evidence). RECOMMENDATION 4: ACP recommends
further research to evaluate treatment of osteoporosis in men and women.
J Agric Food Chem. 2008 Sep 19. [Epub ahead of print]
Major Phenolic Compounds in Olive Oil Modulate
Bone Loss in an Ovariectomy/Inflammation Experimental
Model.
Puel C, Mardon J, Agalias A, Davicco MJ, Lebecque P, Mazur A, Horcajada MN, et al
This study was conducted to
determine whether the daily consumption for 84 days of tyrosol
and hydroxytyrosol, the main olive oil phenolic compounds, and olive oil mill wastewater (OMWW), a
byproduct of olive oil production, rich in
micronutrients, may improve bone loss in ovariectomized
rats (an experimental model of postmenopausal osteoporosis) and in ovariectomized rats with granulomatosis
inflammation (a model set up for senile osteoporosis). As expected, an induced
chronic inflammation provoked further bone loss at total, metaphyseal,
and diaphyseal sites in ovariectomized
rats. Tyrosol and hydroxytyrosol
prevented this osteopenia by increasing bone
formation ( p < 0.05), probably because of their antioxidant properties. The
two doses of OMWW extracts had the same protective effect on bone ( p <
0.05), whereas OMWW did not reverse established osteopenia.
In conclusion, polyphenol consumption seems to be an
interesting way to prevent bone loss.
Menopause. 2008 Sep 10. [Epub ahead of print]
The influence of physiological and surgical menopause on coronary heart
disease risk markers.
Verhoeven MO, van der Mooren MJ, Teerlink T, Verheijen RH, Scheffer PG, Kenemans P.
From the Project "Aging
Women", the Netherlands.
OBJECTIVE:: To investigate the
influence of physiological and surgical menopause on serum concentrations of coronary
heart disease (CHD) risk markers and sex hormones. DESIGN:: Physiological
menopausal transition was investigated in two studies. In a longitudinal study,
16 women were followed from 2 years before until 2 years after physiological
menopause. In a case-control study, 27 early postmenopausal women were compared
with 27 age-matched late premenopausal women. Surgical menopause was
investigated in 11 women undergoing a prophylactic bilateral salpingo-oophorectomy. The following parameters were
measured: serum concentrations of estradiol,
follicle-stimulating hormone, inhibin A, inhibin B, asymmetric dimethylarginine,
lipids, leptin, homocysteine,
C-reactive protein, and coenzyme Q10, as well as weight and body mass index.
RESULTS:: After physiological and surgical menopause, serum estradiol
and inhibin A and B decreased, whereas
follicle-stimulating hormone increased (all P values < 0.01). Serum
asymmetric dimethylarginine, total and low-density
lipoprotein cholesterol, and leptin concentrations
were significantly higher in postmenopausal women compared with premenopausal
women (all P values < 0.05). Serum homocysteine
concentrations increased significantly during the physiological menopausal
transition. Total and low-density lipoprotein cholesterol increased after
surgical menopause (both P values = 0.01). None of the other parameters studied
were influenced significantly by the menopausal transition. No difference in
change in the various CHD risk markers investigated was observed between
physiological and surgical menopause. CONCLUSIONS:: The CHD risk profile was
affected unfavorably by both physiological and
surgical menopause. Changes in most CHD risk markers were small, despite the
substantial changes in hormonal parameters.
Osteoporos Int. 2008 Sep 19. [Epub ahead of print]
The impact of incident fractures on health-related quality of life: 5
years of data from the Canadian Multicentre Osteoporosis Study.
Papaioannou A, Kennedy CC, Ioannidis
G, Sawka A, Hopman WM, Pickard L, Brown JP, et al.
McMaster University, Hamilton
Health Sciences-Chedoke Site, Hamilton, ON, Canada.
Using prospective data from
the Canadian Multicentre Osteoporosis Study (CaMos),
we compared health utilities index (HUI) scores after 5 years of follow-up
among participants (50 years and older) with and without incident clinical
fractures. Incident fractures had a negative impact on HUI scores over time.
INTRODUCTION: This study examined change in health-related quality of life
(HRQL) in those with and without incident clinical fractures as measured by the
HUI. METHODS: The study cohort was 4,820 women and 1,783 men (50 years and
older) from the CaMos. The HUI was administered at
baseline and year 5. Participants were sub-divided into incident fracture
groups (hip, rib, spine, forearm, pelvis, other) and were compared with those
without these fractures. The effects of both time and fracture type on HUI
scores were examined in multivariable regression analyses. RESULTS: Men and
women with hip fractures, compared to those without, had lower HUI measures that
ranged from -0.05 to -0.25. Both women and men with spine fractures had
significant deficits on the pain attributes (-0.07 to -0.12). In women,
self-care (-0.06), mobility and ambulation (-0.05) were also negatively
impacted. Women with rib fractures had deficits similar to women with spine
fractures, and these effects persisted over time. In men, rib fractures did not
significantly affect HUI scores. Pelvic and forearm fractures did not
substantially influence HUI scores. CONCLUSION: The HUI was a sensitive measure
of HRQL change over time. These results will inform economic analyses evaluating
osteoporosis therapies.
Osteoporos Int. 2008 Sep 18. [Epub ahead of print]
Nitrate use and changes in bone mineral density: the Canadian
Multicentre Osteoporosis Study.
Jamal SA, Goltzman D, Hanley DA, Papaioannou A, Prior JC, Josse RG.
Medicine, University of
Toronto, Toronto, ON, Canada, sophie.jamal@utoronto.ca.
Nitrates may have beneficial
effects on bone. To determine if nitrates were associated with increased bone
mineral density (BMD), we conducted a secondary analysis using data from
subjects in a prospective study. Subjects reporting nitrate use had increased
BMD compared with non-users, confirming that nitrates have positive BMD effects
in women and men. INTRODUCTION: Prior studies suggest positive associations
between nitrates and bone. METHODS: We used linear regression models,
stratified by gender and adjusted for age, weight, and baseline differences, to
determine the association between daily nitrate use and BMD among subjects
participating in the Canadian Multicentre Osteoporosis Study. All results are
reported as annualised percent change in BMD at the hip and spine among nitrate
users compared to non-users. RESULTS: We included 1,419 men (71 reported daily
nitrate use) and 2,587 women (97 reported daily nitrate use). Male non-users
had decreased hip BMD (-1.3%; 95% confidence interval [95%CI] = -1.6 to -1.1)
and increased spine BMD (2.8%; 95%CI = 2.5 to 3.1). Male nitrate users had
increased hip BMD (1.4%; 95%CI = 0.1 to 2.8) and spine BMD (4.5%; 95%CI = 3.2
to 5.7). Among women, non-users had decreased hip BMD (-1.9; 95%CI = -2.1 to
-1.7) and increased spine BMD (2.1%; 95%CI = 1.9 to 2.4) whilst users had an
increase in hip BMD (2.0%; 95%CI = 1.2 to 2.8) and spine BMD (4.1%; 95%CI = 3.4
to 4.9). CONCLUSION: Nitrate use is associated with increased BMD at the hip
and spine in men and women.
Blood Press Monit. 2008 Oct;13(5):277-83.
Low-dose transdermal hormone therapy does not
interfere with the blood pressure of hypertensive menopausal women: a pilot
study.
de Carvalho MN, Nobre F, Mendes MC, Dos Reis RM, Ferriani RA, Silva de Sá MF.
Department of Gynecology and Obstetrics. University of São Paulo, São
Paulo, Brazil.
OBJECTIVES: To determine the
effects of low-dose transdermal hormone therapy (HT)
on systolic (SBP) and diastolic (DBP) blood pressure (BP) evaluated by 24-h
ambulatory blood pressure monitoring (ABPM) in hypertensive postmenopausal
women. METHODS: The study was conducted on 24 hypertensive postmenopausal women
aged, on average, 54 years and under treatment with enalapril
maleate (10-20 mg/day) combined or not with
hydrochlorothiazide (25 mg/day). Thirteen women used a transdermal
adhesive containing estradiol and norethisterone
(25 and 125 mug active substance/day, respectively) and 11 did not receive HT.
ABPM, lipid profile, and climacteric symptoms were evaluated before and 3 and 6
months after treatment. RESULTS: After 3 and 6 months of follow-up, there was a
statistically significant reduction of the Blatt-Kupperman
menopausal index in the treated group (19.6+/-8.3 vs. 9.6+/-5.9 vs. 9.7+/-7.0;
P=0.01). No significant difference in any of the ABPM variables (areas under
the systolic and diastolic curves, mean SBP and DBP, SBP and DBP loads and
wakefulness-sleep variation) or in the lipid profile was observed between or
within groups at the three time points studied. CONCLUSION: Low-dose transdermal HT administered for 6 months was effective in
improving climacteric symptoms and did not change BP values or circadian
pattern in postmenopausal women with mild-to-moderate arterial hypertension
taking antihypertensive medications.
Ginecol Obstet
Mex. 2008 May;76(5):261-6.
Osteoporosis prevalence in open population at Mexico City
De Lago Acosta A, Parada Tapia MG, Somera Iturbide J.
BACKGROUND: In Mexico there
isn't accurate epidemiologic information of osteoporosis prevalence, however it
is estimated that 24.5 million people are at risk or suffer it yet. OBJECTIVE:
To show prevalence of osteoporosis in open population of several areas of
Mexico City. PATIENTS AND METHOD: Retrospective, transversal and open study at
an osseous densitometric data base information from
5,924 patients. RESULTS: Densitometry evidence that 17.9% suffer osteoporosis
(79.8 female and 20.1% male), 34.5% osteopeny (76.1
female and 23.8 female), and 47.4% had normal bones (75.8% female and 24.1%
female). CONCLUSIONS: Since osseous mineral density changes exponentially
increases with age, osteopenic and osteoporosis index
is very high after 40 years old; due to that there must be considered
preventative programs for young groups, and to practice densitometries to 30
year old men and women.
J Clin Endocrinol Metab. 2008 Sep 16. [Epub
ahead of print]
Breast safety and efficacy of genistein aglycone for post-menopausal bone loss: a follow-up study.
Marini H, Bitto A, Altavilla D, Burnett BP, Polito F, Di Stefano
V, Minutoli L, Atteritano M, et al
Department of Biochemical,
University of Messina, Italy.
CONTEXT: Genistein
aglycone improves bone metabolism in women. However,
questions about the long-term safety of genistein on
breast as well as its continued efficacy still remain. OBJECTIVE: We assessed
the continued safety profile of genistein aglycone on breast and endometrium,
and its effects on bone after 3 years of therapy. DESIGN: The parent study was
a randomized, double-blind, placebo-controlled trial involving 389 osteopenic, postmenopausal women for 24-months.
Subsequently, a subcohort (138 patients) continued
therapy for an additional year. PATIENTS AND INTERVENTIONS: Participants
received 54mg of genistein aglycone
daily (n=71) or placebo (n=67). Both arms received calcium and vitamin D3 in
therapeutic doses. MAIN OUTCOMES: Mammographic density was assessed at
baseline, 24 and 36 months by visual classification scale and digitized
quantification. BRCA1 and BRCA2, sister chromatid
exchange and endometrial thickness were also evaluated. Lumbar spine and
femoral neck BMD were also assessed. Secondary outcomes were biochemical levels
of bone markers. RESULTS: After 36 months, genistein
did not significantly change mammographic breast density or endometrial
thickness, BRCA1 and BRCA2 expression was preserved while sister chromatid exchange were reduced compared with placebo. BMD
increases were greater with genistein for both
femoral neck and lumbar spine compared to placebo. Genistein
also significantly reduced PYR, as well as serum CTX and sRANKL
while increasing B-ALP, IGF-I and OPG levels. There were no differences in
discomfort or adverse events between groups. CONCLUSIONS: After 3-years of
treatment, genistein exhibited a promising safety
profile with positive effects on bone formation in a cohort of osteopenic, postmenopausal women.
Ann Epidemiol. 2008
Sep;18(9):671-7.
HDL-cholesterol and incidence of breast cancer in the ARIC cohort study.
Kucharska-Newton AM, Rosamond
WD, Mink PJ, Alberg AJ, Shahar E, Folsom AR.
Department of Epidemiology,
University of North Carolina at Chapel Hill, NC, USA.
PURPOSE: An association of low
plasma HDL-cholesterol with risk of breast cancer has been suggested by
multiple studies; the evidence, however, is not conclusive. We examined the
possible association of low HDL-cholesterol with incidence of breast cancer
using data from the Atherosclerosis Risk in Communities Study (ARIC) cohort, a
prospective study of a randomly selected sample of women and men from four U.S.
communities. METHODS: Among 7,575 female members of the ARIC cohort, 359 cases
of incident breast cancer were ascertained during the follow-up from 1987
through 2000. RESULTS: In analysis adjusted for age, race, body mass index,
smoking, and reproductive variables, we observed no association of low baseline
HDL-cholesterol (<50mg/dL) with incident breast
cancer in the total sample (hazard ratio [HR]=1.08 [95% confidence interval
(CI), 0.84-1.40]) and a modest association (HR=1.67 [95% CI, 1.06-2.63]) among
women who were premenopausal at baseline. No association was observed among
women who were postmenopausal at baseline. Removal from analysis of the first 5
years of follow-up did not appreciably change the observed associations.
CONCLUSION: Results of our study suggest that low HDL-cholesterol among
premenopausal women may be a marker of increased breast cancer risk.
Menopause. 2008 Sep 10. [Epub ahead of print]
Implications of diminished ovarian reserve (DOR) extend well beyond
reproductive concerns.
Pal L, Bevilacqua K, Zeitlian G, Shu J, Santoro N.
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven,
CT.
OBJECTIVES:: To investigate whether
a diagnosis of diminished ovarian reserve (DOR) in premenopausal years has
adverse implications for skeletal health and quality of life. DESIGN:: This was
a cross-sectional study of infertile, albeit healthy, mid-reproductive-age
women (younger than 42 y) attending an academic infertility practice. RESULTS::
Eighty-nine women with varying causes of infertility were prospectively
enrolled. Serum (cycle d 1-3) was collected for markers of ovarian reserve,
bone metabolism, testosterone, and free androgen index. Bone mineral density
(BMD) was assessed and categorized as low if the Z score was less than -1.0).
Infertile women with DOR (n = 28) demonstrated significantly higher serum
follicle-stimulating hormone levels (P < 0.001), lower müllerian-inhibiting
substance (MIS) levels (P < 0.001), smaller ovarian dimensions (P <
0.05), lower testosterone levels (P = 0.035), lower free androgen index (P =
0.019), and enhanced bone metabolism (P = 0.003); although the prevalence of
low BMD was higher in women with DOR who were younger than 41, this
relationship was not of statistical significance (P = 0.106). Women younger
than 41 years of age with DOR were significantly more likely to manifest
disturbed sleep (P = 0.049) and acknowledge dissatisfaction with sexual
intimacy (P = 0.004) compared with those with infertility and normal ovarian
reserve. After adjustment for potential confounders, a diagnosis of DOR was
significantly associated with low BMD, increased bone turnover, sexual
dissatisfaction, and disturbed sleep. CONCLUSIONS:: Our data suggest that DOR
unmasked in the context of infertility evaluation has adverse implications for
a woman's well-being that extend well beyond the thus far appreciated
reproductive concerns. A decline in ovarian hormones, specifically estrogen and testosterone, concomitant with DOR may be
hypothesized as a mechanism that can explain the observed multisystem
ramifications of DOR including increased bone turnover, low BMD, sexual
distress, and disturbed sleep.
Semana del 24 al 30 de Septiembre 2008
Breast Cancer Res. 2008 Sep 19;10(5):R78. [Epub ahead of print]
Menopausal hormone
therapy in relation to breast cancer characteristics and prognosis: a cohort
study.
Rosenberg
LU, Granath F, Dickman PW, Einarsdottir K, Wedren S, Persson I, Hall P.
INTRODUCTION:
Menopausal hormone therapy has been reported to increase the risk of certain
subtypes of breast cancer and to be associated with a favorable
survival. This could either be due to an increased mammographic surveillance or
a biological effect. We assessed these associations in a Swedish cohort of
postmenopausal breast cancer patients holding information on mammographic
examinations, menopausal hormone therapy use, other breast cancer risk factors,
and cancer treatment. METHODS: We analyzed 2,660 postmenopausal women aged
50-74 years, diagnosed with invasive breast cancer in 1993-1995 and followed
until the end of year 2003 (median follow-up 9 years and 3 months). We assessed
the influence of hormone therapy before diagnosis on tumor
characteristics and breast cancer specific survival. We analyzed hormone
therapy before diagnosis by regimen (estrogen-progestin
therapy or estrogen alone therapy), recency (current or past), and duration of use (<5 years
or [greater than or equal to]5 years). RESULTS: Current, but not past use,
compared to never use of hormone therapy before diagnosis seemed to be
associated with tumors of low grade and improved
breast cancer specific survival. The associations were stronger with longer
duration, but did not vary significantly by regimen. The favorable
survival among current users of hormone therapy was only partly explained by
differences in available tumor characteristics and
mammographic surveillance. CONCLUSIONS: We conclude that current menopausal
hormone therapy, especially long-term, is associated with favorable
tumor characteristics and survival.
J Natl
Cancer Inst. 2008 Sep 23. [Epub
ahead of print
Hormone Therapy and
the Risk of Breast Cancer in BRCA1 Mutation Carriers.
Eisen A, Lubinski J, Gronwald J, Moller P, Lynch HT, Klijn J, Kim-Sing C, Neuhausen SL, et al.
Sunnybrook
Regional Cancer Center, Toronto, Ontario, Canada
Background Hormone
therapy (HT) is commonly given to women to alleviate the climacteric symptoms
associated with menopause. There is concern that this treatment may increase
the risk of breast cancer. The potential association of HT and breast cancer
risk is of particular interest to women who carry a mutation in BRCA1 because
they face a high lifetime risk of breast cancer and because many of these women
take HT after undergoing prophylactic surgical oophorectomy
at a young age. Methods We conducted a matched case-control study of 472
postmenopausal women with a BRCA1 mutation to examine whether or not the use of
HT is associated with subsequent risk of breast cancer. Breast cancer case
patients and control subjects were matched with respect to age, age at
menopause, and type of menopause (surgical or natural). Odds ratios (ORs) and
95% confidence intervals (CIs) were estimated with conditional logistic
regression. Statistical tests were two-sided. Results In this group of BRCA1
mutation carriers, the adjusted OR for breast cancer associated with ever use
of HT compared with never use was 0.58 (95% CI = 0.35 to 0.96; P = .03). In
analyses by type of HT, an inverse association with breast cancer risk was
observed with use of estrogen only (OR = 0.51, 95% CI
= 0.27 to 0.98; P = .04); the association with use of estrogen
plus progesterone was not statistically significant (OR = 0.66, 95% CI = 0.34
to 1.27; P = .21). Conclusion Among postmenopausal women with a BRCA1 mutation,
HT use was not associated with increased risk of breast cancer; indeed, in this
population, it was associated with a decreased risk.
Int J Gynaecol
Obstet. 2008 Sep 22. [Epub ahead of print
Effects of hormone
therapy with estrogen and/or progesterone on sleep
pattern in postmenopausal women.
Hachul H, Bittencourt LR, Andersen
ML, Haidar MA, Baracat EC, Tufik S.
Department of Gynecology, Federal University of São Paulo (UNIFESP/EPM),
São Paulo, Brazil.
OBJECTIVE: To investigate
the effects of estrogen and progesterone on sleep in
postmenopausal women. METHOD: The 33 participants were randomly assigned to an estrogen or placebo group after undergoing clinical and
hormonal assessments and a polysomnogram, and they
underwent the same tests again after 12 weeks. Then, while still taking estrogen or placebo, they all received progesterone for
another 12 weeks and underwent a final polysomnogram.
RESULTS: Estrogen plus progesterone was more
effective than estrogen alone in decreasing the
prevalence of periodic limb movement (PLM) (8.1% vs
2.8%), hot flashes (14.2% vs 0%), and bruxism (11.1% vs 0%) at night,
or somnolence and attention difficulty during the day. The prevalences
of breathing irregularities, arousal from sleep, anxiety, and memory impairment
were decreased in both groups following progesterone treatment. CONCLUSION:
While not significantly affecting sleep quality, hormone therapy decreased the
prevalence of arousal in both groups and that of PLM in the group treated with estrogen plus progesterone.
Heart
Vessels. 2008
Sep;23(5):295-300. Epub 2008 Sep 20
Carotid intima-media thickness in pre-and postmenopausal women with
suspected coronary artery disease.
Kablak-Ziembicka A, Przewlocki T, Tracz W, Pieniazek P, Musialek P, Sokolowski A, et al.
Institute of
Cardiology, Collegium Medicum,
Jagiellonian University, 31-202, Krakow, Poland.
Carotid intima-media thickness (CIMT) is an early marker of
coronary artery disease (CAD). This study aimed to evaluate CIMT value for CAD
prediction in pre-and postmenopausal women referred for coronary angiography
with angina-like symptoms and a positive result of the treadmill test. The
study comprised 321 women referred for coronary angiography with symptoms
suggesting CAD. Carotid intima-media thickness was
measured in common, bifurcation, and internal carotid artery, and expressed as
the mean maximum value. Coronary angiography showed coronary stenosis >/=50% in 211 (65.7%) women, including 27 with
regular menses (47.3 +/- 3.4 years) and 184 postmenopausal (65.8 +/- 7.2
years). Normal coronary arteries were found in 110 women: 17 (47.3 +/- 4.9
years) with regular menses and 93 postmenopausal (64.3 +/- 6.5 years). The
highest CIMT values were found in postmenopausal CAD women (1.360 +/- 0.32 mm),
as compared to premenopausal with CAD (1.178 +/- 0.36 mm, P = 0.005),
pre-(0.860 +/- 0.23 mm, P < 0.001) and postmenopausal (1.022 +/- 0.30 mm, P
< 0.001) women without CAD. Carotid intima-media
thickness (P < 0.001), hyperlipidemia (P = 0.018),
and myocardial infarction (P < 0.001), but not menopause itself or the
number of years since menses cessation, were found to be independent CAD
predictors. By receiver operating characteristic calculation, the mean maximum
CIMT cut-off values discriminating CAD were lower in premenopausal (>/=0.933
mm) than in postmenopausal women (>/=1.075 mm; P < 0.05) resulting in
similar sensitivity (85.2% and 82.6%) and specificity (70.6% and 69.9%).
Carotid intima-media thickness is a strong CAD
predictor in both pre-and postmenopausal women, in contrast to the menopausal
status.
Am J Surg. 2008 Oct;196(4):505-11
Improved breast
cancer survival among hormone replacement therapy users is durable after 5
years of additional follow-up.
Christante D, Pommier S, Garreau J, Muller P, LaFleur B, Pommier R.
Division of
Surgical Oncology, Department of Surgery, Portland, OR, USA.
BACKGROUND: We
previously reported that breast cancer patients who used hormone replacement
therapy (HRT) had significantly lower stage tumors
and higher survival than never-users. We present an update with longer
follow-up, HRT use data, and in vitro research. METHODS: Our database of 292
postmenopausal breast cancer patients was updated to include HRT type,
duration, and disease status. In vitro effects of estrogen
(E) and/or medroxyprogesterone (MPA) on breast cancer
cell growth were measured. RESULTS: Tumor prognostic
factors were better and survival rates higher for both E and combination HRT
users of any duration. Use greater than 10 years correlated with node-negative
disease, mammographically detected tumors, and 100% survival. E supported minimal
proliferation; MPA induced cell death; E+MPA results were similar to E alone.
CONCLUSIONS: HRT users, regardless of type or duration of HRT use, continued to
have higher survival rates. In vitro results supported the clinical finding
that outcomes for users of E and E+MPA were similar.
Expert Opin
Investig Drugs. 2008
Oct;17(10):1435-63
Statins: under
investigation for increasing bone mineral density and augmenting fracture
healing.
Tang QO, Tran GT, Gamie Z, Graham S, Tsialogiannis E, Tsiridis E, Linder T, Tsiridis E.
University of
Leeds School of Medicine, Leeds General Infirmary Teaching Hospitals NHS Trust,
Academic Department of Trauma and Orthopaedics, Leeds, LS1 3EX, UK.
BACKGROUND: Statins are 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase inhibitors and have
been shown to possess anti-lipidaemic properties
effective in lowering cholesterol. Recent evidence has suggested beneficial pleiotropic effects, including that of fracture healing,
alongside its widely accepted ability to reduce the incidence of cardiovascular
disease. OBJECTIVES: A comprehensive review of the recent literature on the
effect of statins on bone mineral density and
fracture healing. METHODS: Medline/Ovid and EMBASE search and manual search of
bibliography of key papers, on the effects of statins
on bone metabolism including in vitro and in vivo studies, as well as clinical
trials on the effects of statins on bone mineral
density and fracture risk. RESULTS/CONCLUSIONS: There is robust in vitro and in
vivo evidence to suggest the anabolic effects of statins
on bone metabolism. Although evidence in patients with osteoporosis is
conflicting, several studies have shown that the use of statins
is associated with increases in bone mass density and reduction in fracture
risk. Conflicting studies identified may be due to different routes of
administration, types of statins employed and low
doses used. Taken together, there is strong evidence to suggest that statins have beneficial effects on fracture healing that
would support further clinical trials investigating such properties.
J Hypertens. 2008
Oct;26(10):1983-1992
Menopause does not affect
blood pressure and risk profile, and menopausal women do not become similar to
men.
Casiglia E, Tikhonoff V, Caffi S, Bascelli A, Schiavon L, Guidotti F, Saugo M, Giacomazzo M, et al.
Department of
Clinical and Experimental Medicine, University of Padova,
Padova, Italy.
OBJECTIVE: Menopause
is considered to be a cardiovascular risk factor, but this belief is based on
opinions rather than on evidence. Confounding effects of age are often
neglected. DESIGN: Population-based study with further subanalysis
of case-to-case age-matched cohorts of men and fertile and menopausal women.
SETTING: Epidemiology in primary, public, institutional frame. PARTICIPANTS:
Nine thousand three hundred and sixty-four men and women aged 18-70 years
representative of Italian general population followed-up for 18.8 +/- 7.7
years. MAIN OUTCOME MEASURES: Blood pressure (BP), prevalence and incidence of
hypertension, serum total, high-density lipoprotein and low-density lipoprotein
cholesterol, glucose tolerance, body adiposity, vascular reactivity, target organ
damage, overall and cardiovascular mortality and morbidity, by gender and by
menopausal status. RESULTS: Cross-sectional: crude BP, pressor
response to cold, orthostatic BP decrease, BMI, skinfold
thickness, fasting and postload blood glucose and
insulin, serum lipids, left ventricular mass, serum creatinine,
microalbuminuria and augmetantion
index were higher in menopausal than in fertile women, and comparable in
menopausal women and men, a difference that was no longer present when
adjusting for age or considering age-matched cohorts. Longitudinal: BP increase
during follow-up, cardiovascular mortality and morbidity were greater in
menopausal than in fertile women, and comparable in menopausal women and men, a
difference no longer present in age-matched cohorts. Menopausal status was
rejected from multivariate Cox analysis also including age. CONCLUSION: The
cardiovascular effects usually attributed to menopause seem to be a mere
consequence of the older age of menopausal women.
J
Hypertens. 2008
Oct;26(10):1976-1982
Blood pressure
around the menopause: a population study.
Cifkova R, Pitha J, Lejskova M, Lanska V, Zecova S.
Department of
Preventive Cardiology, Institute for Clinical and Experimental Medicine, Czech
Republic.
Background:
Hypertension is a major cardiovascular risk factor possibly explaining the
excessive cardiovascular morbidity and mortality in postmenopausal women.
Cross-sectional and longitudinal studies have explored this issue with
diverging results. Our study sought to elucidate the impact of the menopause on
blood pressure in a representative population sample. Methods: The study
involved randomly selected 908 female residents of a Prague district, aged
45-54 years (respondence rate, 63.9%). Three
definitions of the menopause were used: self-reported menstrual characteristics
(premenopausal with the final menstrual period less than 60 days; late
menopausal transition, with final menstrual period 60-365 days; and
postmenopausal, final menstrual period more than 365 days before the
examination), levels of follicle-stimulating hormone (</=40 IU/l for
premenopausal and more than 40 IU/l for postmenopausal women), and both.
Results: Age-adjusted and BMI-adjusted systolic blood pressure and diastolic
blood pressure did not differ among the groups regardless of the definition of menopause.
There was also no difference in the prevalence of hypertension and in the
age-adjusted and BMI-adjusted odds ratio for hypertension. Multiple regression
analysis testing the association between systolic blood pressure and diastolic
blood pressure, and age, BMI, heart rate, smoking, and antihypertensive
medication explained a rather small proportion of the BP variation. No
correlation was found between BP and age in either subgroup; the closest
correlation was always found between BP and BMI. Conclusion: In our rather
representative population random sample of women around the menopause, the rise
in blood pressure after the menopause appeared to be due to increased BMI
rather than to ovarian failure per se.
Med
Clin (Barc). 2008 Sep
20;131(9):333-8
Clinical usefulness
of biochemical markers of bone turnover in early postmenopausal women: two
years longitudinal study.
Navarro Casado L, Blázquez Cabrera JA, Del Pino Montes J, Almar Marqués E, Cháfer Rudilla M,
et al.
Laboratorio de
Análisis Clínicos. Hospital General Universitario de Albacete. Albacete.
España.
BACKGROUND AND
OBJECTIVE: Many studies have been performed on the ability of bone turnover
markers (BTM) for the prediction of bone loss and to assess the correlation of
BTM with bone mineral density (BMD). However, the results from these studies
have been mixed. The aim of this study was to assess the usefulness of BTM to
predict bone loss and to analize the correlation of
BTM with BMD in early postmenopausal women. SUBJECTS AND METHOD: 183 healthy
women, aged 50 to 55 years, with natural menopause of 6 to 36 months were
randomly selected. We measured bone alkaline phosphatase
(BALP), intact osteocalcine (OC) and C-telopeptide (sCTx) in serum, and
calcium, deoxipiridinoline (DPD) and N-telopeptide (NTx) in urine. Bone
densitometry of the spine (L(2)-L(4)) was performed at the start of the study
and two years later. Student t test, ANOVA, chi(2) test and ROC curves were
used for the statistical analysis. RESULTS: Bone markers, mainly OC and CTx, correlated with BMD and discriminated osteoporosis, osteopenia and normal bone mass (p < 0.001). According
to the ROC curves, OC had a sensitivity of 77.8% and specificity of 80.6% for
the diagnosis of osteoporosis and sCTx, 83.3% and
74.5%, respectively. Regarding the relation to bone loss, only sCTx showed difference between the lowest and the highest
quartile (p = 0.042), but we did not find an association between high turnover
and fast bone losers. CONCLUSIONS: Bone markers, mainly OC and sCTx, are useful for identification of osteoporotic and osteopenic early postmenopausal women. However, regarding
the bone loss, only CTx has a weak predictive value.
Int J Gynaecol
Obstet. 2008 Sep 20. [Epub ahead of print
Isosorbide mononitrate versus alendronate
for postmenopausal osteoporosis.
Department of
Obstetrics and Gynecology, University of Ain Shams,
Cairo, Egypt.
OBJECTIVE: To
compare the effectiveness, safety, and affordability of isosorbide
mononitrate with alendronate
for postmenopausal osteoporosis. METHODS: A randomized controlled trial of 60
postmenopausal women with osteoporosis. Participants were randomly assigned to
receive either 20 mg daily of isosorbide mononitrate or 70 mg weekly of alendronate
for 12 months. Bone mineral density (BMD) was measured using dual X-ray absorptiometry (DXA) at baseline and after 12 months.
RESULTS: Both groups showed significant improvement in BMD. Isosorbide
mononitrate yielded a comparable effect to alendronate for BMD and T-score at the end of the follow-up
period. For BMD and T score the mean differences between the 2 groups were
-0.005 (95% CI, -0.02 to 0.03) and 0.31 (95% CI, -0.03 to 0.64), respectively.
A 10.8% and 12.1% change in BMD after 12 months was seen for isosorbide mononitrate and alendronate, respectively. CONCLUSION: Isosorbide
mononitrate is comparable to alendronate.
Nitric oxide donors may be an effective and affordable therapy to improve bone
mineral density.