Selección de
Resúmenes de Menopausia
Noviembre 2007
Juan Enrique Blümel.
Departamento Medicina Sur. Universidad de Chile
Semana del
21 al 27 de Noviembre de 2007
Women Health. 2007;45(3):31-51.
Age-Related Differences in Health Complaints:The
Sievert LL, Morrison LA, Reza AM, Brown DE, Kalua E, Tefft HA.
Machmer Hall,
The purpose of this study was
to determine the age distribution of health-related complaints and symptom
groupings from a random postal survey carried out in the multi-ethnic city of
Curr Med Res Opin. 2007 Nov 20; [Epub
ahead of print]
Non-vertebral fracture risk reduction with oral bisphosphonates:
challenges with interpreting clinical trial data.
BACKGROUND: To license a
therapy for the treatment of postmenopausal osteoporosis pharmacological agents
must show ability to reduce the incidence of morphometric vertebral fractures
versus placebo over a 3-year study period. In
Menopause. 2007 Nov 19; [Epub
ahead of print
Impact of menopause on quality of life in community-based women in
Chen Y, Lin SQ, Wei Y, Gao HL, Wang SH, Wu ZL.
From the 1Department of
Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union
Medical College, Chinese Academy of Medical Science, Beijing, P. R. China;
2Century Forum Hospital, Beijing, P. R. China; and 3Department of Epidemiology,
Institute of Basic Medical Sciences, Peking Union Medical College, Chinese
Academy of Medical Science, Beijing, P. R. China.
OBJECTIVE:: To assess the
impact of menopause, age, and other factors on quality of life (QOL). DESIGN::
Generally healthy women aged 35 to 64 years were recruited from a general
community in
J Allergy Clin Immunol. 2007 Oct 26; [Epub
ahead of print
Lung function, respiratory symptoms, and the menopausal transition.
Real FG, Svanes C, Omenaas ER, Antò JM, Plana E, Jarvis D, Janson C, Neukirch F, Zemp E, Dratva J, Wjst M, Svanes K, Leynaert B, Sunyer J.
From the Department of
Gynecology and Obstetrics, Haukeland University Hospital, Bergen; Centre de
Recerca en Epidemiologia Ambiental (CREAL)–Institut Municipal d'Investigació
Mèdica (IMIM-IMAS), Barcelona; Respiratory Research Group, Institute of Medicine,
University of Bergen.
BACKGROUND: There is limited
information on potential changes in respiratory health when women enter the
menopausal transition. OBJECTIVE: We sought to investigate whether the
menopausal transition is related to lung function and asthma and whether body
mass index (BMI) modifies associations. METHODS: Four thousand two hundred
fifty-nine women from 21 centers (ECRHS II, 2002) responded to a questionnaire
concerning women's health. Women aged 45 to 56 years not using exogenous sex hormones
(n = 1274) were included in the present analysis. Lung function measurements (n
= 1120) and serum markers of hormonal status (follicle-stimulating hormone,
luteinizing hormone, and estradiol; n = 710) were available. Logistic and
linear regression analyses were adjusted for BMI, age, years of education,
smoking status, center, and height. RESULTS: Women not menstruating for the
last 6 months (n = 432, 34%) had significantly lower FEV(1) values (-120 mL
[95% CI, -177 to -63]), lower forced vital capacity values (-115 mL [95% CI,
-181 to -50]), and more respiratory symptoms (odds ratio [OR], 1.82 [95% CI,
1.27-2.61]) than those menstruating regularly. Results were similar when
restricting analyses to those who never smoked. Associations were significantly
stronger in women with BMIs of less than 23 kg/m(2) (respiratory symptoms: OR,
4.07 [95% CI, 1.88-8.80]; FEV(1) adjusted difference: -166 [95% CI, -263 to
-70]) than in women with BMIs of 23 to 28 kg/m(2) (respiratory symptoms: OR,
1.10 [95% CI, 0.61-1.97], P(interaction): .04; FEV(1) adjusted difference, -54
[95% CI, -151 to 43], P(interaction) = .06). CONCLUSIONS: Menopause is
associated with lower lung function and more respiratory symptoms, especially
among lean women. CLINICAL IMPLICATIONS: Clinicians should be aware of
increased asthma risk and lower lung function in women reaching menopause.
These problems appeared to be less pronounced among women with a BMI of
approximately 25 kg/m(2)
Osteoporos Int. 2007 Nov 16; [Epub
ahead of print
Greater first year effectiveness drives favorable cost-effectiveness of
brand risedronate versus generic or brand alendronate: modeled Canadian
analysis.
Grima DT, Papaioannou A, Thompson MF, Pasquale MK, Adachi JD.
Cornerstone Research Group
Inc.,
The RisedronatE and
ALendronate (REAL) study provided a unique opportunity to conduct
cost-effectiveness analyses based on effectiveness data from real-world
clinical practice. Using a published osteoporosis model, the researchers found
risedronate to be cost-effective compared to generic or brand alendronate for
the treatment of Canadian postmenopausal osteoporosis in patients aged 65 years
or older. INTRODUCTION: The REAL study provides robust data on the real-world
performance of risedronate and alendronate. The study used these data to assess
the cost-effectiveness of brand risedronate versus generic or brand alendronate
for treatment of Canadian postmenopausal osteoporosis patients aged 65 years or
older. METHODS: A previously published osteoporosis model was populated with
Canadian cost and epidemiological data, and the estimated fracture risk was
validated. Effectiveness data were derived from REAL and utility data from
published sources. The incremental cost per quality-adjusted life-year (QALY)
gained was estimated from a Canadian public payer perspective, and
comprehensive sensitivity analyses were conducted. RESULTS: The base case
analysis found fewer fractures and more QALYs in the risedronate cohort,
providing an incremental cost per QALY gained of $3,877 for risedronate
compared to generic alendronate. The results were most sensitive to treatment
duration and effectiveness. CONCLUSIONS: The REAL study provided a unique
opportunity to conduct cost-effectiveness analyses based on effectiveness data
taken from real-world clinical practice. The analysis supports the
cost-effectiveness of risedronate compared to generic or brand alendronate and
the use of risedronate for the treatment of osteoporotic Canadian women aged 65
years or older with a BMD T-score </=-2.5.
Clin Endocrinol (Oxf). 2007 Nov 22; [Epub
ahead of print
The evaluation of metabolic parameters and insulin sensitivity for a
more robust diagnosis of the polycystic ovary syndrome.
Amato MC, Galluzzo A, Finocchiaro S, Criscimanna A, Giordano C.
Department: Section of Endocrinology, DOSAC,
Università degli Studi di Palermo, Palermo, Italy.
Background: Polycistic Ovary
Syndrome (PCOS) is considered a predominantly hyperandrogenetic syndrome and
the evaluation of metabolic parameters and insulin sensitivity is not
mandatory. Context: PCOS diagnostic criteria [National Institutes of Health
(NIH),
J Am Geriatr Soc. 2007 Nov 20; [Epub ahead
of print]
Weight, Mortality, Years of Healthy Life, and Active Life Expectancy in
Older Adults.
Diehr P, O'Meara ES, Fitzpatrick A, Newman AB, Kuller L, Burke G.
Department of Biostatistics,
OBJECTIVES: To determine
whether weight categories predict subsequent mortality and morbidity in older
adults. DESIGN: Multistate life tables, using data from the Cardiovascular
Health Study, a longitudinal population-based cohort of older adults. SETTING:
Data were provided by community-dwelling seniors in four
MMWR Morb Mortal Wkly Rep. 2007 Nov
23;56(46):1209-12
Prevalence of regular physical activity among adults--
Centers for Disease Control and Prevention (CDC).
Regular physical activity is
associated with decreased risk for obesity, heart disease, hypertension,
diabetes, certain cancers, and premature mortality. CDC and the
Semana del
14 al 20 de Noviembre de 2007
Menopause. 2007 Nov 12; [Epub ahead of print]
Effects of alcohol and cigarette smoking on change in serum estrone
levels in postmenopausal women randomly assigned to fixed doses of conjugated
equine estrogens with or without a progestin.
McDivit AM, Greendale GA, Stanczyk FZ, Huang MH.
From the 1Cleveland Clinic,
General Internal Medicine, Cleveland, OH; 2Division of Geriatrics, David Geffen
School of Medicine, University of California, Los Angeles; 3Departments of
Obstetrics and Gynecology, and Preventive Medicine, University of Southern
California Keck School of Medicine, Los Angeles, CA.
OBJECTIVE:: To determine the
effects of alcohol and smoking on serum estrone levels among women assigned to
hormone therapy. DESIGN:: We analyzed the data from 676 participants in the
Postmenopausal Estrogen/Progestin Interventions study. RESULTS:: Those who
consumed more than
Histol Histopathol. 2008 Feb;23(2):219-26.
Human postmenopausal ovary - hormonally inactive fibrous connective
tissue or more?
Laszczynska M, Brodowska A, Starczewski A, Masiuk M, Brodowski J.
Laboratory of Embryology,
The ovary undergoes several
changes after the menopause. In this period, the main structural changes in
both the cortex and medulla were observed. In the cortex, they included: 1)
reduction of its thickness; 2) epithelial inclusions forming cysts; 3) blurring
the line between medulla and cortex; 4) reduction of follicles number; 5)
tendency to fragmentation of corpora albicantia; 6) surface epithelium
invaginations. Whereas the changes in the medulla included: 1) fibrosis and
scars in stroma; 2) architectonical changes in blood vessels with hyalinization
of walls and constriction of lumen. The loss of follicles and several changes
in the ovary are due to apoptotic processes. Despite age related atrophic
changes, the postmenopausal ovary is not devoid of hormonal activity. Our
results are coherent with the reports of other researchers, and reveal that
postmenopausal ovary produces trace quantities of steroid hormones, mainly
androgens, and confirm the presence of steroid receptors and activity of main enzymes
involved in steroidogenesis process.
Maturitas. 2007 Nov 8; [Epub ahead of print]
Differences in health related quality of life in a sample of Spanish
menopausal women with and without obesity.
Llaneza P, Iñarrea J, Gonzalez C, Alonso A, Arnott I, Ferrer-Barriendos J.
Central University Hospital of
Asturias, C/ Celestino Villamil s/n, 33006 Oviedo, Spain.
OBJECTIVE: To investigate
whether body mass index, abdominal obesity or fat distribution in
postmenopausal women influence their quality of Life. METHODS: A
cross-sectional study was carried out on 250 postmenopausal women (age: 50-64
years), with intact uterus and ovaries, sexually active, and non-hormone
therapy users. Various anthropometric measurements were considered and a
specific health-related quality of life (HR-QoL) instrument, the Cervantes
scale, was performed. RESULTS: Thirty-three women were not included as they
refused to participate in the study, had chronic disease such as hypertension,
diabetes type 2, depression or did not answer all the scale items, so 217
patients were evaluated. According with BMI values, 34% of women were obese,
46.1% were in overweight, 19.8% were in normal weight and there were not
underweight women. Any consistent relation was found between BMI and global
values of HR-QoL, but obese women were diagnosed with "high level of
problems" in the "psychical domain" and in the "sexuality
domain". This difference in "sexuality domain" was also
appreciated in women with abdominal obesity. Fat or lean mass was not
correlated with HR-QoL. CONCLUSION: In our study, obesity did not affect the
global HR-QoL in Spanish postmenopausal women, but could have an influence on
the psychical and sexual domains. Others anthropometric measurements are not
associated with changes in HR-QoL. Additional research with HR-QoL specific and
validated instruments and with a longitudinal design seems necessary to confirm
our results.
Fertil Steril. 2007 Nov 12; [Epub ahead of print]
Effect of oral estrogen on substrate utilization in postmenopausal
women.
Lwin R, Darnell B, Oster R, Lawrence J, Foster J, Azziz R, Gower BA.
Department of Nutrition
Sciences.
We tested the hypothesis that
a 2-month intervention with unopposed oral conjugated equine estrogens (0.625
mg/d) would decrease lipid oxidation, as assessed by 24-hour, whole-room,
indirect calorimetry in 14 postmenopausal women. Estrogen (E) treatment was
associated with declines in both 24-hour and postprandial lipid oxidation and
an increase in fat mass (mean [+/-SD] 2-month difference 1.1 +/-
Nutr Cancer. 2007;59(2):269-277.
Black Cohosh Does Not Exert an Estrogenic Effect on the Breast.
Ruhlen RL, Haubner J, Tracy JK, Zhu W, Ehya H, Lamberson WR, Rottinghaus GE, Sauter ER.
Department of Surgery,
University of Missouri-Columbia,
Women's Health Initiative
findings indicate that hormone replacement therapy may increase breast cancer
and cardiovascular disease risk. Black cohosh extract (BCE) is a popular
alternative that reduced menopausal symptoms in several clinical trials.
Preclinical studies have addressed the estrogenic properties of BCE, with
conflicting results. The estrogenic influence of BCE on the breast has not been
investigated. Black cohosh is standardized to triterpenes, but the activity and
mechanism of action of these compounds are unknown. The study goals were to
determine 1) triterpene content of 2 commercially available BCE preparations
and 2) the effect of BCE on circulating and breast-specific estrogenic markers.
Two black cohosh preparations were analyzed for triterpene content.
Postmenopausal women took BCE for 12 wk followed by a 12-wk washout. One BCE
preparation contained trace amounts and another contained 2.5% triterpenes.
Women taking BCE with 2.5% triterpenes experienced relief of menopausal
symptoms, with reversion toward baseline after washout. BCE had no effect on
estrogenic markers in serum and no effect on pS2 or cellular morphology in
nipple aspirate fluid. Triterpene content in commercially available black
cohosh preparations varies. BCE standardized to 2.5% triterpenes relieved
menopausal symptoms without systemic or breast-specific estrogenic effects.
J Natl Cancer Inst. 2007 Nov 15; [Epub
ahead of print]
Predicting Risk of Breast Cancer in Postmenopausal Women by Hormone
Receptor Status.
Chlebowski RT, Anderson GL, Lane DS, Aragaki AK, Rohan T, Yasmeen S, Sarto G, Rosenberg CA, Hubbell FA; For the Women's Health
Initiative Investigators.
Affiliations of authors: Los
Angeles Biomedical Research Institute at
Background Strategies for
estrogen receptor (ER)-positive breast cancer risk reduction in postmenopausal
women require screening of large populations to identify those with potential
benefit. We evaluated and attempted to improve the performance of the Breast
Cancer Risk Assessment Tool (i.e., the Gail model) for estimating invasive
breast cancer risk by receptor status in postmenopausal women. Methods In The
Women's Health Initiative cohort, breast cancer risk estimates from the Gail
model and models incorporating additional or fewer risk factors and 5-year
incidence of ER-positive and ER-negative invasive breast cancers were
determined and compared by use of receiver operating characteristics and area
under the curve (AUC) statistics. All statistical tests were two-sided. Results
Among 147 916 eligible women, 3236 were diagnosed with invasive breast cancer.
The overall AUC for the Gail model was 0.58 (95% confidence interval [CI]=0.56
to 0.60). The Gail model underestimated 5-year invasive breast cancer incidence
by approximately 20% (P<.001), mostly among those with a low estimated risk.
Discriminatory performance was better for the risk of ER-positive cancer (AUC =
0.60, 95% CI = 0.58 to 0.62) than for the risk of ER-negative cancer (AUC =
0.50, 95% CI = 0.45 to 0.54). Age and age at menopause were statistically
significantly associated with ER-positive but not ER-negative cancers (P=.05
and P=.04 for heterogeneity, respectively). For ER-positive cancers, no
additional risk factors substantially improved the Gail model prediction.
However, a simpler model that included only age, breast cancer in first-degree
relatives, and previous breast biopsy examination performed similarly for
ER-positive breast cancer prediction (AUC=0.58, 95% CI= 0.56 to 0.60);
postmenopausal women who were 55 years or older with either a previous breast
biopsy examination or a family history of breast cancer had a 5-year breast
cancer risk of 1.8% or higher. Conclusions In postmenopausal women, the Gail
model identified populations at increased risk for ER-positive but not
ER-negative breast cancers. A model with fewer variables appears to provide a
simpler approach for screening for breast cancer risk.
Osteoporos Int. 2007 Nov 13; [Epub ahead of print]
Calcium and vitamin D intake influence bone mass, but not short-term
fracture risk, in Caucasian postmenopausal women from the National Osteoporosis
Risk Assessment (NORA) study.
Nieves JW, Barrett-Connor E, Siris ES, Zion M, Barlas S, Chen YT.
Clinical
The impact of calcium and
vitamin D intake on bone density and one-year fracture risk was assessed in
76,507 postmenopausal Caucasian women. Adequate calcium with or without vitamin
D significantly reduced the odds of osteoporosis but not the risk of fracture
in these Caucasian women. INTRODUCTION: Calcium and vitamin D intake may be
important for bone health; however, studies have produced mixed results.
METHODS: The impact of calcium and vitamin D intake on bone mineral density
(BMD) and one-year fracture incidence was assessed in 76,507 postmenopausal
Caucasian women who completed a dietary questionnaire that included childhood,
adult, and current consumption of dairy products. Current vitamin D intake was
calculated from milk, fish, supplements and sunlight exposure. BMD was measured
at the forearm, finger or heel. Approximately 3 years later, 36,209
participants returned a questionnaire about new fractures. The impact of
calcium and vitamin D on risk of osteoporosis and fracture was evaluated by
logistic regression adjusted for multiple covariates. RESULTS: Higher lifetime
calcium intake was associated with reduced odds of osteoporosis (peripheral BMD
T-score </=-2.5; OR = 0.80; 95% CI 0.72, 0.88), as was a higher current
calcium (OR = 0.75; (0.68, 0.82)) or vitamin D intake (OR = 0.73; 95% CI
0.0.66, 0.81). Women reported 2,205 new osteoporosis-related fractures. The
3-year risk of any fracture combined or separately was not associated with
intake of calcium or vitamin D. CONCLUSIONS: Thus, higher calcium and vitamin D
intakes significantly reduced the odds of osteoporosis but not the 3-year risk
of fracture in these Caucasian women.
J Bone Miner Res. 2007 Nov 12; [Epub ahead of print]
Strontium Ranelate Reduces the Risk of Vertebral Fractures in Patients
with Osteopenia.
Seeman E, Devogelaer J, Lorenc R, Spector T, Brixen K, Balogh A, Stucki G, Reginster J.
Microabstract Many fractures
occur in women with moderate fracture risk due to osteopenia. Strontium
ranelate was studied in 1431 postmenopausal women with osteopenia. Vertebral
fracture risk reduction of 41% to 59% was shown depending on the site and
fracture status at baseline. This is the first report of anti-vertebral
fracture efficacy in women with vertebral osteopenia.
Maturitas. 2007 Nov 8; [Epub ahead of print]
A study of 17beta-estradiol-regulated genes in the vagina of
postmenopausal women with vaginal atrophy.
Cotreau MM, Chennathukuzhi VM, Harris HA, Han L, Dorner AJ, Apseloff G, Varadarajan U, Hatstat E, Zakaria M, Strahs AL, Crabtree JS, Winneker RC, Jelinsky SA.
Discovery Translational
Medicine, Wyeth Research,
BACKGROUND: Vaginal atrophy
(VA) is a prevalent disorder in postmenopausal women that is characterized by
decreased epithelial thickness, reduced vaginal maturation index (VMI) and
increased vaginal pH. Current medical therapy consists of local or systemic
replacement of estrogens. OBJECTIVE: The goal of this study was to understand,
at a molecular level, the effect of estradiol (E2) on the vaginal epithelium.
METHODS: Nineteen women were treated with E2 delivered through a skin patch at
a dose of 0.05mg/day for 12 weeks. The diagnosis of VA was confirmed by a VMI
with </=5% superficial cells and vaginal pH>5.0. Vaginal biopsy samples
were collected at baseline and after treatment. Differentially expressed mRNA
transcripts in these biopsies were determined by microarray analysis. RESULTS:
All 19 subjects had increased VMI (>5%) and/or reduced pH (</=5)
following treatment. Most subjects also had increased serum E2 levels and
reduced serum FSH levels. Transcriptional profiling of vaginal biopsies
identified over 3000 E2-regulated genes, including those involved in several
key pathways known to regulate cell growth and proliferation, barrier function
and pathogen defense. CONCLUSIONS: E2 controls a plethora of cellular pathways
that are concordant with its profound effect on vaginal physiology. The data
presented here are a useful step toward understanding the role of E2 in vaginal
tissue and the development of novel therapeutics for the treatment of VA.
Clin Biochem. 2007 Oct 26; [Epub ahead of print]
Effects of bone disease and calcium supplementation on antioxidant
enzymes in postmenopausal women.
Hahn M, Conterato GM, Frizzo CP, Augusti PR, da Silva JC, Unfer TC, Emanuelli T.
Programa de Pós-Graduação em
Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Universidade
Federal de Santa Maria, 97105-900, Santa Maria, RS, Brazil.
OBJECTIVES:: The study was
aimed at investigating the effects of osteopenia and calcium supplementation on
antioxidant enzyme activity (superoxide dismutase, SOD; catalase, CAT; and
glutathione peroxidase, GPx) in postmenopausal women. DESIGN AND METHODS::
Postmenopausal women (n=75) were divided into two groups, control (no bone
disease) and osteopenia, according to their bone mineral density. Each group
was still divided into calcium-supplemented and nonsupplemented sub-groups.
Antioxidant enzyme activities were determined in whole blood using
spectrophotometric methods. RESULTS:: CAT and SOD activities were not different
among the studied groups. However, GPx activity was significantly higher in
osteopenia groups as compared to control groups. Calcium supplementation had no
effect on the parameters evaluated. Bone mineral density was negatively
correlated with GPx activity (p<0.05). CONCLUSIONS:: Increased GPx activity could
be interpreted as a defense response to counteract the overproduction of
reactive oxygen species in women with osteopenia, and this effect was not
prevented by calcium supplementation.
BJOG. 2007 Dec;114(12):1522-9.
Tibolone and low-dose continuous combined hormone treatment: vaginal
bleeding pattern, efficacy and tolerability.
Hammar ML, van de Weijer P, Franke HR, Pornel B, von Mauw EM, Nijland EA; TOTAL Study Investigators Group.
Division of Obstetrics and
Gynecology, Department of Molecular and Clinical Medicine, Faculty of Health
Sciences,
Objectives The primary
objective was to compare the vaginal bleeding pattern during administration of
tibolone and low-dose continuous combined estradiol plus norethisterone acetate
(E(2)/NETA). The secondary objectives were efficacy on vasomotor symptoms and
vaginal atrophy. Design A randomised, double-blind, double-dummy, group
comparative intervention trial. Setting Multicentre study executed in 32
centres in 7 European countries. Sample Five hundred and seventy-two healthy
symptomatic postmenopausal women, aged 45-65 years. Methods Participants were
randomised to receive 2.5 mg tibolone or 1 mg 17beta estradiol plus 0.5 mg
norethisterone acetate (E(2)/NETA) daily for 48 weeks. Main outcome measures
Prevalence of vaginal bleeding, hot flushes and adverse events. Results The
incidence of bleeding was significantly lower in the tibolone group during the
first 3 months of treatment (18.3 versus 33.1%; P < 0.001) when compared
with the E(2)/NETA group. This effect on the bleeding pattern was sustained
throughout the study, although reaching statistical significance again only in
7-9 months of treatment (11 versus 19%; P < 0.05). In both treatment groups,
vasomotor symptoms and vaginal atrophy were significantly reduced to a similar
extent when compared with baseline. The prevalence of breast pain/tenderness
was significantly lower with tibolone compared with E(2)/NETA (3.2 versus 9.8%;
P < 0.001). Conclusion Tibolone reduces menopausal symptoms to a similar extent
as conventional low-dose continuous combined hormone therapy but causes
significant less vaginal bleeding in the first 3 months of treatment. This
constitutes an important argument for woman adherence to therapy.
Semana del 7 al 13 de Noviembre
de 2007
Am J Clin Nutr. 2007
Nov;86(5):1572S-6S.
Keeping the young-elderly healthy: is it too late to improve our health
through nutrition?
Anne Fisher Nutrition Center,
Strang Cancer Research Laboratory, and Department of Medicine, Weill Medical
College of Cornell University, New York, NY.
Healthy older individuals can
take several measures to preserve and improve their health. Even if past
nutritional and lifestyle practices were not optimal, much can be done to
reduce the risk of chronic disease and disability in future years. The first
challenge is to recognize and address the profound changes in body composition
that occur with aging. Older persons tend to accumulate relatively more body
fat and less lean body mass, ie, muscle and bone. With a gain in body weight,
which usually occurs, these changes are exaggerated. Because muscle tissue has
a much higher metabolic rate than does fat tissue, older individuals generally
develop lower metabolic rates. To avoid excess weight gain, older individuals
must make major restrictions in caloric intake and increases in energy
expenditure. Women experience changes in body composition similar to those in
men, with changes becoming more prominent at menopause. Exercise improves body
composition among healthy elderly, both by reducing fat mass and by increasing
bone and muscle mass, thereby helping to restore higher metabolic rates. In men
and women aged >/=65 y and taking calcium and vitamin D supplements for 3 y,
the rate of bone loss slowed and the incidence of nonvertebral fractures was
reduced. Several population studies of older persons show that following
nutritional and lifestyle guidelines for cancer prevention reduces risk by
one-third. Improving serum lipid concentrations in adults over 65 y of age with
coronary artery disease decreases the risk of future cardiac events by as much
as 45%. Furthermore, the greatest benefit from control of hypertension is in
older individuals.
Am J Clin Nutr. 2007 Nov;86(5):1445-55.
Associations between healthy eating patterns and immune function or
inflammation in overweight or obese postmenopausal women.
Boynton A, Neuhouser ML, Wener MH, Wood B, Sorensen B, Chen-Levy Z, Kirk EA, Yasui Y, Lacroix K, McTiernan A, Ulrich CM.
BACKGROUND: The link between
poor nutritional status and impaired immune function is well established;
however, most studies have focused on individual nutrients instead of overall
dietary patterns. OBJECTIVE: Our objective was to investigate associations
between 3 indexes of overall diet quality [the Diet Quality Index (DQI), the
DQI including supplementary calcium (DQI-Ca), and the Healthy Eating Index
(HEI)] and biomarkers of inflammation and immunity. DESIGN: This cross-sectional
study included 110 overweight or obese postmenopausal women. Dietary intake
measured by food-frequency questionnaire was used to calculate diet quality
scores. C-reactive protein (CRP) and serum amyloid A (SAA) were measured by
latex-enhanced nephelometry. Flow cytometry was used to measure natural killer
(NK) cell cytotoxicity and to enumerate and phenotype lymphocyte subsets. T
lymphocyte proliferation was assessed by (3)H-thymidine incorporation as well
as by the carboxyfluorescein-succinimidyl ester method of cell division
tracking. Multivariable-adjusted linear regression analysis was used to
investigate associations between diet quality scores and markers of
inflammation and immune function. RESULTS: Higher diet quality was associated
with increased proportions of cytotoxic and decreased proportions of helper T
lymphocytes. CRP and SAA concentrations were higher among women with a
lower-quality diet; these associations became nonsignificant after adjustment
for body mass index or percentage body fat. We observed limited evidence for an
association between healthy eating patterns and greater lymphocyte
proliferation and no evidence for an association with NK cell cytotoxicity.
CONCLUSION: Our results provide limited evidence that healthy eating patterns
contribute to enhanced immune function and reduced inflammation in overweight
and obese postmenopausal women.
Am J Clin Nutr. 2007 Nov;86(5):1420-1425.
Higher serum vitamin D concentrations are associated with longer
leukocyte telomere length in women.
Richards JB, Valdes AM, Gardner JP, Paximadas D, Kimura M, Nessa A, Lu X, Surdulescu GL, Swaminathan R, Spector TD, Aviv A.
From Twin Research and Genetic
Epidemiology, St Thomas’ Hospital, King's College, London School of Medicine,
London, United Kingdom.
BACKGROUND: Vitamin D is a
potent inhibitor of the proinflammatory response and thereby diminishes turnover
of leukocytes. Leukocyte telomere length (LTL) is a predictor of aging-related
disease and decreases with each cell cycle and increased inflammation.
OBJECTIVE: The objective of the study was to examine whether vitamin D
concentrations would attenuate the rate of telomere attrition in leukocytes,
such that higher vitamin D concentrations would be associated with longer LTL.
DESIGN: Serum vitamin D concentrations were measured in 2160 women aged 18-79 y
(mean age: 49.4) from a large population-based cohort of twins. LTL was
measured by using the Southern blot method. RESULTS: Age was negatively
correlated with LTL (r = -0.40, P < 0.0001). Serum vitamin D concentrations
were positively associated with LTL (r = 0.07, P = 0.0010), and this relation
persisted after adjustment for age (r = 0.09, P < 0.0001) and other
covariates (age, season of vitamin D measurement, menopausal status, use of
hormone replacement therapy, and physical activity; P for trend across tertiles
= 0.003). The difference in LTL between the highest and lowest tertiles of
vitamin D was 107 base pairs (P = 0.0009), which is equivalent to 5.0 y of
telomeric aging. This difference was further accentuated by increased
concentrations of C-reactive protein, which is a measure of systemic inflammation.
CONCLUSION: Our findings suggest that higher vitamin D concentrations, which
are easily modifiable through nutritional supplementation, are associated with
longer LTL, which underscores the potentially beneficial effects of this
hormone on aging and age-related diseases.
Harefuah. 2007 Oct;146(10):781-4, 813.
Extended cycle oral contraceptives
Department of Obstetrics and
Gynecology,
Oral contraceptive pills are
conventionally prescribed in a manner that causes monthly withdrawal uterine
bleeding (lunar month). The reasons for this are historical without an inherent
medical need. According to our literature search, there are patients' demands
for less frequent menstrual cycles. We have learned from patients who were
given the pill continuously for long periods due to medical or social
indications that continuous administration of the contraceptive pill is
feasible and safe. In the current review, the authors have searched the
literature regarding extended cycle oral contraception for periods of time up
to one year. This way of administration of the pill is not compromising the
efficacy of pregnancy prevention, nor is it detrimental in terms of cardiovascular
and hemostatic complications or endometrial malignancy. It is known that there
is a slightly increased risk of breast cancer in users of oral contraceptives
up to 10 years, regardless of the mode of administration. From a few studies of
hormone replacement therapy in postmenopausal women, there is concern that
continuous treatment may be deleterious, while sequential is not. Extended
cycle contraceptive treatment has a few side effects, mainly increased
breakthrough bleeding but decreased withdrawal bleeding. Other side effects
were less prevalent than in conventional administration.
Br J Cancer. 2007 Nov 6; [Epub ahead of print]
Hormone replacement therapy, body mass, and the risk of colorectal
cancer among postmenopausal women from
Hoffmeister M, Raum E, Winter J, Chang-Claude J, Brenner H.
1Division of Clinical
Epidemiology and Aging Research,
Previous studies have reported
inconsistent results regarding the modifying effect of hormone replacement
therapy (HRT) on the association of body mass index (BMI) and the risk of
colorectal cancer (CRC) among postmenopausal women. We assessed the use of HRT
and BMI in 208 postmenopausal women with histologically confirmed incident CRC
and 246 controls in a population-based case-control study in
BMJ. 2007 Nov 6; [Epub ahead of print]
Cancer incidence and mortality in relation to body mass index in the
Million Women Study: cohort study.
Reeves GK, Pirie K, Beral V, Green J, Spencer E, Bull D.
Cancer Epidemiology Unit,
OBJECTIVE: To examine the
relation between body mass index (kg/m(2)) and cancer incidence and mortality.
DESIGN: Prospective cohort study. PARTICIPANTS: 1.2 million
Fertil Steril. 2007 Nov 1; [Epub ahead of print]
Educational and organizational interventions used to improve the knowledge
of metabolic syndrome among postmenopausal women.
Barriga J, Castelo-Branco C, Chedraui P, Hidalgo L, Veas P.
A total of 105 postmenopausal
women previously diagnosed with metabolic syndrome consented to take part in
this educational program. After receiving the training, women significantly
improved their knowledge regarding menopause and related issues, and, since the
program increased their awareness of menopause and related risks, we propose
that these cost-effective measures could eventually reduce cardiovascular
morbidity and mortality among high-risk populations.
J Clin Endocrinol Metab. 2007 Nov 6; [Epub ahead of print]
Insulin Secretion and Clearance After Subacute Estradiol Administration
in Postmenopausal Women.
Van Pelt RE, Schwartz RS, Kohrt WM.
Department of Medicine,
Division of Geriatric Medicine, University of Colorado at Denver and Health
Sciences Center, Denver, Colorado 80262.
Context: Data from large
clinical trials of postmenopausal women suggest incidence of diabetes is
reduced in women randomized to estrogen-based hormone therapy when compared with
placebo. Whether this is due to an effect of estrogen on insulin or glucose
metabolism remains unclear. Objective: To test the hypothesis that estradiol
(E2) increases insulin secretion and clearance. Design: Serum insulin and
C-peptide responses to hyperglycemia (250 mg/dL) plus intravenous L-arginine
were measured on 2 separate days, with (EST) and without (CON) subacute (24 h)
transdermal E2 administration. Study Participants: Eleven postmenopausal women
(mean+/-SD; 55+/-4 y). Main Outcomes: Insulin secretion and clearance were
estimated from the C-peptide AUC and the molar ratio of C-peptide-to-insulin
AUC, respectively. Mean glucose disposal rate (GDR) was estimated from the rate
of glucose infusion during the final 30 min of the hyperglycemic clamp.
Results: There were no differences in insulin secretion or clearance between
the EST day and CON day. Fasting glucose was lower on the EST day compared with
the CON day (93+/-6 vs. 98+/-8 mg/dL), but mean GDR was not different. However,
when one outlier was excluded from analysis GDR was increased after EST
compared with CON. Further, a strong inverse association was observed between
years since menopause and E2-mediated changes in GDR (r=-0.794, p=0.004).
Conclusions: Contrary to our hypothesis, 24 hours of transdermal E2
administration did not alter insulin secretion or clearance in postmenopausal
women. However, a longer time since menopause was associated with a reduced
effect of E2 to increase glucose uptake.
Eur J Epidemiol. 2007 Nov 6; [Epub
ahead of print]
Inflammation a possible link between economical stress and coronary
heart disease.
Preventive
Medicine, Department of Public Health Sciences, Karolinska Institutet,
Objective: To
assess the relationship between economical stress, as an indictor of SES, and
inflammation in women patients with coronary heart disease (CHD). Design: a
cross-sectional study. Setting and participants: Two hundred and thirteen women
patients recruited from two hospitals in Stockholm, Sweden; mean age 63 +/- 8,
range 35-75 years, hospitalised for acute myocardial infarction, coronary
angioplasty or bypass surgery between 1996 and 2000, examined in a stable
phase, 1 year and 5 months (+/-2.5 months) after the index event. Main outcome
measures: Economical stress, and other SES indicators were assessed by
questionnaires. Levels of high-sensitivity C-reactive protein (CRP) were
measured by nephelometry and the concentrations of interleukin-6 (Il-6) and
interleukin-1 receptor antagonist (Il-1ra) were determined by enzyme-linked
immunoassay. Results: After controlling for the potential confounders, i.e.
treatment, menstruational, marital and education status in addition to age,
patients having economical stress showed higher levels of hsCRP (2.79 vs. 1.83
mg/l, p = 0.04), Il-6 (3.12 vs. 2.38 mg/l, p = 0.015) and Il-1ra (599 vs. 456
mg/l, p = 0.02). The association persisted after controlling for other measures
of economical status, like personal and household income. According to our
mediational analyses, lifestyle variables, especially BMI, could partly explain
the observed association. Conclusion: High economical stress was associated
with higher Il-6, CRP and Il-1ra levels in women with stable CHD. The direction
of causality cannot be inferred from such a cross-sectional study however, our
results raise the possibility that increased inflammatory activity is a
mediator for the effect of economical stress on adverse outcomes after a
coronary event.
Semana del
31 de Octubre al 6 de Noviembre de 2007
Menopause. 2007 Oct 19; [Epub
ahead of print]
NIH and
WHI-time for a mea culpa and steps beyond*
From The North American
Menopause Society.
The termination of the
estrogen-progestin arm of the Women's Health Initiative (WHI) 5 years ago was
abrupt and poorly planned. It has also become manifestly clear that the
reporting at that time of the balance of risk and benefit for perimenopausal
and early postmenopausal women was grossly exaggerated. Subsequent WHI
publications including subanalyses of original data suggest a persistent
pattern of over-reading of results toward a negative bias. The initial 2002
conclusion of the WHI investigators that harm was greater than benefit appears
to be the result of several factors. One was the failure to recognize that
initiation of therapy by decade of age or time since menopause was highly
relevant; the WHI committee aggregated all outcome data into one group, even
though in their demographic description they had the ability to investigate by
age. An overhanging question is, therefore, what did they know, and when did
they know it? Another factor was the utilization of a nonvalidated index termed
the "global health index" that inexplicably assumed for comparison
sake that all diseases were equivalent, for example, that a stroke was
equivalent to a hip fracture in morbidity, mortality, and impact on quality of
life. Although not a study about menopause, the data were extrapolated to all
peri- and postmenopausal women. Despite the overall positive outcome of their
results for women aged 50 to 60 years, most particularly those receiving
estrogen-only therapy, the WHI investigators have irrationally maintained a
defense of their misinterpretations of 2002. It is time for the National
Institutes of Health and the WHI investigators to issue a final overall report
that is clear and based on their actual results and not their personal interpretations.
There is too much relevant and important information within the WHI to allow
the overall study to continue to be perceived as biased to the detriment of
both the National Institutes of Health and the study itself.
J Fam Pract. 2007
Nov;56(11):907-910.
Double-dose vitamin D lowers cancer risk in women over 55.
Department of Family Medicine,
The
Wouldn't it be nice if we
could recommend something as simple and safe as a daily vitamin to reduce the
risk of cancer? Until now, we have had no definitive evidence to support such a
recommendation. The Lappe et al trial, however, concluded that improving
calcium and vitamin D nutritional status substantially reduces all-cancer risk
in postmenopausal women. Will this single, relatively small study pass the test
of time and be confirmed by future clinical trials? We think so. The estimated
relative risk reduction was dramatic (0.232) and the 95% confidence interval
was 0.09 to 0.60, meaning that the true relative risk reduction has a 95%
probability of being in the range of 40% to 91%. The P value of <.005
suggests that the probability of this finding occurring by chance alone is less
than
J Cell Biochem. 2007 Nov 1; [Epub
ahead of print]
Understanding the pathology and mechanisms of type I diabetic bone loss.
Department of Physiology,
Type I (T1) diabetes, also called
insulin dependent diabetes mellitus (IDDM), is characterized by little or no
insulin production and hyperglycemia. One of the less well known complications
of T1-diabetes is bone loss which occurs in humans and animal models. This
complication is receiving increased attention because T1-diabetics are living
longer due to better therapeutics, and are faced with their existing health
concerns being compounded by complications associated with aging, such as
osteoporosis. Both male and female, endochondrial and intra-membranous, and
axial and appendicular bones are susceptible to T1-diabetic bone loss. Exact
mechanisms accounting for T1-diabetic bone loss are not known. Existing data
indicate that the bone defect in T1-diabetes is anabolic rather than catabolic,
suggesting that anabolic therapeutics may be more effective in preventing bone
loss. Potential contributors to T1-diabetic suppression of bone formation are
discussed in this review and include: increased marrow adiposity,
hyperlipidemia, reduced insulin signaling, hyperglycemia, inflammation, altered
adipokine and endocrine factors, increased cell death, and altered metabolism.
Differences between T1-diabetic- and age-associated bone loss underlie the
importance of condition specific, individualized treatments for osteoporosis.
Optimizing therapies that prevent bone loss or restore bone density will allow
T1-diabetic patients to live longer with strong healthy bones.
Carcinogenesis. 2007 Oct 31; [Epub
ahead of print]
Serum 25-hydroxyvitamin D and risk of postmenopausal breast cancer -
results of a large case-control study.
Abbas S, Linseisen
J, Slanger T, Kropp S, Mutschelknauss
E, Flesch-Janys
D, Chang-Claude
J.
Division of Cancer
Epidemiology,
Various studies suggest that
vitamin D may reduce breast cancer risk. Most studies assessed the effects of dietary
intake only, although endogenous production is an important source of vitamin
D. Therefore, the measurement of serum 25-hydroxyvitamin D [25(OH)D] better
indicates overall vitamin D status. To assess the association of 25(OH)D serum
concentrations with postmenopausal breast cancer risk, we used a
population-based case-control study in
Clin Endocrinol (Oxf). 2007 Oct 31; [Epub
ahead of print
Effect of progestins with different glucocorticoid activity on bone
metabolism.
Department of Orthopaedic
Surgery,
Objective Progestins are
commonly prescribed for hormone replacement therapy (HRT) and contraception.
However, the effects of progestins on bone metabolism remain unclear and are
often controversial. Design and patients This study was conducted to test the
hypothesis that progestins with no significant glucocorticoid activity may be a
better choice for HRT to achieve increased beneficial effects on bone
metabolism than progestins with strong glucocorticoid activity. A total of 104
postmenopausal women aged 50-75 years with osteoporosis were allocated randomly
to three groups: (1) conjugated oestrogen plus medroxyprogesterone acetate
(HRT-MPA, with significant glucocorticoid activity); (2) conjugated oestrogen
plus norethisterone (HRT-NET, with no significant glucocorticoid activity); and
(3) control (no treatment). Measurements Vertebral X-rays and bone mineral
density (BMD) at distal 1/3 radius were assessed at baseline and every 6 months
during the 2-year study period, along with markers of bone turnover. The
occurrence of new nonvertebral fractures was identified by X-ray. Results After
the 2-year treatment, mean BMD changes relative to baseline in the HRT-MPA,
HRT-NET and control groups were 1.6%, 2.3% and -1.9%, respectively. In
addition, the rate of increase in HRT-NET was significantly greater than that
in HRT-MPA (P = 0.019). The incidence of new fractures during the 2-year
treatment in the control group was 26% (9/34). HRT-NET treatment significantly
inhibited the occurrence of new fractures (RR 0.14, 95% CI 0.02-0.93, P =
0.04), while HRT-MPA treatment failed to show a statistically significant
reduction (RR 0.41, 95% CI 0.14-1.24, P = 0.11). Both HRT-MPA and HRT-NET
treatments significantly decreased serum osteocalcin levels by 29.4% and 23.5%,
respectively, after 6 months of treatment, with the decrease in HRT-MPA being
significantly greater than that in HRT-NET (P = 0.042). Conclusions These
findings suggest that progestins with no significant glucocorticoid activity
may be a better choice for HRT, resulting in increased beneficial effects on
bone metabolism compared with progestins with strong glucocorticoid activity.
J Clin Endocrinol Metab. 2007 Oct 30; [Epub
ahead of print
Reduced Bone Mineral Density Is Associated With Breast Arterial
Calcification.
Reddy J, Bilezikian
JP, Smith SJ, Mosca L.
Brigham and Women's Hospital,
Background: Arterial
calcification, a marker of atherosclerosis, results from a complex process of
biomineralization resembling bone formation. Breast arterial calcification
(BAC) has been associated with angiographic and clinical cardiovascular disease
(CVD). The purpose of this study was to determine the association between
reduced bone mineral density (BMD) and BAC, which may share a common
pathophysiology. Methods: We conducted a retrospective study of 228 women (55%
Hispanic, mean age 64 +/-10 yrs) who had both mammography and BMD evaluation at
J Bone Miner Res. 2007 Oct 29; [Epub
ahead of print
Risedronate Reduces Osteoclast Precursors and Cytokine Production in
Postmenopausal Osteoporotic Women.
D'Amelio P, Grimaldi A, Di Bella S, Tamone C, Brianza SZ, Ravazzoli MG, Bernabei P, Cristofaro MA, Pescarmona GP, Isaia G.
Microabstract This paper
studies the effect of oral risedronate on osteoclast precursors, osteoclast
formation and cytokine production in 25 osteoporotic women. Risedronate is
effective in reducing the number of osteoclast precursors, their formation,
vitality and activity and the level of RANKL and TNF alpha in cultures.
Int J Cancer. 2007 Oct 26; [Epub ahead of print
Interactions between intakes of alcohol and postmenopausal hormones on
risk of breast cancer.
National
Alcohol and postmenopausal
hormone use are well-established modifiable risk factors for breast cancer.
Alcohol may decrease the metabolic clearance of estradiol, whereby the risk of
breast cancer associated with hormone use may depend on blood alcohol levels.
The objective is to determine whether alcohol interacts with hormone use on
risk of breast cancer. The 5,035 postmenopausal women who participated in the
Copenhagen City Heart Study were asked about their alcohol intake and hormone
use at baseline in 1981-1983 and were followed until
Osteoporos Int. 2007 Oct 27; [Epub
ahead of print
Relationships between fat and bone.
Faculty of Medical and Health
Sciences,
Body weight impacts both bone
turnover and bone density, making it, therefore, an important risk factor for
vertebral and hip fractures and ranking it alongside age in importance. The
effect of body weight is probably contributed to by both fat mass and lean
mass, though in postmenopausal women, fat mass has been more consistently demonstrated
to be important. A number of mechanisms for the fat-bone relationship exist and
include the effect of soft tissue mass on skeletal loading, the association of
fat mass with the secretion of bone active hormones from the pancreatic beta
cell (including insulin, amylin, and preptin), and the secretion of bone active
hormones (e.g., estrogens and leptin) from the adipocyte. These factors alone
probably do not fully explain the observed clinical associations, and study of
the actions on bone of novel hormones related to nutrition is an important area
of further research. An understanding of this aspect of bone biology may open
the way for new treatments of osteoporosis. More immediately, the role of
weight maintenance in the prevention of osteoporosis is an important public
health message that needs to be more widely appreciated.
Ann Rheum Dis. 2007 Oct 26; [Epub
ahead of print
Effects of strontium ranelate on spinal osteoarthritis progression.
Bruyere O, Delferriere
D, Roux C, Wark JD, Spector T, Devogelaer
JP, Brixen K, Adami S, Fechtenbaum
J, Kolta S, Reginster
JY.
OBJECTIVE: The aim of the
present study was to determine whether a 3-year treatment with strontium
ranelate could delay the progression of spinal osteoarthritis (OA). METHODS:
This study was a post-hoc analysis of pooled data from the Spinal Osteoporosis
Therapeutic Intervention (SOTI) and TReatment Of Peripheral OSteoporosis
(TROPOS) trials performed on 1105 osteoporotic women with concomitant
radiological spinal OA at baseline and for whom lumbar x-rays were available at
baseline and over the 3-year treatment period. The presence and severity of
osteophytes, disc space narrowing, and sclerosis in the lumbar intervertebral
spaces was graded according to the method of Lane et al, and an overall OA
score was calculated for each intervertebral space. Back pain (measured on a
5-point Likert scale only in SOTI) and health-related quality of life (SF-36
questionnaire) were assessed at baseline and after 3 years. Patients who
suffered an incident or progressive vertebral fracture during the study were
excluded from the analysis. RESULTS: Strontium ranelate, compared with placebo,
reduced by 42% the proportion of patients with worsening overall spinal OA
score (RR, 0.58; 95% CI, 0.42-0.79; P=0.0005). Significantly more patients in
the strontium ranelate group experienced an improvement in back pain after 3
years, compared with placebo (P=0.03), while no significant difference was
observed in terms of health-related quality of life between these patients
groups. CONCLUSION: The results of this post-hoc analysis suggest that
strontium ranelate could reduce radiographic spinal OA progression and back
pain in osteoporotic women with prevalent spinal OA.
Horm Behav. 2007 Oct 25; [Epub
ahead of print
Estradiol interacts
with the cholinergic system to affect verbal memory in postmenopausal women:
Evidence for the critical period hypothesis.
Dumas J, Hancur-Bucci
C, Naylor M, Sites C, Newhouse P.
Clinical Neuroscience Research
Unit,
Estradiol has been shown to
interact with the cholinergic system to affect cognition in postmenopausal
women. This study further investigated the interaction of estradiol and cholinergic
system functioning on verbal memory and attention in two groups of healthy
younger (ages 50-62) and older (ages 70-81) postmenopausal women. Twenty-two
postmenopausal women were randomly and blindly placed on 1 mg of 17-beta
estradiol orally for 1 month then 2 mg for 2 months or matching placebo pills
after which they participated in three anticholinergic challenge sessions when
verbal memory and attention were assessed. Subjects were administered either
the antimuscarinic drug scopolamine (SCOP), the antinicotinic drug mecamylamine
(MECA), or placebo. After the first challenge phase, they were crossed over to
the other hormone treatment for another 3 months and repeated the challenges.
Results showed that estradiol pretreatment significantly attenuated the
anticholinergic drug-induced impairments on a test of episodic memory (the
Buschke Selective Reminding Task) for the younger group only, while estradiol
treatment impaired performance of the older group. The results suggest that
younger subjects may experience more cholinergic benefit from estradiol
treatment than older subjects, supporting the concept of a critical period for
postmenopausal estrogen use.