Selección
de Resúmenes de Menopausia
Semana del 27 de
Marzo al 2 de Abril 2007
Dr. Juan Enrique Blümel
J Sex Med. 2007 Mar;4 Suppl
3:227-34.
Testosterone treatment for hypoactive sexual desire disorder in
postmenopausal women.
Kingsberg
S.
Introduction. The reduced
levels of testosterone in postmenopausal women are associated with loss of
libido, decreased sexual activity, diminished feelings of physical well-being,
and fatigue. A bilateral oophorectomy can lead to decreases in sexual desire in
50% of cases by removing ovarian contribution to the circulating levels of
testosterone. Testosterone therapy is an option for the restoration of sexual
drive. Aim. Transdermal
testosterone administration may bypass the effects of first pass hepatic
metabolism. To this end a series of studies have been carried out using a novel
transdermal testosterone system. A review of the results from these studies are
presented here. Main Outcome
Measures. A key feature of these studies was the use of validated study
instruments to measure sexual function: Sexual Activity Log((c)) (SAL((c))),
Profile of Female Sexual Function((c)) (PFSF((c))) and Personal Distress
Scale((c)). Methods. The data from the
Phase III studies, known as the Investigation of Natural Testosterone in
Menopausal women Also Taking Estrogen in Surgically Menopausal women (INTIMATE
SM) 1 and 2 were reviewed and the salient information is presented here. Results. Both INTIMATE 1
and 2 showed a significant increase in total satisfying sexual activity, via
the SAL((c)) in those women receiving testosterone, compared with those women
in the placebo group. Total satisfying sexual activity increased by 74% and 51%
for INTIMATE 1 and 2, respectively. The PFSF((c)) instrument demonstrated
significant improvements in INTIMATE 1 and 2 in all domains of sexual function
in testosterone-treated women compared with the placebo patients. In both
studies, personal distress decreased in those patients receiving testosterone,
compared with the placebo group. The most commonly reported adverse events were
application site reactions. Eight-five percent of patients said they would
probably or definitely continue treatment. Conclusions. The transdermal
testosterone patch is an effective treatment for hypoactive sexual desire
disorder in surgically postmenopausal women receiving concomitant estrogen
therapy. The treatment has a favorable safety profile.
J
Psychosom Res. 2007 Apr;62(4):473-85
Hormonal therapy and depression: Are we overlooking an important
therapeutic alternative?
Ancelin ML, Scali J, Ritchie K.
Inserm,
U888,
OBJECTIVE:
This review aimed to examine evidence for the role of hormonal changes in the
onset and course of depressive symptomatology and to assess the possible future
role of hormonal therapies in the treatment of depression. METHODS: A Medline
and PsycINFO search of the literature published between 1965 and 2006 was made
of studies of depressive symptoms and hormonal treatment in women at all stages
of reproductive life. RESULTS: The cyclic fluctuation of gonadal steroids at
menarche coincides with the beginning of gender-based differences in depression
rates, which continue throughout reproductive life until menopause.
Modifications in hormonal status, whether related to endogenous or exogenous
exposure or to hormone deprivation, appear to be associated with affective
disorder in a subgroup of women. For these women, a growing body of evidence
indicates a biological pattern of vulnerability to mood disorders in response
to hormonal fluctuations. This could have three major implications: that women
vary in vulnerability to mood disorder when abrupt change in steroid levels
occur, that these effects could be cumulative across the female life span, and
that women do not arrive at menopause with equal risk of mood disorders or
equal susceptibility to the effects of hormonal replacement therapy as has been
assumed by current clinical research and practice. CONCLUSION: While hormonal
therapies could have positive effects in the treatment and prevention of
depressive disorders, further research is required to differentiate hormone-responsive
subgroups of women for whom specific hormonal treatments may be most
beneficial. To this end, we suggest that a multifactorial model of cumulative
vulnerability, which takes into account hormonal exposure throughout life,
genetic vulnerability, and environmental factors, may provide better prediction
of treatment response.
Bone. 2007 Mar
27; [Epub ahead of print]
Beyond clinical trials: The importance of large databases in evaluating
differences in the effectiveness of bisphosphonate therapy in postmenopausal
osteoporosis.
Randomized
controlled clinical trials (RCTs) are the established method used to support
the efficacy and safety of medicines prior to marketing. For the
bisphosphonates currently marketed for osteoporosis, fracture efficacy and
safety have been evaluated in RCTs. Because of their strict design, RCTs ensure
effective control of internal biases and high internal validity, allowing
inferences to be drawn about cause and effect. However, this very restrictive
design also means that RCTs provide limited data about the performance of a
drug in the real world of clinical practice, where there are wider patient
profiles, and variable health care practices, prescribing habits, and patient
adherence to the regimen. Nonrandomized studies using large health care
databases have increasingly been used to help evaluate the effectiveness of
medicines in producing the required health outcomes. Because of the nature of
such observational studies, they allow the inclusion of very large numbers of
subjects and can be an important source of both effectiveness and safety for
medicines and allow comparison between medicines in a fashion that is unlikely
to occur in the RCT setting.
Ann
Epidemiol. 2007 Mar 28; [Epub ahead of print]
Body Mass Index and Mortality in Middle-Aged Korean Women.
Department
of Family Medicine,
PURPOSE:
We sought to evaluate the association between body mass index (BMI) and
mortality in Korean women and to determine whether the association differs
depending on menopausal status. METHODS: A total of 338,320 Korean women ages
40 to 64 years categorized into seven groups by BMI level were prospectively
followed for mortality from approximately 1994 to 2004. RESULTS:
Multivariable-adjusted analysis using Cox proportional hazards model showed a
U-shaped association between BMI and all-cause deaths, with the lowest risk at
BMI between approximately 25 and 26.9 kg/m(2), even after excluding earlier
deaths, which did not change when we did a stratified analysis according to
menopausal status. A U-shaped association was observed between BMI and cancer
death, and the risk associated with low BMI decreased significantly after
excluding earlier cancer deaths. There was a J-shaped association between BMI
and coronary heart disease (CHD) with a significantly increased risk at greater
BMI (>26 kg/m(2)). Additional adjustment for possible biological effects of
obesity (i.e., serum total cholesterol, glucose, and systolic blood pressure)
changed the U-shaped association between BMI and all-causes mortality into an
inverse shape and substantially reduced the size of risk for CHD death
associated with high BMI level. In stratified analysis, the association between
BMI and CHD was positive linear in women at premenopausal status, whereas it
was U-shaped in women at postmenopausal status. CONCLUSIONS: Obesity was
associated with an increased risk of mortality in both premenopausal and
postmenopausal Korean women, indicating that preventive strategies to control
obesity are important even in population with a relatively low mean BMI level.
Nutr
Metab Cardiovasc Dis. 2007 Mar 27; [Epub ahead of print]
Role of endogenous androgens on carotid atherosclerosis in non-obese
postmenopausal women.
Montalcini T, Gorgone G, Gazzaruso C, Sesti G, Perticone F, Pujia A.
Department of
Medicina Sperimentale e Clinica "G. Salvatore", University of
Catanzaro Magna Graecia, Italy.
BACKGROUND:
Recent randomized trials on hormone replacement therapy in postmenopausal women
raised many doubts about their role in cardiovascular disease prevention.
Therefore the role of other sex hormones needed to be investigated. In
particular androgens seem to have a protective role on atherosclerosis. The
present study was performed to assess the role of endogenous sex hormones on
carotid atherosclerosis in postmenopausal women. METHODS AND RESULTS: We
consecutively enrolled 101 postmenopausal women aged 45-75 (mean age 57.4)
years referred to our University hospital menopausal health-screening clinic.
The subjects underwent a medical history, a physical examination and
biochemical analysis. Extracranial carotid arteries were assessed by
ultrasound. Fifty percent of our sample had carotid plaques. On the
multivariate logistic regression analysis age, glycaemia (positively) and
testosterone (negatively) (P=0.02) were significantly correlated to carotid
atherosclerosis. In non-obese subjects we found that participants in the third
tertile had a significantly lower prevalence of carotid atherosclerosis
(P=0.02) compared to those in the first tertile of testosterone. CONCLUSIONS:
These results suggest a possible protective role of endogenous androgens at
least on carotid atherosclerosis. Of course these preliminary results should be
supported by prospective studies. Also the different role of these hormones on
obese and non-obese subjects needs to be clarified.
J Sex Med. 2007 Mar;4
Suppl 3:235-53.
Current management strategies of the postmenopausal patient with sexual
health problems.
The
Journal of Sexual Medicine,
Introduction.
Sexual health concerns of menopausal women include decreases in sexual
interest, arousal, lubrication, and orgasm, and increases in sexual pain, all
of which may be associated with distress. Aim. To review a step-care
progression of sexual healthcare management: identification of the sexual
health problem; education of the patient and the partner; modification of
reversible causes; first-line therapies consisting of devices and medications;
and second-line therapies with more invasive treatments including surgery.
Methods. The healthcare provider is presented with a clinical diagnosis and
treatment paradigm that engages mind, body, and relationship issues proceeding
step-wise in a rational and cost-effective fashion. Main Outcome Measure.
Literature review in women's sexual health. Results. Women's health, including
sexual health, is a fundamental human right. Supported by evidence-based data,
a step-care approach to diagnosis and management of women with sexual health
problems is advised. Multidisciplinary interventions should be considered as
needed. Identification of sexual health concerns engages diagnostic components
of psychologic consultation, history, physical examination, and laboratory
testing as appropriate. Key to clinical assessment is the detailed sexual,
medical, and psychosocial history. No agreement exists on necessary laboratory
tests. Patient (and partner) education improves understanding of treatment
options and expectations, and promotes a trusting patient-physician
partnership. Modification of reversible causes includes sex therapy,
lubricants, altering medications, modifying lifestyle and physical therapy for
pelvic floor disorders. First-line therapies should be administered based upon
diagnosis, needs, expectations, risks, benefits, and cost, and include medical
devices and drugs such as hormones, vasoactive agents, dopamine agonists,
topical steroids, anti-infectious agents, and analgesic agents. Second-line
therapies, such as surgery, are initiated upon failure, insufficient response,
or adverse side effects associated with one or more of the first-line therapies
or patient preference. Conclusions. For postmenopausal women with sexual
dysfunction, a rational clinical management strategy begins with treatment
options that are most reversible and least invasive and costly.
Diabetes
Care. 2007 Apr;30(4):967-73
Soy Consumption, Markers of Inflammation, and Endothelial Function: A
cross-over study in postmenopausal women with the metabolic syndrome.
Azadbakht L, Kimiagar M, Mehrabi Y, Esmaillzadeh A, Hu FB, Willett WC.
Department
of Nutrition,
OBJECTIVE:
To determine the effects of soy consumption on markers of inflammation and
endothelial function in postmenopausal women with the metabolic syndrome.
RESEARCH DESIGN AND METHODS: This randomized cross-over clinical trial included
42 postmenopausal women with the metabolic syndrome. Participants were randomly
assigned to consume a control diet (Dietary Approaches to Stop Hypertension
[DASH]), soy protein diet, or soy nut diet, each for 8 weeks. Red meat in the
DASH diet (one serving/day) was replaced by soy protein in the soy protein diet
and by soy nut in the soy nut diet. RESULTS: For nitric oxide levels, the
difference from the control diet was 9.8% (P < 0.01) on the soy nut and
-1.7% (P = 0.10) on the soy protein diets. The difference from the control diet
for serum E-selectin was -11.4% (P < 0.01) on the soy nut consumption and
-4.7% (P = 0.19) on the soy protein diet. Soy nut consumption reduced
interleukin-18 compared with the control diet (difference from the control
diet: -9.2%, P < 0.01), but soy protein did not (difference from the control
diet: -4.6%, P = 0.14). For C-reactive protein, the difference from the control
diet was -8.9% (P < 0.01) on the soy nut diet and -1.6% (P < 0.01) on the
soy protein diet. CONCLUSIONS: Short-term soy nut consumption reduced some
markers of inflammation and increased plasma nitric oxide levels in
postmenopausal women with the metabolic syndrome.
J Sex Med. 2007 Mar;4
Suppl 3:211-9.
Prevalence and Evaluation of Sexual Health Problems-HSDD in
Graziottin
A.
Introduction.
The complex condition of the menopause is experienced by all women going through
the physical and emotional changes associated with ovarian sexual hormones
loss. It may impact directly on their physical and mental health. Aim. The
complexity of this condition makes it necessary to accumulate large bodies of
data to define the patterns and trends in its evaluable manifestations. To this
end, large amounts of data were collected on women from
Scand J
Med Sci Sports. 2007 Apr;17(2):191.
The reduction of physical activity reflects on the bone mass among young
females: a follow-up study of 142 adolescent girls.
Rautava E, Lehtonen-Veromaa M, Kautiainen H, Kajander S, Heinonen OJ, Viikari J, Mottonen T.
Jyvaskyla
Central Hospital, Jyvaskyla, Finland.
AIM:
Maintenance of positive effects of physical activity on growing bone is
unknown. Physical activity was associated with increased BMC and BMD in a
7-year follow-up with 142 adolescent girls. Marked reduction in physical
activity had an unfavorable effect on bone measurements, which is an important
finding when the prevention of osteoporosis is considered. INTRODUCTION:
Environmental factors influence quality and durability of bone. Physical
activity, with high-impact weight bearing activity during puberty in
particular, has been shown to have a beneficial effect on growing bone. Only
few studies have been published on the maintenance of these effects. METHODS:
At baseline, 142 girls aged 9-15 years participated in the present 7-year
follow-up study. Growth and development, physical activity and intakes of
calcium and vitamin D were recorded at intervals. BMC and BMD measurements were
repeated using DXA. Based on the recording of physical activity during the
follow-up measurements, the effect of the reduction in physical activity was
examined with the bone measurements, and the measurements in the tertiles based
on the amount of physical activity during the whole follow-up period were
compared. RESULTS: Physical activity was positively associated with the development
of BMC and BMD during the follow-up. The mean BMC of the lumbar spine increased
1.69 g (3%) (P=0.021) more among those girls who maintained the physical
activity level as compared with those who reduced it during last 4 years. In
the femoral neck, the corresponding difference was 0.14 g (4.6%) (P=0.015)
between the same two groups of girls. The mean increases in BMC at lumbar spine
and femoral neck were more substantial among those girls having the highest
physical activity levels during the 7-year follow-up (46.7% and 22.6%) as
compared with those having the lowest physical activity levels (43.3% and
17.4%, respectively). CONCLUSIONS: The findings of the present study show that
regular physical activity is valuable in preserving the peak bone mass acquired
at puberty in particular. Many of the girls who markedly reduced their activity
levels lost bone in their femoral neck before their 25th birthday.
Ultrasound
Obstet Gynecol. 2007 Mar 27;29(4):443-448
Sonohysterographic endometrial sampling and hysteroscopic endometrial
biopsy: a comparative study.
Leone FP, Carsana L, Lanzani C, Vago G, Ferrazzi E.
Department
of Obstetrics and Gynaecology, Clinical Sciences Institute L. Sacco,
OBJECTIVES:
To compare the quantity and quality of endometrial tissue sampled at saline
contrast sonohysterography (SCSH) with that obtained by directed endometrial
biopsy by operative hysteroscopy in patients with diffusely thickened and/or
inhomogeneous endometrium at SCSH. A secondary aim was a comparison of the
extent of procedure-related pain. METHODS: One hundred and twenty-eight
patients with diffusely thickened (> 4 mm) and/or inhomogeneous endometrium
at SCSH were prospectively recruited. Endometrial sampling was performed at the
end of SCSH using the same 4.7-mm intrauterine catheter that had been used for
saline instillation. These samples were compared to directed endometrial
biopsies obtained with the guidance of an office 5-mm hysteroscope. After
hysteroscopy, an extended guided curettage was performed under general
anesthesia, providing specimens that were considered the gold standard for
histological diagnosis. Endometrial specimen area (mm(2)), histologic
concordance and procedure related pain (10-cm VAS) were compared for the two
techniques. RESULTS: The median age of 88 pre- and of 40 post-menopausal
patients was 41 (interquartile range, 34-48) years and 57 (interquartile range,
52-67) years, respectively. The median area of endometrial specimen obtained by
SCSH was 25.1 (interquartile range, 12.4-52.3) mm(2) and was not significantly
different from that obtained by hysteroscopy (16.9 (interquartile range,
10.0-52.7) mm(2)). The K values of the two different techniques for typical
hyperplasia (n = 61) and for premalignant and malignant lesions (n = 26) were
0.91 and 0.94, respectively. Procedure-related pain was not significantly
different between pre- and postmenopausal patients for both sampling
techniques. CONCLUSIONS: SCSH with sampling proved to be as good as and as
tolerable as hysteroscopic biopsy in cases with diffusely thickened and/or
inhomogeneous endometrium. Both these imaging and biopsy techniques should be
considered a reliable outpatient procedure in the management of patients with
abnormal uterine bleeding.
J Thromb
Haemost. 2007 Mar 27; [Epub ahead of print]
Postmenopausal oral estrogen therapy affects hemostatic factors, but
does not account for reduction in the progression of subclinical
atherosclerosis.
Vigen C, Hodis HN, Chandler WL, Lobo RA, Mack WJ.
Department
of Preventive Medicine,
Background:
Hemostatic factors influenced by postmenopausal hormone therapy may contribute
to atherosclerosis. The Estrogen in the Prevention of Atherosclerosis Trial
(EPAT), a 2-year, randomized, double-blind, placebo-controlled trial,
demonstrated reduced subclinical atherosclerosis progression measured by change
in common carotid artery intima-media thickness with unopposed oral 17beta-estradiol.
Objectives: To assess the effect of postmenopausal hormone therapy on the level
of several hemostatic factors, and the relationship between these factors and
the progression of subclinical atherosclerosis. Patients/Methods: We measured
tPA antigen, factor VII, D-dimer, and albumin longitudinally, and PAI-1 and
fibrinogen at trial-end, in 186 postmenopausal women. Results: Estradiol versus
placebo was associated with greater factor VII and lower tPA, albumin, PAI-1
and fibrinogen (all p </= 0.001), with no estradiol effect on D-dimer (p =
0.42). Only mean on-trial tPA was positively associated with the absolute level
of CIMT on-trial (r = .29, p < 0.0001), but this was attenuated with age and
BMI adjustment. No longitudinally measured hemostatic factor was associated
with carotid artery intima-media thickness progression. However, higher carotid
artery intima-media thickness during the trial was significantly related to
increases in tPA. Conclusions: These results confirm previous findings regarding
estrogen's effect on hemostatic factors and show that albumin is negatively
associated with estrogen therapy. These hemostatic factors did not account for
the reduction of carotid artery intima-media thickness progression with
17beta-estradiol seen in EPAT. Atherosclerosis itself may affect levels of
hemostatic factors (reverse causality), with subsequent involvement in
atherosclerosis-associated thrombosis.
Maturitas. 2007 Mar
24; [Epub ahead of print]
Androgens and the breast.
von
Schoultz B.
Department
of Obstetrics and Gynecology,
There is
increasing interest in the role of androgens in the treatment of women but
little is known about their long-term safety. There are also very few studies
on testosterone therapy and breast cancer risk. However, some observations
support the concept that androgens may counteract the stimulatory effects of
estrogen and progestogen in the mammary gland. Mammographic breast density and
breast cell proliferation could be regarded as surrogate markers for the risk
of breast cancer. Recently the addition of testosterone to a common
estrogen/progestogen regimen was found to inhibit the stimulatory effects of
hormones on breast cell proliferation. The effects of testosterone alone on the
postmenopausal breast remain to be investigated.
Mol Cell
Endocrinol. 2007 Feb 11; [Epub ahead of print]
Human chorionic gonadotropin (hCG) and prevention of breast cancer.
Janssens JP, Russo J, Russo I, Michiels L, Donders G, Verjans M, Riphagen I, Van den Bossche T, Deleu M, Sieprath P.
Animal and
'in vitro' experiences learned that human chorionic gonadotropin (hCG) is
capable to protect from breast cancer. Receptors for hCG/luteinizing hormone
(LH) are present on human female and male breast cancer cells. hCG decreases
proliferation and invasion of breast cancer MCF-7 cells by inhibiting NF-kappa
B, AP-1 activation and other genes. Doxorubicin toxicity is enhanced by
conjugation with beta-hCG in MCF-7 cells. All these pieces of evidence suggest
that hCG is active in human breast cancer. Direct proof however is missing. We
performed a pilot study phase I trial for testing the inhibitory effects or recombinant
hCG (rhCG) on primary breast cancer. Twenty-five postmenopausal women with
newly diagnosed breast cancers of more than 1.5cm were biopsied before
randomization to receive either 500mugrhCG (n=20) or placebo. After 2 weeks,
surgery was done and tissues were analysed with regard to morphological,
immunohistochemical and biochemical changes in tissues and plasma. rhCG reduces
significantly the proliferative index and the expression of both the oestrogen
receptor and progesterone receptor. rhCG does not modify the hormonal level of
estradiol, progesterone, inhibin and follicle stimulating hormone (FSH) but
increases significantly the level of LH. In a second pilot study, we tested the
clinical efficacy through an open-label single centre study in 13 postmenopausal
women with metastatic breast cancer. A 500mugrhCG once every 2 days shows
activity in postmenopausal metastatic breast cancer. The time to progression is
relatively short. Response to previous hormonal treatment is indicative for
rhCG activity. Given the data in primary and metastatic breast cancer rhCG
further large scale investigation is highly warranted. rhCG can be an realistic
option in (chemo) prevention trials.
Siguiente artículo comentado en http://www.climaterio.cl/Stevenson_TRH_CVDisease.html
Maturitas. 2007
Mar 23; [Epub ahead of print]
HRT and the primary prevention of cardiovascular disease.
National
Heart and Lung Institute,
Observational
studies have consistently shown a benefit of hormone replacement therapy (HRT)
on coronary heart disease (CHD), but some randomised studies have not shown any
significant effect. Thus questions still remains as to whether HRT is
beneficial for CHD, and in whom this benefit might be achieved. The biological
effects of oestrogen on the cardiovascular system have been extensively
studied, and beneficial effects on metabolic CHD risk factors, as well as on
arterial function and on surrogate clinical markers of CHD, have been
demonstrated. Thus it seems implausible that HRT should not benefit CHD in
postmenopausal women. Most randomised trials using clinical outcomes have
studied just one dose of one HRT regimen, a dose inappropriately high with the average
starting age of the participants being in their mid-60s. The observational
population studies largely comprise women starting on HRT at appropriate dose
around the age of menopause, i.e. early 50s. In fact, it was the older women in
the randomised trials that failed to show benefit, whereas there was a trend to
benefit in the younger ones for whom the starting dose of HRT was appropriate.
Furthermore, a pilot study of lower dose HRT in older women did not show any
cardiovascular harm. Inappropriately high doses of oestrogen could cause
cardiovascular harm due to transient disturbances in thrombogenesis and
vascular remodelling. Whilst the greatest CHD benefit may be seen by starting
HRT in the early postmenopause, this does not exclude benefit in older women
given appropriate low dose therapy.
Maturitas. 2007 Mar
22; [Epub ahead of print]
Rationale for use of lower estrogen doses for postmenopausal hormone
therapy.
156 Lombard
Street #13, San Francisco, CA 94111, USA.
In
placebo-controlled clinical trials low dose estrogens have been shown to reduce
hot flashes an average of 65%. Low dosage is effective in preventing bone loss
in early menopause and both low and ultralow estrogen dosages can prevent bone
loss among women many years beyond menopause. Epidemiological studies indicate
less risk of cardiovascular disease and venous thromboembolism in women who use
low dose estrogens compared to standard dose. Low dosages of estrogens are less
likely to produce unacceptable side effects, such as vaginal bleeding or breast
tenderness. When prescribing low dosage estrogen, one can safely use less
progestogen, either less daily dosage or less frequent cycles. Older women on
ultralow estrogen may not require regular progestogen because the endometrium
is not stimulated. In conclusion, there is a strong rationale for use of lower
estrogen dosage in HT. Low dosage estrogen can relieve vasomotor symptoms and
can prevent postmenopausal bone loss. Women taking low dosages of estrogens are
less likely to have unacceptable side effects, such as vaginal bleeding or
breast tenderness. Moreover, the potential harm caused by standard dosages of
estrogen with progestin, including coronary heart disease, venous
thromboembolism, stroke, and breast cancer may be mitigated by use of lower
estrogen doses that do not require daily or monthly progestin opposition.
Semana del 20 al 26 de Marzo
2007
Dr. Juan Enrique Blümel
J Vasc Interv Radiol. 2007 Mar;18(3):451-4.
Uterine artery embolization: a treatment option for symptomatic fibroids
in postmenopausal women.
Chrisman HB, Minocha J, Ryu RK, Vogelzang RL, Nikolaidis P, Omary RA.
Northwestern
The authors tested the
hypothesis that UAE is an effective treatment option in postmenopausal women
with fibroid-related bulk symptoms. The authors retrospectively reviewed a
prospectively acquired HI-IQ database. Between 2001 and 2004, 24 women with an
average age of 52 years meeting the Stages of Reproductive Aging Workshop
criteria for menopause underwent UAE for fibroid-related bulk symptoms. All
patients underwent preprocedural gadolinium-enhanced magnetic resonance (MR)
imaging to confirm the presence of fibroid disease and exclude other pathology.
These patients were followed at 1-, 3-, 6-, 12-, and 24-month intervals to
assess their clinical response to therapy. Clinical success was defined as a
qualitative reduction in bulk symptoms. Postprocedural gadolinium-enhanced MR
imaging was performed routinely between 3 and 6 months and at 12 or 24 months,
if indicated. Technical success was achieved in 24 of 24 (100%) patients. The
follow-up period ranged from
Bone. 2007 Feb 17; [Epub
ahead of print]
Antifracture efficacy of strontium ranelate in postmenopausal
osteoporosis.
Strontium ranelate is a
bone-seeking element that has been assessed in postmenopausal osteoporosis in
two large double-blind, placebo-controlled studies. This treatment is able to
decrease the risk of vertebral fractures, by 38% after 3 years, and by 52%
within the first year of treatment. Moreover, in postmenopausal patients with
osteoporosis, the risk of having a first vertebral fracture is decreased by 48%
after 3 years. The risk of nonvertebral fractures is decreased by 16%, and, in
patients at high risk for such a fracture, the risk of hip fracture is decreased
by 36% over 3 years. Recent 5-year data from these double-blind,
placebo-controlled studies show that the antifracture efficacy is maintained
over time. Current recommendations for therapeutic decision-making in
osteoporosis are based on risk factor assessment; treatment efficacy with
strontium has been documented across a wide range of patient profiles: age,
bone mineral density, body mass index, as well as family history of
osteoporosis and addiction to smoking are not determinants of antifracture efficacy.
Strontium ranelate is an attractive treatment option across the postmenopausal
osteoporosis continuum.
Maturitas. 2007 Mar 19; [Epub
ahead of print]
Postmenopausal hormone therapy: The way ahead.
Department of Medicine
"T",
This article follows the
milestones in the history of postmenopausal hormone treatment, with a look into
the future. In the first era, hormones were regarded as an anti-aging panacea,
the fountain of eternal youth. It was recommended then that every
postmenopausal woman should consider the use of hormone replacement therapy. In
the second era, people realized that hormones are medications, and as such
should be given for clear and scientifically proven indications. When the issue
of harm as a result of hormone treatment led to professional and public
debates, the concept was changed into a clinically oriented approach commonly
phrased as "the expected benefits should be weighed individually against
potential risks". In the third era, individualization had a further step,
stressing the prognostic importance of the following parameters: women's age,
age at start of hormone use, duration of therapy, dosage, route of
administration, and the exact type and combination of estrogen and progestogen.
The fourth era is already knocking on our door, as new molecules are sought,
which will maximize the desired effects of therapy while minimizing or
eliminating the risks. The fifth era is still a wishful thinking, searching for
the ultimate treatment which will be based on individual gene mapping and
accurate assessment of the chance to achieve treatment goals vis-a-vis the risk
of having a serious adverse event.
Mol
Cell Endocrinol. 2007 Feb 6; [Epub ahead of print]
Increases in luteinizing hormone are associated with declines in
cognitive performance.
Casadesus G, Milliken EL, Webber KM, Bowen RL, Lei Z, Rao CV, Perry G, Keri RA, Smith MA.
Department of Neurosciences,
Questions surrounding estrogen
therapy for post-menopausal cognitive decline and dementia led us to examine
the role of luteinizing hormone that becomes elevated after menopause. We
examined hippocampal-associated cognitive performance, as measured with the
Y-maze task, in two strains of transgenic mice, one (Tg-LHbeta) which
over-expresses luteinizing hormone and another (LHRKO), which has increased
circulating luteinizing hormone levels, but its receptors are silenced. Our results
demonstrate that Tg-LHbeta, but not LHRKO mice, show decreased Y-maze
performance when compared to aged-matched wild-type animals. These findings
indicate that increased luteinizing hormone levels, in the presence of
functional receptors may, at least in part, be responsible for cognitive
decline after menopause. As such, modulation of luteinizing hormone or its
receptor levels may prove to be useful therapeutic strategies for cognitive
decline associated with aging and age-related neurodegenerative diseases such
as Alzheimer disease.
Eur
J Gynaecol Oncol. 2007;28(1):45-7.
Serum CA-125 is a good predictor of benign disease in patients with
postmenopausal ovarian cysts.
Dikensoy E, Balat O, Ugur MG, Ozkur A, Erkilic S.
Department of Obstetrics and
Gynecology,
AIM: To determine whether
serum CA-125 levels, in addition to tumor size and ultrasonographic findings
can help in differentiating benign ovarian cysts from malignant disease.
METHODS: All postmenopausal women who had undergone explorative laporatomy for
a preoperative diagnosis of an adnexal cyst between January 1999 and February
2006 were included if serum CA-125 levels were below 50 IU/ml. RESULTS:
Ninety-three patients with ovarian cysts and serum CA-125 levels lower than 50
IU/ml were included. Seventy-five (80%) of the patients (53 unilocular, 22
multilocular) had ovarian cysts < 13 cm. Of 18 patients with ovarian cysts
> 13 cm, seven had unilocular and 11 had multilocular cysts. All the
patients (n = 77) with a serum CA-125 level < 35 IU/ml had benign
histopathology regardless of the tumor size or ultrasonic features. Among 16
patients with CA-125 levels between 35 and 50 IU/ml, two with unilocular cysts
> 13 cm and nine with multilocular cysts (3 < 13 cm, 6 > 13 cm) had
borderline histopathology. CONCLUSION: We concluded that when unilocular
ovarian cyst size is < 13 cm and serum CA-125 levels are below 35 IU/ml in a
postmenopausal woman, the possibility of a benign etiology is most likely.
J
Natl Cancer Inst. 2007 Mar 21;99(6):475-86
Dietary lignan intake and postmenopausal breast cancer risk by estrogen
and progesterone receptor status.
Touillaud MS, Thiebaut AC, Fournier A, Niravong M, Boutron-Ruault MC, Clavel-Chapelon F.
Institut National de la Sante et de la Recherche
Medicale, ERI 20, Institut Gustave-Roussy,
France.
BACKGROUND: Studies conducted
in Asian populations have suggested that high consumption of soy-based foods
that are rich in isoflavone phytoestrogens is associated with a reduced risk of
breast cancer. However, the potential associations of other dietary
phytoestrogens--i.e., the lignans or their bioactive metabolites, the
enterolignans--with the risk of breast cancer are unclear. METHODS: We
prospectively examined associations between the risk of postmenopausal invasive
breast cancer and dietary intakes of four plant lignans (pinoresinol,
lariciresinol, secoisolariciresinol, and matairesinol) and estimated exposure
to two enterolignans (enterodiol and enterolactone), as measured with a
self-administered diet history questionnaire, among 58,049 postmenopausal
French women who were not taking soy isoflavone supplements. Relative risks
(RRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox
proportional hazards regression models. Analyses were further stratified by the
combined estrogen and progesterone receptor (ER/PR) status of the tumors.
Statistical tests were two-sided. RESULTS: During 383,425 person-years of
follow-up (median follow-up, 7.7 years), 1469 cases of breast cancer were
diagnosed. Compared with women in the lowest intake quartiles, those in the
highest quartile of total lignan intake (>1395 microg/day) had a reduced
risk of breast cancer (RR = 0.83, 95% CI = 0.71 to 0.95, P(trend) = .02, 376 versus
411 cases per 100,000 person-years), as did those in the highest quartile of
lariciresinol intake (RR = 0.82, 95% CI = 0.71 to 0.95, P(trend) = .01). The
inverse associations between phytoestrogen intakes and postmenopausal breast
cancer risk were limited to ER- and PR-positive disease (e.g., RR for highest
versus lowest quartiles of total plant lignan intake = 0.72, 95% CI = 0.58 to
0.88, P(trend) = .01, 174 versus 214 cases per 100,000 person-years, and RR for
highest versus lowest quartiles of total enterolignan level = 0.77, 95% CI =
0.62 to 0.95, P(trend) = .01, 164 versus 204 cases per 100,000 person-years).
CONCLUSIONS: High dietary intakes of plant lignans and high exposure to
enterolignans were associated with reduced risks of ER- and PR-positive
postmenopausal breast cancer in a Western population that does not consume a
diet rich in soy.
J
Natl Cancer Inst. 2007 Mar 21;99(6):451-62.
Dietary fat and postmenopausal invasive breast cancer in the National
Institutes of Health-AARP Diet and Health Study cohort.
Thiebaut AC, Kipnis V, Chang SC, Subar AF, Thompson F, Rosenberg PS, Hollenbeck AR, Leitzmann M, Schatzkin A.
Nutritional Epidemiology
Branch, Division of Cancer Epidemiology and Genetics, National Cancer
Institute,
BACKGROUND: Although ecologic
association and animal studies support a direct effect of dietary fat on the
development of breast cancer, results of epidemiologic studies have been
inconclusive. METHODS: We prospectively analyzed the association between fat
consumption and the incidence of postmenopausal invasive breast cancer in the
National Institutes of Health-AARP Diet and Health Study, a
J
Clin Endocrinol Metab. 2007 Mar 20; [Epub ahead of print
Effects of oral and trans-vaginal ethinyl estradiol on hemostatic
factors and hepatic proteins in a randomized, cross-over study.
Sitruk-Ware R, Plu-Bureau G, Menard J, Conard J, Kumar S, Thalabard JC, Tokay B, Bouchard P.
Center for Biomedical
Research, Population Council, New York, USA; Rockefeller University, New York,
USA; APHP, Universite Paris V and Hotel-Dieu, Paris, France; Institut National
de la Sante et de la Recherche Medicale (INSERM) U652, Paris, France; Hopital
Saint-Antoine, Paris, France.
Context: The use of combined
hormonal contraceptives with ethinyl estradiol (EE) and a progestin results in
alterations in potential biomarkers of venous thromboembolism risk. Evaluation of
the impact of delivery route on these changes is difficult due to an
interaction between EE and the progestin component. Objective: To compare the
impact of oral and vaginal administration of EE alone on hemostatic variables
and estrogen-sensitive liver proteins. Design: This was single-center,
randomized, cross-over study with 2 treatment cycles separated by a washout
cycle. Setting: An academic outpatient center. Participants: Fourteen healthy
postmenopausal women were enrolled; 13 completed the study and were included in
the analyses. Intervention: Participants were randomized to receive EE (15
microg/day) delivered by oral tablet or vaginal ring for 21 days in 1 of 2
treatment sequences. Main outcome measures: Changes in plasma concentration or
activity of 10 hemostatic variables and 6 estrogen-sensitive liver proteins
between baseline and day 21 of treatment. Results: Prothrombin fragment 1 + 2
plasma level was unaffected by treatment or delivery route. Angiotensinogen
(expressed as plasma level of angiotensin I) increased similarly with oral and
vaginal delivery: mean (SD) increases were 2757 (1033) and 2864 (893) ng /mL,
respectively (P = 0.0002). Alterations in other study variables, except total
cholesterol, were similar with oral and vaginal administration. Conclusion: Our
results provide evidence that the customary effects of combined hormonal
contraceptives on hemostatic variables and estrogen-sensitive liver proteins
are largely related to EE and independent of delivery route during short-term treatment.
Immun
Ageing. 2007 Mar
20;4(1):1 [Epub ahead of print
The Interleukin-6 inflammation pathway from cholesterol to aging - Role
of statins, bisphosphonates and plant polyphenols in aging and age-related
diseases.
ABSTRACT: We describe the
inflammation pathway from Cholesterol to Aging. Interleukin 6 mediated
inflammation is implicated in age-related disorders including Atherosclerosis,
Peripheral Vascular Disease, Coronary Artery Disease, Osteoporosis, Type 2
Diabetes, Dementia and Alzheimers disease and some forms of Arthritis and
Cancer. Statins and Bisphosphonates inhibit Interleukin 6 mediated inflammation
indirectly through regulation of endogenous cholesterol synthesis and
isoprenoid depletion. Polyphenolic compounds found in plants, fruits and
vegetables inhibit Interleukin 6 mediated inflammation by direct inhibition of
the signal transduction pathway. Therapeutic targets for the control of all the
above diseases should include inhibition of Interleukin-6 mediated inflammation.
Scott
Med J. 2007
Feb;52(1):13-6
Lack of knowledge of osteoporosis: a multi-centre, observational study.
Department of Orthopaedic
Surgery
BACKGROUND AND AIM:
Osteoporosis poses a significant health problem. As the population ages, its
incidence increases. Effective prevention requires good awareness of the
disease among the general public. The aim of this study was to assess the level
and source of osteoporosis knowledge in a group of patients attending for Dual
Emission X-ray Absorpitometry (DEXA) scanning. METHODS: A questionnaire was
devised to assess knowledge of the osteoporosis risk factors, risk-reducing
measures and signs/symptoms. Questionnaires were completed by 176 patients in
two centres; Glasgow Royal Infirmary,
Cancer
Epidemiol Biomarkers Prev. 2007 Mar;16(3):451-7.
Premenopausal Insulin-Like Growth Factor-I Serum Levels and Changes in
Breast Density over Menopause.
Verheus M, Peeters PH, Kaaks R, van Noord PA, Grobbee DE, van Gils CH.
BACKGROUND: A high proportion
of glandular and stromal tissue in the breast (percentage breast density) is a
strong risk factor for breast cancer development. Insulin-like growth factor-I
(IGF-I) is hypothesized to influence breast cancer risk by increasing breast
density. OBJECTIVES: We studied the relation between premenopausal circulating
IGF-I levels and premenopausal and postmenopausal, absolute nondense and dense
area, and percentage breast density as well as changes in these measures over
menopause. Design and METHODS: Mammograms and blood samples of 684
premenopausal participants of the Prospect-European Prospective Investigation
into Cancer and Nutrition cohort were collected at baseline. A second mammogram
of these women was collected after they became postmenopausal. Premenopausal
IGF-I levels were measured in serum. Premenopausal and postmenopausal breast
measures were assessed using a computer-assisted method. Mean values of breast
measures were calculated for quartiles of serum IGF-I using linear regression
analysis. RESULTS: Women with higher premenopausal IGF-I levels showed a
slightly smaller decrease in dense area over menopause (-12.2 cm(2) in the
highest versus -12.9 cm(2) in the lowest quartile; P trend = 0.58) and, at the
same time, a smaller increase in the nondense (fat) area (P trend = 0.09). Due
to the changes over menopause, high premenopausal IGF-I serum levels were
associated with lower nondense area (P trend = 0.05), somewhat higher dense
area (P trend = 0.66), and consequently higher percentage breast density (P
trend = 0.02) after menopause. Conclusion and DISCUSSION: Women with higher
premenopausal IGF-I levels have a smaller increase in nondense area and also a
slightly smaller decrease in absolute dense area during menopause, resulting in
higher breast density after menopause.
Int
J Cancer. 2007 Mar
19; [Epub ahead of print]
Hormone replacement therapy and breast cancer in former users of oral
contraceptives-The Norwegian Women and Cancer study.
Lund E, Bakken K, Dumeaux V, Andersen V, Kumle M.
Combined estrogen-progestin
menopausal therapy (HRT) and combined estrogen-progestin contraceptives (OC)
both increase breast cancer risk during current use and a few years after. We
investigated risk of breast cancer in women who were users of HRT dependant on
former history of OC use in a large, national population-based cohort study,
the Norwegian Women and Cancer study (NOWAC). Exposure information was
collected through postal questionnaires. Based on follow-up of 30,118
postmenopausal women by linkage to national registers of cancer, deaths, and
emigration we revealed 540 incident breast cancer cases between 1996 and 2004.
Compared to never users of either drugs current use of HRT gave a significant
(p = 0.002) higher risk of breast cancer in former OC users, RR = 2.45 (95% CI
1.92-3.12), than among never users of OCs, RR = 1.67 (1.32-2.12). Relative risk
of current use of HRT was similar for estrogen only and combinations with
progestin added in ever users of OCs. The increased risk of breast cancer in
current HRT users with a history of former OC use could have potential great
impact on postmenopausal breast cancer risk as the proportion of postmenopausal
women with former OC use will continue to increase. (c) 2007 Wiley-Liss, Inc.
Int
J Cancer. 2007 Mar
19; [Epub ahead of print
Incidence of breast cancer among postmenopausal, hypertensive women.
Lindgren A, Pukkala E, Tuomilehto J, Nissinen A.
Department of child
psychiatry,
Elevated blood pressure has
been proposed to be a risk factor for breast cancer but the results remain
controversial. In this study, the incidence of breast cancer among 9,112
postmenopausal, hypertensive women included in the community-based hypertension
register of the
Cancer
Epidemiol Biomarkers Prev. 2007 Mar;16(3):613-6.
Overweight and obese perimenopausal and postmenopausal women exhibit
increased abnormal mammary epithelial cytology.
Seewaldt VL, Goldenberg V, Jones LW, Peace C, Broadwater G, Scott V, Bean GR, Wilke LG, Zalles CM,
High body mass index (BMI
>/= 25 kg/m(2)) is associated with increased postmenopausal breast cancer
incidence and mortality. However, few studies have explored associations
between BMI and direct measures on target tissue. Epithelial cytology was
assessed in 62 high-risk perimenopausal and postmenopausal women using random
periareolar fine needle aspiration. Masood cytology index scores were
significantly higher among women with BMIs >/=25 kg/m(2) than in women with
BMIs <25 kg/m(2) (13.9 +/- 0.42 versus 12.7 +/- 0.29 kg/m(2); P = 0.017).
Overweight or obese women also had significantly higher random periareolar fine
needle aspiration epithelial cell counts compared with those who were normal
weight (1,230 +/- 272 versus 521 +/- 185; P = 0.028). These data suggest that
overweight in perimenopausal and postmenopausal women is associated with direct
cytologic abnormalities within the breast. Further research is needed to
confirm these findings and to determine if this potential biomarker is
responsive to changes in body weight resulting from diet and/or exercise
interventions.
Rev
Med Chil. 2007
Jan;135(1):31-6. Epub 2007 Mar 6
Vertebral fractures, osteoporosis and vitamin D levels in Chilean
postmenopausal women.
Rodriguez P JA, Valdivia C G, Trincado M P.
Departamento
de Endocrinologia, Escuela de Medicina, Pontificia Universidad Catolica de
ChileChile.
Background: Approximately
one-third of vertebral fractures can be clinically diagnosed. Aim: To study the
frequency of vertebral fractures in postmenopausal women. Patients and methods:
We recruited 555 postmenopausal women from
Maturitas. 2007 Mar 17; [Epub
ahead of print
Androgens and female sexual function.
Palacios Institute of Woman's
OBJECTIVES: There is evidence
that suggests that androgen might play an important role in different tissues
and in modulating sexual response. In women of reproductive age the most
important source of androgens present in the blood is the ovary. Androgens
complement the contribution of adrenal precursors, which in peripheral organs
and target tissue can be transformed into bioactive androgens. The human brain
is an important target organ of the sex hormones. The expression in the brain
of men and women of estrogenic and/or androgenic receptors (AR) in the cerebral
nucleus, especially the hypothalamus, whose important participation in the
regulation of the secretion of gonadotrophins, sexual motivation and sexual
response is well documented by experimental research on animals and is being
verified by studies on functional neuroimaging in humans. METHODS AND RESULTS:
The two pivotal studies that have served for acceptance of the testosterone
patch as therapy for hypoactive sexual desire by the European Agency for the
Evaluation of Medicinal Products (EMEA) have been The Intimate Study (SM1) and
The Intimate Study (SM2). The data on the efficiency of these studies have
therefore been clear and positive; the side effects have also been studied and
were found in general to be the same as those of the placebo group. CONCLUSION:
There are certain limitations in the studies that are currently being
evaluated. Studies with androgens alone and androgens plus estrogens in the
natural menopause are ongoing at present.
Semana del 13 al 19 de Marzo 2007
Dr. Juan Enrique Blümel
Climacteric. 2007 Feb;10(1):46-50
Depressed mood through women's reproductive cycle: correlation to mood
at menopause.
Becker D, Orr A, Weizman A, Kotler M, Pines A.
Objectives
Depressive symptoms are frequent through the different stages of a woman's
reproductive cycle. The aim of this study was to evaluate a possible correlation
of depressive mood before menstruation, during pregnancy, after delivery and
around the menopause. Methods The sample consisted of 110 women (mean age 52
years, standard deviation 4 years) who rated their mood at present and
retrospectively at different stages of the reproductive cycle. Mood was rated
using a visual analogue scale. Results A significant statistical association
was found between the present mood and mood at the premenstrual period, but not
with mood at pregnancy or after delivery. These findings were independent of
age, menopausal status or use of hormone replacement therapy. Conclusions The
statistical association between depressed mood around menopause and before
menstruation supports the assumption that there is a common etiology, which
could be attributed to hormonal or psychological factors, or both.
Climacteric. 2007
Feb;10(1):38-45
Effects of acupuncture, applied relaxation, estrogens and placebo on hot
flushes in postmenopausal women: an analysis of two prospective, parallel,
randomized studies.
Zaborowska E, Brynhildsen J, Damberg S, Fredriksson M, Lindh-Astrand L, Nedstrand E, Wyon Y, Hammar M.
Division
of Obstetrics and Gynecology.
Objective
To assess if transdermal or oral estrogens, acupuncture and applied relaxation
decrease the number of menopausal hot flushes/24 h and improve climacteric
symptoms, as assessed by the Kupperman index, more than transdermal placebo
treatment. Setting An outpatient clinic at a Swedish university hospital.
Methods A total of 102 postmenopausal women were recruited to two studies
performed in parallel. In Study I, the women were randomized between
transdermal placebo or estrogen treatment and, in Study II, between oral
estrogens, acupuncture or applied relaxation for 12 weeks. Climacteric symptoms
were measured with daily logbooks on hot flushes. Women completed the
assessment questionnaire for the Kupperman index at baseline and after 12
weeks. Results The number of flushes/24 h decreased significantly after 4 and
12 weeks in all groups except the placebo group. Both at 4 and 12 weeks,
acupuncture decreased the number of flushes more (p < 0.05; p < 0.01,
respectively) than placebo. At 12 weeks, applied relaxation decreased the
number of flushes more (p < 0.05) than placebo. The Kupperman index score
decreased in all groups except the placebo group. The decrease in score was
significantly greater in all treatment groups than in the placebo group (p <
0.01). Conclusion Acupuncture and applied relaxation both reduced the number of
hot flushes significantly better than placebo and should be further evaluated
as alternatives to hormone therapy in women with menopausal vasomotor
complaints.
Climacteric. 2007
Feb;10 Suppl
Effects of blood pressure reduction on cardiovascular risk estimates in
hypertensive postmenopausal women.
Department
of Medicine, Miller
Menopause
is accompanied by an increased prevalence of hypertension, which may partially
explain the corresponding cardiovascular risk observed in postmenopausal women.
The relationship between blood pressure and cardiovascular risk is continuous,
consistent and independent of other risk factors. There are profound benefits
of treating hypertension: antihypertensive therapy has been associated with
large reductions in stroke, myocardial infarction and heart failure. Despite these
proven benefits, hypertension is inadequately treated, or not treated at all,
in the majority of patients. There has been concern regarding the use of
hormone therapy in hypertensive postmenopausal women.
Drospirenone/17beta-estradiol, a hormone therapy, has been demonstrated to
lower blood pressure in hypertensive postmenopausal women either alone or when
administered simultaneously with antihypertensive drugs. This might offer a
potential advantage in patients with elevated blood pressure. It is also known
that the risk for target organ events extends to levels well below the
established definition of 140/90 mmHg. High-normal blood pressure carries an
increased cardiovascular risk when compared to lower levels of blood pressure.
Identification and management of elevated blood pressure are an important
component of the successful management of the postmenopausal woman and can help
prevent the untoward consequences of elevated blood pressure.
Climacteric. 2007
Feb;10 Suppl
Drospirenone with 17beta-estradiol in the postmenopausal woman with
hypertension.
Division
of Hypertension and Clinical Pharmacology, Pat and
Hypertension
is one of the most important risk factors for the development of cardiovascular
disease. The prevalence of hypertension increases with age and also after the
menopause; therefore, blood pressure monitoring and effective control of
elevated blood pressure are very important in postmenopausal women. The
knowledge that aldosterone is a dual cardiovascular and endocrine hormone has
blurred the once distinct boundary between gynecology and cardiovascular
medicine. Aldosterone plays a major role in salt and water homeostasis, but
also binds to mineralocorticoid receptors in the cardiovascular system, leading
to structural and functional changes and consequent organ damage. Highly
selective aldosterone blockade via the mineralocorticoid receptor has long-term
antihypertensive effects. Drospirenone is a novel progestogen with aldosterone
receptor antagonism (
Climacteric. 2007
Feb;10 Suppl
Menopause and cardiovascular disease: the evidence.
Rosano GM, Vitale C, Marazzi G, Volterrani M.
Department
of Medical Sciences, Center for Clinical and Basic Research, Cardiovascular
Research Unit, IRCCS San Raffaele.
Menopause
is a risk factor for cardiovascular disease (CVD) because estrogen withdrawal
has a detrimental effect on cardiovascular function and metabolism. The
menopause compounds many traditional CVD risk factors, including changes in
body fat distribution from a gynoid to an android pattern, reduced glucose
tolerance, abnormal plasma lipids, increased blood pressure, increased
sympathetic tone, endothelial dysfunction and vascular inflammation. Many CVD
risk factors have different impacts in men and women. In postmenopausal women,
treatment of arterial hypertension and glucose intolerance should be
priorities. Observational studies and randomized clinical trials suggest that
hormone replacement therapy (HRT) started soon after the menopause may confer
cardiovascular benefit. In contrast to other synthetic progestogens used in
continuous combined HRTs, the unique progestogen drospirenone has
antialdosterone properties. Drospirenone can therefore counteract the water-
and sodium-retaining effects of the estrogen component of HRT via the
renin-angiotensin-aldosterone system, which may otherwise result in weight gain
and raised blood pressure. As a continuous combined HRT with 17beta-estradiol,
drospirenone has been shown to significantly reduce blood pressure in postmenopausal
women with elevated blood pressure, but not in normotensive women. Therefore,
in addition to relieving climacteric symptoms, drospirenone/17beta-estradiol
may offer further benefits in postmenopausal women, such as improved CVD risk
profile.
Climacteric. 2007
Feb;10 Suppl
Drospirenone and its antialdosterone properties.
Genazzani AR, Mannella P, Simoncini T.
Department
of Obstetrics and Gynecology,
Drospirenone
is a unique progestogen derived from 17alpha-spirolactone, with a pharmacologic
profile very similar to that of endogenous progesterone. In contrast with other
available progestins, drospirenone is a progestogen with aldosterone receptor
antagonism (
Climacteric. 2007
Feb;10 Suppl 1:3-10
Drospirenone and estradiol: a new option for the postmenopausal woman.
CONRAD
Clinical
The
efficacy of estrogen with or without a progestogen as hormone replacement
therapy (HRT) for menopausal symptoms is well-established. Recent large-scale
randomized studies with combined estrogen/progestogen therapy (EPT) have raised
a number of safety issues, specifically the potential risk for coronary heart
disease. Subsequent analyses and other studies have indicated that HRT may be
cardioprotective in younger postmenopausal women. A new continuous EPT combines
natural 17beta-estradiol (E2) 1 mg with the novel progestin, drospirenone
(DRSP) either 0.5 or 2 mg. DRSP has a physiological profile closer to that of
natural progesterone than any other synthetic progestin. This paper reviews
recent clinical trial data demonstrating the efficacy and safety of combined
DRSP/E2 therapy as EPT in postmenopausal women. DRSP/E2 provides symptomatic
relief of vasomotor symptoms and improvement in genitourinary atrophy. DRSP/E2
protects against endometrial hyperplasia and reduces the risk of osteoporosis.
Combined DRSP/E2 therapy has a favorable impact on cholesterol and triglyceride
levels, and decreases blood pressure in women with elevated blood pressure. The
favorable efficacy and safety profile of DRSP/E2, and potential for long-term
health benefits, represents a new option for the effective management of
menopause and its clinical sequelae.
Acta
Otolaryngol. 2007 Feb;127(2):149-55
Hearing in women at menopause. Prevalence of hearing loss, audiometric
configuration and relation to hormone replacement therapy.
Hederstierna C, Hultcrantz M, Collins A, Rosenhall U.
Department
of Audiology,
Conclusion.
Hormone replacement therapy (HRT) may have a protective effect on hearing
impairment in postmenopausal women. New guidelines for classification of
audiometric configuration in age-related hearing loss are suggested.
Objectives. To describe prevalence of hearing loss and audiometric
configuration in a group of middle-aged women with respect to menopausal stage
and HRT. Subjects and methods. A total of 143 women around menopause were
sampled through the Swedish population register. The mean hearing threshold
levels were compared according to menopausal status. The audiograms in the 57
women with hearing loss were classified according to audiometric configuration.
Results. In all, 57 women (40%) had any kind of hearing loss; 42 had very
minute hearing loss; 15 had a 4FA (average of thresholds at 0.5, 1, 2, and 4
kHz) of at least 20-39 dB HL in at least one ear. Two of these had a 4FA of
40-69 dB HL in at least one ear. The most common configurations were: gently
sloping (47%), steeply sloping (14%), and high-frequency U-shaped (14%). The
postmenopausal women who were not on HRT had poorer hearing mainly at 2 and 3
kHz, compared with pre- and perimenopausal women, and postmenopausal women on
HRT.
Drugs
Aging. 2007;24(3):173-85
Might DHEA be Considered a Beneficial Replacement Therapy in the
Elderly?
Genazzani AD, Lanzoni C, Genazzani AR.
Department
of Obstetrics and Gynecology,
Dehydroepiandrosterone
(DHEA) [prasterone] is typically secreted by the adrenal glands and its
secretory rate changes throughout the human lifespan. When human development is
completed and adulthood is reached, DHEA and DHEA sulphate (DHEAS) [PB-008]
levels start to decline so that at 70-80 years of age, peak DHEAS
concentrations are only 10-20% of those in young adults. This age-associated
decrease has been termed 'adrenopause', and since many age-related disturbances
have been reported to begin with the decline of DHEA/DHEAS levels, this
provides a potential opportunity for use of DHEA as replacement therapy.For
these reasons, use of DHEA as a replacement therapy in aging men and women has
been proposed and this paper outlines the reported beneficial effects of such
treatment in humans. Many interesting results have been obtained in
experimental animals suggesting that DHEA positively modulates most age-related
disturbances. However, renewed interest in DHEA has arisen as a result of recent
studies suggesting that DHEA appears to be beneficial in hypoandrogenic men as
well as in postmenopausal and aging women. Menopause is the event in a woman's
life that induces a dramatic change in the steroid milieu, and use of DHEA as
'replacement treatment' has been reported to restore both the androgenic and
estrogenic environment and reduce most of the symptoms of this change. As
menopause is the beginning of the biological transition of women towards
senescence, it is of great interest to better understand how DHEA might help to
solve and/or overcome the problems of this complex stage of life. In men with
adrenal insufficiency and hypogonadism without androgen replacement, DHEA
administration results in a significant increase in circulating androgens.Though
most data are suggestive for use of DHEA as hormonal replacement treatment,
more defined and specific clinical trials are needed to uncover all of the
'secrets' and features of this steroid before it can be used as a standard
treatment. Furthermore, DHEA is perceived differently around the world, being
considered only a 'dietary supplement' in the US, while in many European
countries it is considered a 'true hormone' that has not been approved for use
as a hormonal treatment by the European health authorities. This overview
offers some points of view on use of DHEA as an experimental hormonal
replacement therapy.
Maturitas. 2007 Mar
9; [Epub ahead of print]
Tibolone for prevention and treatment of postmenopausal osteoporosis.
156 Lombard
Street #13, San Francisco, CA 94111, USA.
Tibolone
has been widely accepted as remedy for vasomotor symptoms and for prevention of
bone loss. Studies over the past 25 years have documented its effects on bone
mineral density in younger and older women. Tibolone reduces bone turnover
substantially (about the same amount as hormone therapy). Increases in bone
mineral density (BMD) accompany this reduction in bone turnover, but like all
other antiresorptive therapies, reduction in fracture risk (i.e. 50%) is always
greater than would be predicted from BMD change. Finally, as with hormone
therapies, dosage reductions have been prompted by new evidence of low dosage
efficacy and concern over dose-related side effects. Solid evidence has now
emerged from large, dose-ranging studies that the 1.25mg tibolone dosage is
adequate for preservation of BMD and for reduction of fracture risk. Now that
fracture efficacy has been added to the list of tibolone's documented bone
benefits, physicians must consider this in the overall risks and benefits of
its use.
Am J
Ophthalmol. 2007 Mar 14; [Epub ahead of print]
Itchy-Dry Eye Associated with Polycystic Ovary Syndrome.
Bonini S, Mantelli F, Moretti C, Lambiase A, Bonini S, Micera A.
Interdisciplinary
Center for Biomedical Research (CIR), Laboratory of Ophthalmology, University
Campus Bio-Medico of Rome, Italy; IRCCS G.B. Bietti Eye Foundation, Rome,
Italy.
PURPOSE:
The authors aimed to define the ocular symptomatology of women with polycystic
ovaries and hyperandrogenism. DESIGN: Prospective, observational case series.
METHODS: Of the 62 consecutive patients with an ultrasonographic diagnosis of
polycystic ovary (PCO), 16 were identified as having clinical and biochemical
signs of hyperandrogenism. All women with a history of ocular symptoms (20/62
total patients [32.3%], 15/16 polycystic ovary syndrome (PCOS) patients
[93.7%], and 5/46 PCO patients [10.8%]) underwent a complete eye examination
with conjunctival impression cytologic sampling. Clinical measurements of tear
function (tear film break-up time [BUT], Schirmer I test) were completed along
with analysis of conjunctival goblet cell number, conjunctival immunostaining,
and reverse-transcriptase polymerase chain reaction for the mucins MUC1 and
MUC5AC. Clinical, histologic, and biochemical data of patients with PCOS were
compared statistically with that of patients with PCO and with eight age- and
gender-matched healthy controls. Eight of the most severely affected patients
received systemic antiandrogen therapy and underwent further ocular evaluation
four months after systemic therapy. RESULTS: Women with PCOS had greater
conjunctival hyperemia (P < .001), dryness (P < .001), itching (P <
.001), mucous discharge (P < .001), and contact lens intolerance (P <
.001) than patients with PCO. Patients with PCOS had a significant reduction of
the tear film BUT accompanied by a significant increase in goblet cell number
and conjunctival MUC5AC messenger ribonucleic acid expression compared with
both PCO patients and healthy subjects. CONCLUSIONS: Evaluation of the ocular
surface should be considered in patients with PCO or PCOS. Women with PCOS were
more likely to have itchy-dry eyes, decreased tear film BUT, and
increased goblet cell density.
Semana del 6 al 12 de Marzo
2007
Dr. Juan Enrique Blümel
Osteoporos
Int. 2007 Mar 9; [Epub ahead of print]
Telomere length in leukocytes correlates with bone mineral density and
is shorter in women with osteoporosis.
Valdes
AM,
Richards
JB,
Gardner
JP,
Swaminathan
R,
Kimura
M,
Xiaobin
L,
Aviv
A,
Spector
TD.
Twin Research & Genetic
Epidemiology Unit, King's College
Telomere length decreases with
age and is associated with osteoblast senescence. In 2,150 unselected women,
leukocyte telomere length was significantly correlated with bone mineral
density. Clinical osteoporosis was associated with shorter telomeres,
suggesting that telomere length can be used as a marker of bone aging.
INTRODUCTION: The length of telomeres in proliferative cells diminishes with
age. Telomere shortening and telomerase activity have been linked to in vitro
osteoblast senescence and to increased secretion of pro-inflammatory cytokines.
We explored whether bone mineral density correlates with telomere length in
leukocytes. MATERIALS AND METHODS: The relationship between leukocyte telomere
length, bone mineral density (BMD) and osteoporosis (as defined by the World
Health Organization) was examined in a cohort of 2,150 women from a
population-based twin cohort aged 18-79. RESULTS: After adjusting for age, body
mass index, menopausal status, smoking, hormone replacement therapy status,
telomere length was positively correlated with BMD of the spine (p < 0.005),
forearm (p < 0.013), but not the femoral neck (p < 0.06). Longer
telomeres were associated with reduced the risk of clinical OP at two or more
sites (odds ratio = 0.594 95% CI 0.42-0.84 p < 0.003) and in women over the
age of 50, clinical osteoporosis was associated with 117 bp shorter telomere
length (p < 0.02) equivalent to 5.2 years of telomeric aging. CONCLUSIONS:
Shortened leukocyte telomere length is independently associated with a decrease
in BMD and the presence of osteoporosis in women. Our data provide evidence
that leukocyte telomere length could be a marker of biological aging of bone.
Stem Cells. 2007 Mar 8; [Epub ahead of print]
Induction of senile osteoporosis in normal mice by intra-bone
marrow-bone marrow transplantation from osteoporosis-prone mice.
Ueda
Y,
Inaba
M,
Takada
K,
Fukui
J,
Sakaguchi
Y,
Tsuda
M,
Omae
M,
Kushida
T,
Iida
H,
Ikehara
S.
First Department of Pathology,
Kansai Medical University, Moriguchi City, Osaka, Japan; Department of
Orthopedic Surgery, Kansai Medical University, Moriguchi City, Osaka, Japan.
A substrain of the senescence
accelerated mouse, SAMP6, spontaneously develops osteoporosis early in life.
These mice show the clinical signs of osteoporosis, such as elevated levels of
urinary deoxypiridinoline (Dpd), decreased bone mineral density (BMD), and a
significant loss of trabecular and cortical bone thickness at 12 months of age.
Here, we describe the transfer of osteoporosis to a normal strain by the injection
of bone marrow cells (BMCs) from SAMP6 donors directly into the bone marrow
cavity (intra-bone marrow bone marrow transplantation: IBM-BMT). More than one
month after IBM-BMT, hematolymphoid cells were completely reconstituted by
donor-derived cells, and bone marrow stromal cells that could differentiate
into osteocytes were also found to be of donor origin. In addition, the
recipient C57BL/6 mouse showed the features of osteoporosis in the trabecular
bone. Decreases in BMD and increases in urinary DPD were also observed. When
the message levels of cytokines (IL-11, IL-6, RANKL, OPG, M-CSF and IGF-1) were
examined by RT-PCR and real time RT-PCR analysis, IL-6 and IL-11 were reduced
to a level similar to that in SAMP6 mice, while that of RANKL was increased.
These findings indicate that not only the hemopoietic system but also the bone
marrow microenvironment are reconstituted as a result of IBM-BMT, and suggest
that the development of senile osteoporosis might be attributable to "stem
cell disorders".
Am J Clin Nutr. 2007 Mar;85(3):895-909.
Flavonoid intake and cardiovascular disease mortality: a prospective
study in postmenopausal women.
Mink
PJ,
Scrafford
CG,
Barraj
LM,
Harnack
L,
Hong
CP,
Nettleton
JA,
Jacobs
DR Jr.
From Exponent, Inc,
BACKGROUND: Dietary flavonoids
may have beneficial cardiovascular effects in human populations, but epidemiologic
study results have not been conclusive. OBJECTIVE: We used flavonoid food
composition data from 3 recently available US Department of Agriculture
databases to improve estimates of dietary flavonoid intake and to evaluate the
association between flavonoid intake and cardiovascular disease (CVD)
mortality. DESIGN: Study participants were 34 489 postmenopausal women in the
Iowa Women's Health Study who were free of CVD and had complete food-frequency
questionnaire information at baseline. Intakes of total flavonoids and 7
subclasses were categorized into quintiles, and food sources were grouped into
frequency categories. Proportional hazards rate ratios (RR) were computed for
CVD, coronary heart disease (CHD), stroke, and total mortality after 16 y of
follow-up. RESULTS: After multivariate adjustment, significant inverse
associations were observed between anthocyanidins and CHD, CVD, and total
mortality [RR (95% CI) for any versus no intake: 0.88 (0.78, 0.99), 0.91 (0.83,
0.99), and 0.90 (0.86, 0.95)]; between flavanones and CHD [RR for highest
quintile versus lowest: 0.78 (0.65, 0.94)]; and between flavones and total
mortality [RR for highest quintile versus lowest: 0.88 (0.82, 0.96)]. No
association was found between flavonoid intake and stroke mortality. Individual
flavonoid-rich foods associated with significant mortality reduction included
bran (added to foods; associated with stroke and CVD); apples or pears or both
and red wine (associated with CHD and CVD); grapefruit (associated with CHD); strawberries
(associated with CVD); and chocolate (associated with CVD). CONCLUSION: Dietary
intakes of flavanones, anthocyanidins, and certain foods rich in flavonoids
were associated with reduced risk of death due to CHD, CVD, and all causes.
Am J Clin Nutr. 2007 Mar;85(3):735-41
Soy inclusion in the diet improves features of the metabolic syndrome: a
randomized crossover study in postmenopausal women.
Azadbakht
L,
Kimiagar
M,
Mehrabi
Y,
Esmaillzadeh
A,
Padyab
M,
Hu
FB,
Willett
WC.
Department of Human Nutrition,
BACKGROUND: Little evidence
exists regarding the effects of soy consumption on the metabolic syndrome in
humans. OBJECTIVE: We aimed to determine the effects of soy consumption on
components of the metabolic syndrome, plasma lipids, lipoproteins, insulin
resistance, and glycemic control in postmenopausal women with the metabolic
syndrome. DESIGN: This randomized crossover clinical trial was undertaken in 42
postmenopausal women with the metabolic syndrome. Participants were randomly
assigned to consume a control diet (Dietary Approaches to Stop Hypertension,
DASH), a soy-protein diet, or a soy-nut diet, each for 8 wk. Red meat in the
DASH period was replaced by soy-protein in the soy-protein period and by
soy-nut in the soy-nut period. RESULTS: The soy-nut regimen decreased the
homeostasis model of assessment-insulin resistance score significantly compared
with the soy-protein (difference in percentage change: -7.4 +/- 0.8; P <
0.01) or control (-12.9 +/- 0.9; P < 0.01) diets. Consumption of soy-nut
also reduced fasting plasma glucose more significantly than did the soy-protein
(-5.3 +/- 0.5%; P < 0.01) or control (-5.1 +/- 0.6%; P < 0.01) diet. The
soy-nut regimen decreased LDL cholesterol more than did the soy-protein period
(-5.0 +/- 0.6%; P < 0.01) and the control (-9.5 +/- 0.6%; P < 0.01) diet.
Soy-nut consumption significantly reduced serum C-peptide concentrations
compared with control diet (-8.0 +/- 2.1; P < 0.01), but consumption of
soy-protein did not. CONCLUSION: Short-term soy-nut consumption improved
glycemic control and lipid profiles in postmenopausal women with the metabolic
syndrome.
Orv Hetil. 2007 Feb 18;148(7):319-25
Vitamin D
forming effectiveness of ultraviolet radiation from sunlight in different
months in
Fodor Jozsef Orszagos
Kozegeszsegugyi Kozpont Orszagos Frederic Joliot-Curie Sugarbiologiai es
Sugaregeszsegugyi Kutato Intezete
Introduction: The vitamin D 3
formation in skin is the most important natural source of vitamin D demands of
humans. The key step of the phototransformation of provitamin D into previtamin
D from which the vitamin D 3 is formed by thermal conversion. According to
studies run at the latitudes of
Eur J Radiol. 2007 Mar 5; [Epub ahead of print]
Relationship between the arterial calcification detected in mammography
and coronary artery disease.
Topal U, Kaderli A, Topal NB, Ozdemir B, Yesilbursa D, Cordan J, Ediz B,
Aydinlar A.
Department of Radiology,
OBJECTIVE: Arterial
calcification is frequently encountered in mammography. The frequency of breast
arterial calcification (BAC) increases with increasing age. Studies have shown
that BAC is seen more frequently among the people who are under the risk of
coronary artery diseases (CAD) such as diabetes and hypertension. The objective
of this study is to investigate the relationship between the arterial
calcification detected in mammography and the CAD. MATERIAL AND METHODS:
Screening mammography was performed in 123 women above the age of 40 years who
had been examined with coronary angiography for the evaluation of CAD. The
presence of BAC, number of affected vessels, and the distribution of
calcification in the vessel wall were evaluated in the mammography. Subjects
were questioned in terms of the cardiovasculary risk factors. The severity of
CAD was evaluated according to the Gensini scoring. In addition, the number of
blood vessels with stenosis of more than 50% was used as the vascular score.
The correlation between Gensini and the vascular scores, and BAC was
statistically evaluated using Mann-Whitney U and Kruskal-Wallis tests. RESULTS:
Eighty (65%) of 123 patients had CAD. BAC was detected in the mammography of 49
(39.8%) subjects. The ages and duration of menopause of the cases with BAC were
significantly higher than those without BAC (p<0.001). There was an almost
significant correlation between the BAC and Gensini scores (p=0.059). There was
a significant increase in the frequency of BAC among subjects with more than
two vessels with stenosis (p=0.033). CONCLUSION: Frequency of BAC increases
with increasing age. BAC is also frequently seen in subjects having severe
coronary artery disease. Although increasing age may be a factor increasing the
frequency of BAC, BAC may also be an indicator of CAD. Therefore, the
mentioning of arterial calcification in mammography reports may be important in
warning the clinician in terms of CAD.
J Natl Cancer Inst. 2007 Mar 7;99(5):386-95
Longitudinal measurement of clinical mammographic breast density to
improve estimation of breast cancer risk.
Kerlikowske
K,
Ichikawa
L,
Miglioretti
DL,
Buist
DS,
Vacek
PM,
Smith-Bindman
R,
Yankaskas
B,
Carney
PA,
Ballard-Barbash
R;
National
Institutes of Health Breast Cancer Surveillance Consortium. Department of
Epidemiology and Biostatistics, Department of Veterans Affairs, University of
California, San Francisco, CA, USA. karla.kerlikowske@ucsf.edu
BACKGROUND: Whether a change
over time in clinically measured mammographic breast density influences breast
cancer risk is unknown. METHODS: From January 1993 to December 2003, data that
included American College of Radiology Breast Imaging Reporting and Data System
(BI-RADS) breast density categories (1-4 in order of increasing density) were
collected prospectively on 301,955 women aged 30 and older who were not using
postmenopausal hormone replacement therapy and underwent at least two screening
mammography examinations; 2639 of the women were diagnosed with breast cancer
within 1 year of the last examination. Women's first and last BI-RADS breast
density (average 3.2 years apart) and logistic regression were used to model
the odds of having invasive breast cancer or ductal carcinoma in situ diagnosed
within 12 months of the last examination by change in BI-RADS category. Rates
of breast cancer adjusted for age, mammography registry, and time between
screening examinations were estimated from this model. All statistical tests
were two-sided. RESULTS: The rate (breast cancers per 1000 women) of breast
cancer was higher if BI-RADS breast density category increased from 1 to 2
(5.6, 95% confidence interval [CI] = 4.7 to 6.9) or 1 to 3 (9.9, 95% CI = 6.4
to 15.5) compared to when it remained at BI-RADS density of 1 (3.0, 95% CI =
2.3 to 3.9; P<.001 for trend). Similar and statistically significant trends
between increased or decreased density and increased or decreased risk of
breast cancer, respectively, were observed for women whose breast density
category was initially 2 or 3 and changed categories. BI-RADS density of 4 on
the first examination was associated with a high rate of breast cancer (range
9.1-13.4) that remained high even if breast density decreased. CONCLUSION: An
increase in BI-RADS breast density category within 3 years may be associated
with an increase in breast cancer risk and a decrease in density category with
a decrease in risk compared to breast cancer risk in women in whom breast
density category remains unchanged. Two longitudinal measures of BI-RADS breast
density may better predict a woman's risk of breast cancer than a single
measure.
J Clin Endocrinol Metab. 2007 Mar 6; [Epub
ahead of print
Effects of testosterone treatment on endometrial proliferation in
postmenopausal women.
Zang
H,
Sahlin
L,
Masironi
B,
Eriksson
E,
Hirschberg
AL.
Department of Woman and Child
Health, Divisions of Obstetrics and Gynecology and of Reproductive
Endocrinology, and Department of Oncology-Pathology, Division of Pathology,
Karolinska Institutet, Stockholm, Sweden.
Context: Available data
concerning effects of testosterone on endometrium of postmenopausal women are
seriously limited. Objective: Our aim was to compare the influence of treatment
with testosterone and/or estrogen on endometrial proliferation in healthy
postmenopausal women. Design: An open, randomized clinical study with parallel
comparison of the groups. Setting: Women's health clinical research unit and a
research laboratory at a university hospital. Participants: Sixty-three women
who had experienced natural menopause. Interventions: After random assignment,
the participants were administered orally testosterone undecanoate (40 mg every
second day), estradiol valerate (2 mg daily) or both for three months. Main
Outcome Measures: Endometrial thickness was measured and endometrial
proliferation evaluated on the basis of histopathology and expression of Ki-67,
a proliferation marker. Results: Endometrial thickness was significantly
increased by treatment with estrogen alone or in combination with testosterone
but was unaltered by testosterone alone. Among the women receiving estrogen
alone, the proportion exhibiting histopathology indicative of proliferation
increased significantly to 50% (p <0.05), whereas there was a non-significant
increase to 28% with the combined treatment and testosterone alone had no
effect at all. Expression of Ki-67 was up-regulated significantly in both
glands and stroma (p< 0.05 respectively) in both estrogen treatment groups.
However, the expression was significantly higher in stroma by estrogen
treatment alone than after combined treatment (p<0.05). Conclusions: The
short-term treatment with testosterone of postmenopausal women does not
stimulate endometrial proliferation. In addition, testosterone appears to
counteract endometrial proliferation induced by estrogen to a certain extent.
Ann Intern Med. 2007 Mar
6;146(5):326-339.
Effect of Recombinant Human Parathyroid Hormone (1-84) on Vertebral
Fracture and Bone Mineral Density in Postmenopausal Women with Osteoporosis: A
Randomized Trial.
Greenspan
SL,
Bone
HG,
Ettinger
MP,
Hanley
DA,
Lindsay
R,
Zanchetta
JR,
Blosch
CM,
Mathisen
AL,
Morris
SA,
Marriott
TB.
University of Pittsburgh,
Pittsburgh, Pennsylvania; Michigan Bone and Mineral Clinic, Detroit, Michigan;
Radiant Research Center of South Florida and The Regional Osteoporosis Center,
Stuart, Florida; University of Calgary Health Sciences Center, Calgary,
Alberta, Canada; Helen Hayes Hospital, Regional Bone Center, West Haverstraw,
New York; Instituto de Investigaciones Metabolicas, Buenos Aires, Argentina;
and NPS Pharmaceuticals, Inc., Parsippany, New Jersey.
BACKGROUND: Recombinant human
parathyroid hormone (1-84) (PTH) increases bone mass and strength and improves
bone quality by stimulating new bone formation. OBJECTIVE: To determine the
safety of PTH and its effect on the incidence of vertebral fractures in
postmenopausal women with osteoporosis. DESIGN: 18-month, randomized,
double-blind, placebo-controlled, parallel-group study. SETTING: 168 centers in
9 countries. PATIENTS: 2532 postmenopausal women with low bone mineral density
at the hip or lumbar spine. Interventions: Women received 100 mug of
recombinant human PTH or placebo daily by subcutaneous injection. All received
calcium, 700 mg/d, and vitamin D(3), 400 U/d. MEASUREMENTS: New or worsened
vertebral fractures (primary outcome) and changes in bone mineral density and
safety (secondary outcomes). RESULTS: 67.2% of patients who received at least 1
dose of the study drug completed the study. Parathyroid hormone reduced the
risk for new or worsened vertebral fractures, but in sensitivity analyses, the
magnitude of the reduction was changed with assumptions about fracture
incidence in patients who did not complete the study (relative risk assuming no
fractures, 0.42 [95% CI, 0.24 to 0.72] [P = 0.001]; relative risk assuming
fracture incidence observed in all patients who completed the trial, 0.60 [CI,
0.36 to 1.00] [P = 0.05]; relative risk assuming fracture incidence observed in
the placebo group, 0.62 [CI, 0.37 to 1.04] [P = 0.07]). Compared with placebo,
mean bone mineral density increased at the spine by 6.9% (CI, 6.4% to 7.4%) and
at the hip by 2.1% (CI, 1.7% to 2.5%) but decreased at the forearm in the
PTH-treated group. Parathyroid hormone treatment increased the percentage of
participants with hypercalciuria, hypercalcemia, and nausea by 24% (CI, 20% to
27%), 23% (CI, 21% to 26%), and 14% (CI, 11% to 16%), respectively, compared
with placebo. Limitations: Baseline serum PTH and vitamin D levels were not
measured. Many patients discontinued the trial prematurely. CONCLUSIONS:
Parathyroid hormone (1-84) reduced the overall risk for new or worsened
vertebral fracture in postmenopausal women with osteoporosis. Hypercalciuria,
hypercalcemia, and nausea were more common in women who took the drug. Although
the magnitude of the reduction was sensitive to assumptions about fracture
incidence in patients who did not complete the study, the findings suggest that
PTH provides an alternative therapeutic option for fracture prevention.
Am J Physiol Endocrinol Metab. 2007 Mar 6; [Epub ahead of print
Plasma adiponectin concentration in healthy pre- and postmenopausal
women: relationship with body composition, bone mineral and metabolic
variables.
Centre of Behavioural and
Health Sciences,
The aim of the current
investigation was to determine the possible relationships of fasting
adiponectin level with body composition, bone mineral, insulin sensitivity,
leptin and cardiorespiratory fitness parameters in 153 women. Subjects were
classified as premenopausal (n=42; 40.8+/-5.7 yrs) if they had regular
menstrual periods, early postmenopausal (n=49; 56.7+/-3.6 yrs) if they had been
postmenopausal for more than one year but less than seven years (5.5+/-1.3
yrs), and postmenopausal (n=62; 72.2+/-4.5 yrs) if they had been postmenopausal
for more than seven years. All women studied had a body mass index (BMI) less
than 30 kg/m2. Adiponectin values were higher (p<0.05) in middle-aged
(12.0+/-5.1 microg/ml) and older (15.3+/-7.3 microg/ml) postmenopausal women
compared to middle-aged premenopausal women (8.4+/-3.2 microg/ml). Mean plasma
adiponectin concentration in total group of women (n=153) was 12.2+/-6.3
microg/ml, and was positively related (p<0.05) to age, indices of overall
obesity (BMI, body fat mass) and cardiorespiratory fitness (PWC) values. In
addition, a negative association (p<0.05) between adiponectin with central
obesity (waist-to-hip and waist-to-thigh ratio), fat free mass, bone mineral
(bone mineral content, total and lumbar spine bone mineral density), leptin and
insulin resistance (insulin, fasting insulin resistance index) values was
observed. However, multivariate regression analysis revealed that only age,
fasting insulin resistance index and leptin were independent predictors of
adiponectin concentration. In conclusion, circulating adiponectin
concentrations increase with age in normal weight middle-aged and older women.
It appears that adiponectin is independently related to age, leptin and insulin
resistance values in women across the age span and menstrual status. Key words:
adiponectin, leptin, age, menopausal status, insulin resistance.
Am J Epidemiol. 2007 Mar 3; [Epub
ahead of print]
Age and Menopausal Effects of Hormonal Birth Control and Hormone
Replacement Therapy in Relation to Breast Cancer Risk.
Shantakumar
S,
Terry
M,
Paykin
A,
Teitelbaum
SL,
Britton
J,
Moorman
P,
Kritchevsky
SB,
Neugut
AI,
Gammon
MD.
Department of Epidemiology,
University of North Carolina School of Public Health, Chapel Hill, NC.
It is unclear whether breast
cancer risk varies by age and menopausal status in relation to use of hormonal
birth control (HBC) and hormone replacement therapy (HRT), taken singly or
cumulatively. The authors utilized data from 1,478 cases and 1,493 controls
aged 20-98 years with known menopausal status, who had participated in a
population-based, case-control study conducted on
Semana del 27 de Febrero al 5 de Marzo 2007
Dr. Juan Enrique Blümel
Osteoporos Int. 2007 Feb 28; [Epub
ahead of print
Cost-effectiveness of alendronate in the treatment of postmenopausal
women in 9 European countries - an economic evaluation based on the fracture
intervention trial.
Strom O, Borgstrom F, Sen SS, Boonen S, Haentjens P, Johnell O, Kanis JA.
European
Health Economics, Vasagaatn 38 2 tr, SE-111 20,
Treatment
with alendronate (Fosamax(R)) has been shown to significantly reduce the risk
of fragility fractures. Cost-effectiveness of treatment was assessed in nine
European countries in a Markov model and was generally found to be cost
effective in women with a previous spine fracture. INTRODUCTION: Treatment with
alendronate (Fosamax(R)) reduces the risk of osteoporotic fractures at the
spine, hip and wrist in women with and without prevalent vertebral fracture.
Cost-effectiveness estimates in one country may not be applicable elsewhere due
to differences in fracture risks, costs and drug prices. The aim of this study
was to assess the cost-effectiveness of treating postmenopausal women with
alendronate in nine European countries, comprising
Breast
Cancer Res Treat. 2007 Feb 27; [Epub ahead of print
Unequal risks for breast cancer associated with different hormone
replacement therapies: results from the E3N cohort study.
Fournier A, Berrino F, Clavel-Chapelon F.
Institut
National de la Sante et de la Recherche Medicale ERI 20, Institut Gustave
Roussy, 94805, Villejuif, France,
Large
numbers of hormone replacement therapies (HRTs) are available for the treatment
of menopausal symptoms. It is still unclear whether some are more deleterious
than others regarding breast cancer risk. The goal of this study was to assess
and compare the association between different HRTs and breast cancer risk, using
data from the French E3N cohort study. Invasive breast cancer cases were
identified through biennial self-administered questionnaires completed from
1990 to 2002. During follow-up (mean duration 8.1 postmenopausal years), 2,354
cases of invasive breast cancer occurred among 80,377 postmenopausal women.
Compared with HRT never-use, use of estrogen alone was associated with a
significant 1.29-fold increased risk (95% confidence interval 1.02-1.65). The
association of estrogen-progestagen combinations with breast cancer risk varied
significantly according to the type of progestagen: the relative risk was 1.00
(0.83-1.22) for estrogen-progesterone, 1.16 (0.94-1.43) for
estrogen-dydrogesterone, and 1.69 (1.50-1.91) for estrogen combined with other
progestagens. This latter category involves progestins with different
physiologic activities (androgenic, nonandrogenic, antiandrogenic), but their
associations with breast cancer risk did not differ significantly from one
another. This study found no evidence of an association with risk according to
the route of estrogen administration (oral or transdermal/percutaneous). These
findings suggest that the choice of the progestagen component in combined HRT
is of importance regarding breast cancer risk; it could be preferable to use
progesterone or dydrogesterone.
NIH
Consens State Sci Statements. 2006 May
17-19;23(2):1-30
NIH State-of-the-Science Conference Statement on Multivitamin/Mineral
Supplements and Chronic Disease Prevention.
[No
authors listed]
OBJECTIVE:
To provide health care providers, patients, and the general public with a
responsible assessment of currently available data on Multivitamin/Mineral
Supplements and Chronic Disease Prevention. PARTICIPANTS: A non-DHHS,
non-advocate 13-member panel included experts in the fields of food science and
human nutrition, biostatistics, biochemistry, toxicology, geriatric medicine,
family medicine, pediatrics and pediatric endocrinology, cancer prevention,
epidemiology, disease prevention and health promotion, and consumer protection.
In addition, 19 experts from pertinent fields presented data to the panel and
conference audience. EVIDENCE: Presentations by experts and a systematic review
of the literature prepared by The Johns Hopkins University Evidence-based
Pediatrics. 2007
Mar;119 Suppl 2:S131-6
Childhood bone mass acquisition and peak bone mass may not be important
determinants of bone mass in late adulthood.
National
Institutes of Health, CRC 1-3330, 10 Center Dr, MSC 1103, Bethesda, MD
20892-1103.
During
childhood and adolescence, bone mass acquisition occurs primarily through
skeletal growth. It is widely assumed that bone mass acquisition throughout
childhood is an important determinant of the risk of osteoporosis in late
adulthood; bone mass is thought to resemble a bank account in which deposits
persist indefinitely. However, several well-controlled clinical studies suggest
that increasing bone mass acquisition during childhood will have only transient
effects. A likely explanation is that bone mass is governed by a homeostatic
system that tends to return to a set point after any perturbation and,
therefore, bone mass depends primarily on recent conditions, not those in the
distant past. Indeed, in an animal model, we have shown evidence that bone mass
acquisition in early life has no effect on bone mass in adulthood, in part
because many areas of the juvenile skeleton are replaced in toto through
skeletal growth. Therefore, it should not be assumed that alterations in
childhood bone mass acquisition will affect bone mass many decades later in
late adulthood. This issue remains open and the solution may depend on the type
of childhood condition (for example calcium intake versus exercise) and its
magnitude, timing, and duration. To date, both animal studies and clinical
studies suggest that much of the effect of early bone mass acquisition does not
persist.
Endocrinology. 2007 Mar
1; [Epub ahead of print]
Altered ovarian function affects skeletal homeostasis independent of the
action of follicle-stimulating hormone (FSH).
Gao J, Tiwari-Pandey R, Samadfam R, Yang Y, Miao D, Karaplis AC, Sairam MR, Goltzman D.
Department
of Medicine,
Osteoporosis
is a leading public health problem. Although a major cause in women is thought
to be a decline in estrogen, it has recently been proposed that
follicle-stimulating hormone (FSH) or follitropin is required for osteoporotic
bone loss. We examined the FSH receptor null mouse (FORKO mouse), to determine
if altered ovarian function could induce bone loss independent of FSH action.
By 3 months of age, FORKO mice developed age dependent declines in bone mineral
density and trabecular bone volume of the lumbar spine and femur, which could
be partly reversed by ovarian transplantation. Bilateral ovariectomy reduced
elevated circulating testosterone levels in FORKO mice, and decreased bone mass
to levels indistinguishable from those in ovariectomized wild-type controls.
Androgen receptor blockade and especially aromatase inhibition each produced
bone volume reductions in the FORKO mouse. The results indicate that ovarian
secretory products, notably estrogen, and peripheral conversion of ovarian
androgen to estrogen can alter bone homeostasis independent of any bone
resorptive action of FSH.
J Affect
Disord. 2007 Feb 27; [Epub ahead of print
Depressive symptoms during the menopausal transition: The Study of
Women's Health Across the Nation (SWAN).
Bromberger JT, Matthews KA, Schott LL, Brockwell S, Avis NE, Kravitz HM, Everson-Rose SA, Gold EB, Sowers M,
Department
of Epidemiology, Graduate School of Public Health, University of Pittsburgh,
Pittsburgh, PA, United States.
BACKGROUND:
The influence of menopausal status on depressive symptoms is unclear in diverse
ethnic groups. This study examined the longitudinal relationship between
changes in menopausal status and the risk of clinically relevant depressive
symptoms and whether the relationship differed according to initial depressive
symptom level. METHODS: 3302 African American, Chinese, Hispanic, Japanese, and
White women, aged 42-52 years at entry into the Study of Women's Health Across
the Nation (SWAN), a community-based, multisite longitudinal observational
study, were evaluated annually from 1995 through 2002. Random effects multiple
logistic regression analyses were used to determine the relationship between
menopausal status and prevalence of low and high depressive symptom scores
(CES-D <16 or >/=16) over 5 years. RESULTS: At baseline, 23% of the
sample had elevated CES-D scores. A woman was more likely to report CES-D
>/=16 when she was early peri-, late peri-, postmenopausal or
currently/formerly using hormone therapy (HT), relative to when she was
premenopausal (OR range 1.30 to 1.71). Effects were somewhat stronger for women
with low CES-D scores at baseline. Health and psychosocial factors increased
the odds of having a high CES-D and in some cases, were more important than
menopausal status. LIMITATIONS: We used a measure of current depressive
symptoms rather than a diagnosis of clinical depression. Thus, we can only make
conclusions about symptoms current at annual assessments. CONCLUSION: Most
midlife women do not experience high depressive symptoms. Those that do are
more likely to experience high depressive symptom levels when perimenopausal or
postmenopausal than when premenopausal, independent of factors such as
difficulty paying for basics, negative attitudes, poor perceived health, and
stressful events.
Obstet
Gynecol. 2007 Mar;109(3):588-596
Low Dose of
Transdermal Estradiol Gel for Treatment of Symptomatic Postmenopausal Women: A
Randomized Controlled Trial.
Simon JA, Bouchard C, Waldbaum A, Utian W, Zborowski J, Snabes MC.
OBJECTIVE:
To investigate safety and efficacy and identify the lowest effective dose of a
new transdermal estradiol (E2) gel for relief of menopausal symptoms in a
population of postmenopausal women. METHODS: This study was a randomized,
double-blind, placebo-controlled, multicenter, parallel-group study.
Postmenopausal women with at least 60 hot flushes per week applied 0.87 g/d
(n=136), 1.7 g/d (n=142), or 2.6 g/d (n=69) E2 gel or placebo gel (n=137)
topically for 12 weeks. The changes from baseline in hot flush frequency and
severity at 4 and 12 weeks and changes from baseline in vaginal atrophy
symptoms at 12 weeks were examined. RESULTS: With increasing E2 doses, mean
trough serum E2 increased from 17 to 29 pg/mL. By weeks 3-5, E2 gel reduced
moderate-to-severe hot flush rate by at least seven hot flushes per day
(P<.001) and reduced the severity score (P<.01). The numbers needed to
treat for benefit for an 80% and 100% decrease in hot flush number were 3.2 and
6.3 for the 0.87-g/d group and 1.3 and 2.3 for the 2.6-g/d group. At week 12,
vaginal pH was more acidic and vaginal maturation index more mature compared
with placebo (P<.001). The lowest dose improved most bothersome vulvovaginal
atrophy symptoms (P<.05). Estradiol gel was well tolerated at the site of
application and produced no unexpected adverse effects. The 0.87 g/d dose
produced fewest adverse events. CONCLUSION: The 0.87 g/d dose of this new transdermal
E2 gel, which delivers an estimated 0.0125 mg E2 daily, delivered the lowest
effective dose for treatment of vasomotor symptoms and vulvovaginal atrophy in
a population of postmenopausal women.
Obstet
Gynecol. 2007 Mar;109(3):581-587.
Unopposed Estradiol Therapy in Postmenopausal Women: Results From Two
Randomized Trials.
Steiner AZ, Xiang M, Mack WJ, Shoupe D, Felix JC, Lobo RA, Hodis HN.
Departments
of Obstetrics and Gynecology,
OBJECTIVE:
To estimate the rates of endometrial hyperplasia, bleeding episodes, and
interventions among menopausal women receiving unopposed oral estradiol or
placebo therapy with ultrasound monitoring over 3 years. METHODS: Two-hundred
eighteen healthy women with intact uteri enrolled in the Estrogen in the
Prevention of Atherosclerosis Trial (EPAT) or the Women's Estrogen-Progestin
Lipid-Lowering Hormone Atherosclerosis Regression Trial (WELL-HART) were
randomly assigned to either 1 mg of micronized 17beta-estradiol (n=96) or
placebo (n=122) daily for up to 3 years in a double-blind fashion. Patients
were followed with annual measurement of endometrial thickness using
transvaginal ultrasonography. Logistic regression was used to identify
predictors of uterine bleeding and endometrial biopsy. RESULTS: Over the study
periods, nine women (9.4% of patients, 95% confidence interval [CI] 3.6-15.2%)
in the estradiol group developed hyperplasia. Eight of the nine cases (88.9%)
of hyperplasia were simple without atypia. Women receiving estradiol were more
likely than those receiving placebo to have at least one episode of uterine
bleeding (67% versus 11% at 3 years, respectively, P<.001). Women in the
estradiol group were also more likely to have an endometrial biopsy (48% versus
4% at 3 years, P<.001). Among women on estradiol, obesity (body mass index
[BMI] greater than 30 kg/m(2)) significantly increased the odds of uterine
bleeding compared with normal-weight patients (BMI 25 or less) (OR 3.7, 95% CI
1.2-11.8). CONCLUSION: Short-term, unopposed estradiol therapy with gynecologic
monitoring may be an option for the treatment of menopausal symptoms.
Menopausal women choosing estradiol therapy, especially if obese, should anticipate
uterine bleeding and the possibility of an endometrial biopsy.
Maturitas. 2007 Feb
26; [Epub ahead of print]
Assessing menopausal symptoms among healthy middle aged women with the
Menopause Rating Scale.
Chedraui P, Aguirre W, Hidalgo L, Fayad L.
Universidad Catolica de Santiago de
Guayaquil, Guayaquil, Ecuador.
BACKGROUND:
The frequency and intensity of menopausal symptoms within a given population,
as assessed by several tools, vary and depend on several factors among them
age, menopausal status, chronic conditions and socio-demographic profile.
OBJECTIVE: Determine the frequency and intensity of menopausal symptoms as well
as associated risk factors among healthy middle aged Ecuadorian women. DESIGN:
In this cross-sectional study healthy women aged 40 or more, with intact uterus
and ovaries, working at the
Mol
Endocrinol. 2007 Feb 27; [Epub ahead of print]
Thyroid hormone excess rather than TSH deficiency induces osteoporosis
in hyperthyroidism.
Bassett JH, O'shea PJ, Sriskantharajah S, Rabier B, Boyde A, Howell PG, Weiss RE, Roux JP, Malaval L, et als.
Molecular
Endocrinology Group, Division of Medicine & MRC Clinical Sciences Centre,
Thyrotoxicosis
is an important but under-recognized cause of osteoporosis. Recently, thyroid
stimulating hormone (TSH) deficiency, rather than thyroid hormone excess, has
been suggested as the underlying cause. To investigate the molecular mechanism
of osteoporosis in thyroid disease, we characterized the skeleton in mice
lacking either thyroid hormone receptor alpha or beta (TRalpha(0/0),
TRbeta(-/-)). Remarkably, in the presence of normal circulating thyroid hormone
and TSH concentrations, adult TRalpha(0/0) mice had osteosclerosis accompanied
by reduced osteoclastic bone resorption, whereas juveniles had delayed
endochondral ossification with reduced bone mineral deposition. By contrast,
adult TRbeta(-/-) mice with elevated TSH and thyroid hormone levels were
osteoporotic with evidence of increased bone resorption, whereas juveniles had
advanced ossification with increased bone mineral deposition. Analysis of T3
target gene expression revealed skeletal hypothyroidism in TRalpha(0/0) mice,
but skeletal thyrotoxicosis in TRbeta(-/-) mice. These studies demonstrate that
bone loss in thyrotoxicosis is independent of circulating TSH levels and
mediated predominantly by TRalpha, thus identifying TRalpha as a novel drug
target in the prevention and treatment of osteoporosis.
Diabetes
Care. 2007 Mar;30(3):701-706.
The Effect of Menopause on the Metabolic Syndrome Among Korean Women: The
Korean National Health and Nutrition Examination Survey, 2001.
Kim HM, Park J, Ryu SY, Kim J.
Department
of Preventive Medicine,
OBJECTIVE:
This study examined the effect of menopausal status on the risk of the
metabolic syndrome in Korean women. RESEARCH DESIGN AND METHODS: Data were
obtained from the Korean National Health and Nutrition Examination Survey of
2001. A total of 2,671 women who did not receive hormone replacement therapy
(1,893 premenopausal women and 778 postmenopausal women) were included in the
analysis. The metabolic syndrome was defined according to the National
Cholesterol Education Program Adult Treatment Panel III. RESULTS: Postmenopausal
women had significantly higher mean waist circumference, systolic blood
pressure, pulse pressure, total cholesterol, LDL cholesterol, and triglyceride
levels than premenopausal women after adjusting for age (P = 0.018, P = 0.001,
P < 0.0001, P < 0.0001, P < 0.0001, and P = 0.006, respectively).
Among postmenopausal women, the age-adjusted odds ratio was 1.61 (95% CI
1.15-2.25) for abdominal obesity, 1.11 (0.76-1.61) for elevated blood pressure,
1.24 (0.90-1.72) for low HDL cholesterol, 1.28 (0.89-1.83) for high
triglycerides, and 1.07 (0.69-1.65) for high fasting glucose compared with
premenopausal women. The multivariate-adjusted odds ratio for the metabolic
syndrome was 1.60 (95% CI 1.04-2.46) among postmenopausal women compared with
premenopausal women. CONCLUSIONS: Postmenopausal status is associated with an
increased risk of the metabolic syndrome independent of normal aging in Korean
women.
Hormones
(Athens). 2007 Jan-Mar;6(1):62-70
Subclinical hyperthyroidism of variable etiology and its influence on
bone in postmenopausal women.
Belaya ZE, Melnichenko GA, Rozhinskaya LY, Fadeev VV, Alekseeva TM, Dorofeeva OK, Sasonova NI, et als.
Objetive.
To evaluate the effects of subclinical hyperthyroidism of variable etiology on
bone mineral density (BMD) and bone metabolism in postmenopausal women. Design:
T he study included data of 88 postmenopausal women classified into four groups
depending on the etiology of subclinical hyperthyroidism: (1) 20 with toxic
multinodular goiter without history of clinical hyperthyroidism; (2) 25 on
levothyroxine suppressive therapy after thyroidectomy due to differentiated
thyroid cancer; (3) 21 with Graves' disease (GD) receiving antithyroid drugs;
(4) 22 healthy women matched for age and duration of menopause. In all subjects
biochemical markers of bone turnover and B MD were determined. Results: B iochemical
markers of bone turnover were significantly higher (p-value =0.001) in all
patients with subclinical hyperthyroidism compared to the control group (group
4). T he women of group 1 had significantly lower B MD at all regions of the
skeleton, whereas the women of group 3 had significantly lower B MD at T otal
Hip (p-value = 0.013) and R adius T otal (p-value = 0.0003) compared to group
4. No significant differences in B MD between groups 2 and 4 were detected.
Conclusion: The etiology of subclinical hyperthyroidism influences B MD in
postmenopausal women. Endogenous subclinical hyperthyroidism might be
considered as an additional risk factor for osteoporosis in postmenopausal
women, especially for cortical bone, whereas exogenous subclinical hyperthyroidism
has no effect on BMD.