Selección de Resúmenes de
Menopausia
Semana del 21 al 27 de Mayo 2008
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de Chile
Oncol Rep. 2008
Jun;19(6):1627-34.
Progestins
regulate genes that can elicit both proliferative and antiproliferative effects
in breast cancer cells.
Purmonen S, Manninen T, Pennanen P, Ylikomi T.
Sex steroid hormone progesterone is known to have
profound effects on the growth and differentiation of the normal mammary gland
and malignant breast epithelial cells. In vitro progesterone and synthetic
progesterone-like compounds (progestins) inhibit breast cancer cell growth.
Medroxyprogesterone acetate (MPA) is a synthetic hormone widely used in the
adjuvant treatment of advanced breast cancer, hormone replacement therapy and in
oral contraceptives. It is a paradoxical hormone, since it inhibits breast
cancer cell proliferation, but has also been implicated in increased breast
cancer risk. To better understand the molecular mechanism by which cell
proliferation and differentiation are regulated by progesterone and MPA in
human breast cancer, we utilized cDNA microarray and quantitative real-time
RT-PCR methods to identify their target genes. This study describes novel
progestin/progesterone target genes in breast cancer cells and, notably, novel
target genes that elucidate the underlying molecular mechanism of the dual role
progestins play in the breast. A cDNA microarray containing 3000 genes showed
notable regulation in 30 and 27 genes by MPA and progesterone, respectively. Only
6 out of the 30 genes regulated by MPA are down-regulated, but no progesterone
down-regulation was observed. Overlapping in gene regulation by progesterone
and MPA occurred, but the majority of genes regulated by these hormones were
distinct. Given that progestins both stimulate and inhibit cancer cell growth,
we report our findings on novel progestin and progesterone targets, which could
explain the paradoxical actions of progestins in the breast.
Adv Exp Med Biol. 2008;617:151-60.
Women's
health initiative studies of postmenopausal breast cancer.
Public Health Sciences,
The WHI has provided randomized controlled trial data on
interventions that are among the most important in relation to the health
benefits and risks among postmenopausal women in the
Calcif Tissue Int. 2008 May 22. [Epub
ahead of print]
Echogenic
Carotid Artery Plaques are Associated with Vertebral Fractures in
Postmenopausal Women with Low
Kim SH, Kim YM, Cho MA, Rhee Y, Hur KY, Kang ES, Cha BS, Lee EJ, Lee HC, Lim SK.
Division of Endocrinology, Department of Internal
Medicine, Kwandong University College of Medicine, Myongji Hospital, Goyang,
South Korea, bonesh@naver.com.
Although low bone mass has been associated with
atherosclerosis even after adjustment for age, little is known about the
association between vertebral fractures and calcified atherosclerotic plaques.
Our objective was to investigate whether osteoporotic vertebral fractures are
independently related to the prevalence of atherosclerotic carotid plaques in
postmenopausal women with low bone mass. We enrolled 195 postmenopausal women
with osteopenia or osteoporosis. Bone mineral density and the presence of
vertebral fractures were assessed. Intima media thickness and atherosclerotic
plaques of the carotid artery were assessed using ultrasonography. Of the 195
subjects in the study, 84 had no plaques and 111 had at least one. The
percentage of women with vertebral fractures was significantly higher in
subjects with echogenic carotid plaques than in those without (27% vs. 11%,
respectively; P < 0.05). However, there was no difference in the prevalence
of vertebral fractures between women with echolucent plaques and those without
(10.9% vs. 10.7%, respectively; P = nonsignificant). By logistic regression
analysis with multivariate adjustment, age (P < 0.01), dyslipidemia (P <
0.05), and the presence of vertebral fracture (P < 0.05) were independent
risk factors for echogenic carotid plaques. Osteoporotic vertebral fractures
are associated with an increased risk of echogenic atherosclerotic plaques in
postmenopausal women with low bone mass. It appears that the high association
of echogenic atherosclerotic plaques and vertebral fractures could partially
explain why osteoporotic vertebral fractures are linked to increased mortality.
Kidney Int. 2008 May 21. [Epub
ahead of print]
Oral
estrogen therapy in postmenopausal women is associated with loss of kidney
function.
Ahmed SB, Culleton BF, Tonelli M, Klarenbach SW, Macrae JM, Zhang J, Hemmelgarn BR.
Department of Medicine,
Women are generally protected against progressive loss
of kidney function; however, this advantage seems to diminish with menopause.
Because of conflicting reports on the association between use of hormone
therapy and kidney function we studied 5845 women (1459 on hormone therapy and
4386 non-users) who were over 66 years of age and had at least 2 serum
creatinine measurements during the 2 year study period. After adjustment for
covariates, hormone use (estrogen-only, progestin-only, or both) was associated
with a significant loss of estimated GFR as the primary outcome along with an
increased risk of rapid loss of kidney function as the secondary outcome
compared to non-users. This increased rate of loss was associated with oral but
not transvaginal estrogen use. An increased cumulative dose of estrogen was
also associated with a greater decline in estimated GFR. Our study shows an
independent association in a dose-dependent manner of estrogen use and loss of
kidney function in this elderly population.
BMJ. 2008 May 20. [Epub ahead of print]
Hormone
replacement therapy and risk of venous thromboembolism in postmenopausal women:
systematic review and meta-analysis.
Canonico M, Plu-Bureau G, Lowe GD, Scarabin PY.
Inserm Unit 780, Cardiovascular Epidemiology Section,
OBJECTIVE: To assess the risk of venous
thromboembolism in women using hormone replacement therapy by study design, characteristics
of the therapy and venous thromboembolism, and clinical background. DESIGN:
Systematic review and meta-analysis. DATA SOURCES: Medline. Studies reviewed
Eight observational studies and nine randomised controlled trials. Inclusion
criteria Studies on hormone replacement therapy that reported venous
thromboembolism. Review measures Homogeneity between studies was analysed using
chi(2) and I(2) statistics. Overall risk of venous thromboembolism was assessed
from a fixed effects or random effects model. RESULTS: Meta-analysis of
observational studies showed that oral oestrogen but not transdermal oestrogen
increased the risk of venous thromboembolism. Compared with non-users of
oestrogen, the odds ratio of first time venous thromboembolism in current users
of oral oestrogen was 2.5 (95% confidence interval 1.9 to 3.4) and in current
users of transdermal oestrogen was 1.2 (0.9 to 1.7). Past users of oral
oestrogen had a similar risk of venous thromboembolism to never users. The risk
of venous thromboembolism in women using oral oestrogen was higher in the first
year of treatment (4.0, 2.9 to 5.7) compared with treatment for more than one
year (2.1, 1.3 to 3.8; P<0.05). No noticeable difference in the risk of
venous thromboembolism was observed between unopposed oral oestrogen (2.2, 1.6
to 3.0) and opposed oral oestrogen (2.6, 2.0 to 3.2). Results from nine
randomised controlled trials confirmed the increased risk of venous
thromboembolism among women using oral oestrogen (2.1, 1.4 to 3.1). The combination
of oral oestrogen and thrombogenic mutations or obesity further enhanced the
risk of venous thromboembolism, whereas transdermal oestrogen did not seem to
confer additional risk in women at high risk of venous thromboembolism.
CONCLUSION: Oral oestrogen increases the risk of venous thromboembolism,
especially during the first year of treatment. Transdermal oestrogen may be
safer with respect to thrombotic risk. More data are required to investigate
differences in risk across the wide variety of hormone regimens, especially the
different types of progestogens.
Maturitas. 2008 May 19. [Epub
ahead of print]
Effect of natural early menopause on bone
mineral density.
Francucci
CM, Romagni
P, Camilletti
A, Fiscaletti
P, Amoroso
L, Cenci
G, Morbidelli
C, Boscaro
M.
Division of Endocrinology, Department of Internal
Medicine, Polytechnic
OBJECTIVES: Early menopause (EM) is included among the
risk factors for osteoporosis. Several studies have shown that women with early
menopause have lower bone mineral density (BMD) than those with normal expected
age of menopause. The aim of our cross-sectional study was to investigate the
effects of time of menopause on vertebral bone mass in healthy postmenopausal
women and to evaluate if early menopause is a risk factor for lower vertebral
BMD. METHOD: We studied 782 who had never received drugs acting on bone mass.
The study population was divided into three groups: women with early, normal
(NM), and late (LM) menopause. Our study population was further categorized in
5-year age segments between 45 and >75. RESULTS: The three groups examined
did not differ for age, age at menarche, body mass index (BMI), and vertebral
BMD, while there were significant differences in age at menopause and years
since menopause. Our study showed that women with EM presented significantly
lower vertebral BMD than NM and LM in 50-54 age segments. Beyond 55 years, EM,
NM, and LM women had no differences in lumbar BMD values. CONCLUSIONS: In
conclusion, controversial data demonstrated that the absolute amount of bone
loss is greater after early menopause than after normal or late menopause, even
if a slight effect of early menopause on bone mass cannot be excluded.
Oncology. 2008 May
21;73(5-6):305-310. [Epub ahead of print]
Hormone
Replacement Therapy as a Risk Factor for Non-Small Cell Lung Cancer: Results of
a Case-Control Study.
Ramnath N, Menezes RJ, Loewen G, Dua P, Eid F, Alkhaddo J, Paganelli G, Natarajan N, Reid ME.
Department of Medicine, Roswell Park Cancer Institute,
Purpose: It was the aim of this study to assess the
risk of lung cancer in postmenopausal women who received hormone replacement
therapy (HRT). Experimental Design: This case-control study involves women who
received medical services at Roswell Park Cancer Institute (RPCI) in
Am J Cardiol. 2008 Jun
1;101(11):1599-1605. Epub 2008 Apr 2.
Usefulness
of baseline lipids and C-reactive protein in women receiving menopausal hormone
therapy as predictors of treatment-related coronary events.
Bray PF, Larson JC, Lacroix AZ, Manson J, Limacher MC, Rossouw JE, Lasser NL, Lawson WE, Stefanick ML, Langer RD, Margolis KL; Women's Health Initiative Investigators.
Cardeza Foundation for Hematologic Research and
Blood lipids and high-sensitivity C-reactive protein
(hs-CRP) are altered by hormone therapy. The goal of the present study was to
determine whether lipids and hs-CRP have predictive value for hormone therapy
benefit or risk for coronary heart disease events in postmenopausal women
without previous cardiovascular disease. A nested case-control study was
performed in the Women's Health Initiative hormone trials. Baseline lipids and
hs-CRP were obtained from 271 incident patients with coronary heart disease
(cases) and 707 controls. In a combined trial analysis, favorable lipid status
at baseline tended to predict better coronary heart disease outcomes when using
conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate
(MPA). Women with a low-density lipoprotein (LDL)/high-density lipoprotein
(HDL) cholesterol ratio <2.5 had no increase in risk of coronary heart
disease when using CEE with or without MPA (odds ratio 0.60, 95% confidence
interval 0.34 to 1.06), whereas women with an LDL/HDL cholesterol ratio
>/=2.5 had increased risk of coronary heart disease (odds ratio 1.73, 95%
confidence interval 1.18 to 2.53, p for interaction = 0.02). Low hs-CRP added
marginally to the value of LDL/HDL ratio <2.5 when predicting coronary heart
disease benefit on hormone therapy. In conclusion, postmenopausal women with
undesirable lipid levels had excess coronary heart disease risk when using CEE
with or without MPA. However, women with favorable lipid levels, especially
LDL/HDL cholesterol ratio <2.5, did not have increased risk of coronary
heart disease with CEE with or without MPA irrespective of hs-CRP.
Maturitas. 2008 May 14. [Epub
ahead of print]
Insulin
resistance, obesity and breast cancer risk.
Pichard
C, Plu-Bureau
G, Neves-E
Castro M, Gompel
A.
Unité de Gynécologie endocrinienne,
Hôtel-Dieu, APHP, Université Paris-5, Paris, France.
Breast cancer (BC) is one of the most important
problems of public health. Among the avoidable risk factors during a woman's
life, overweight and obesity are very important ones. Furthermore they are
increasing worldwide. The risk of breast cancer is traditionally linked to
obesity in postmenopausal women; conversely, it is neutral or even protective
in premenopausal women. Since the initiator and promoter factors for BC act
over a long time, it seems unlikely that the menopausal transition may have too
big an impact on the role of obesity in the magnitude of the risk. We reviewed
the literature in an attempt to understand this paradox, with particular
attention to the body fat distribution and its impact on insulin resistance.
The association of insulin resistance and obesity with BC risk are biologically
plausible and consistent. Estradiol (E2) and IGFs act as mitogens in breast
cancer cells. They act together and reciprocally. However the clinical and
biological methods to assess the impact of insulin resistance are not always
accurate. Furthermore insulin resistance is far from being a constant feature
in obesity, particularly in premenopausal women; this complicates the analysis
and explains the discrepancies in large prospective trials. The most consistent
clinical feature to assess risk across epidemiological studies seems to be
weight gain during lifetime. Loss of weight is associated with a lower risk for
postmenopausal BC compared with weight maintenance. This observation should be
an encouragement for women since loss of weight may be an effective strategy
for breast cancer risk reduction.
Selección de Resúmenes de
Menopausia
Semana del 14 al 20 de Mayo 2008
Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile
Cancer Epidemiol
Biomarkers Prev. 2008 May;17(5):1088-95.
Nonsteroidal Anti-inflammatory Drugs and Change in Mammographic Density:
A Cohort Study Using Pharmacy Records on Over 29,000 Postmenopausal Women.
Terry MB, Buist DS, Trentham-Dietz
A, James-Todd
TM, Liao Y.
Department of Epidemiology,
Mailman
BACKGROUND: Use of
nonsteroidal anti-inflammatory drugs (NSAID) has been associated with a
decrease in breast cancer risk, but it is unknown if they also reduce mammographic
density, a strong intermediate marker of breast cancer risk. METHODS: We
investigated NSAID use and mammographic density in 29,284 postmenopausal women
who had two screening mammograms at Group Health in
Infect Disord Drug
Targets. 2008 Mar;8(1):65-7.
Neuroprotective effects of estrogens: cross-talk between estrogen and
intracellular insulin signalling.
Department of Functional
Biology. Physiology Area,
The incidence of
neurodegenerative diseases is higher in postmenopausal women that young women.
In this sense, Alzheimer's and Parkinson's diseases, ischemic brain injury and
memory or cognitive dysfunction increase dramatically when the ovarian function
declines. On the other hand, insulin resistance represents an independent
factor in the etiology of age-associated coronary and cerebrovascular disease.
Therefore, depression, neurodegenerative diseases such as Alzheimer's and
Parkinson's diseases and memory or cognitive dysfunction should be considered,
in some cases, a result of metabolic syndrome, and that postmenopausal women
are more vulnerable that young women to these diseases Several studies have
suggested that the molecular mechanism by which estradiol exerts its
neuroprotective effects involves activation of the PI3-k signalling pathway,
which is activated by insulin and IGF-1. Therefore, it seems possible that
ERalpha can interact with these signalling pathways, mainly with PI3-k and IRS-1,
to promote neuroprotective effects in the brain. In particular, IGF-I seems to
be particularly important in the process of neuroprotection; it can reverse
age-related effects and attenuate the age-related decrease in cerebral glucose
utilization. Moreover, gonadal hormones have been found to regulate IGF-I
receptor. Therefore, it seems clear that the interaction of both systems plays
a role in the prevention of neuronal age-related effects. These findings
suggest that by interacting with some components of the IGF-I signalling
pathway, ERalpha affects the actions of IGF-I in the brain and suggest future
avenues of research. The relationship between insulin resistance states
associated with aging in females, and the cross-talk between estradiol and
proteins includes in the IRS-1/PI3-k/Akt and IGF-1-IR signalling pathways, will
lead to a more complete understanding of the precise mechanism underlying
estradiol-mediated neuroprotection. Numerous clinical studies have demonstrated
that the incidence of neurodegenerative diseases in higher in postmenopausal
women that young women. In this sense, Alzheimer's and Parkinson's disease,
ischemic brain injury and memory or cognitive dysfunction increase dramatically
when the ovarian function declines. Moreover, estrogen replacement therapy
seems to be a good element in order to decrease the risk and/or severity of
neurodegenerative conditions, and it would be able to improve some aspects
related to memory and learning process.
Am J Clin Nutr. 2008
May;87(5):1384-91.
Carbohydrate intake, glycemic index, glycemic load, and risk of
postmenopausal breast cancer in a prospective study of French women.
Lajous M, Boutron-Ruault
MC, Fabre A, Clavel-Chapelon
F, Romieu I.
INSERM, ERI 20, EA 4045, and
Institut Gustave Roussy,
BACKGROUND: Diets high in
carbohydrates may result in chronically elevated insulin concentrations and may
affect breast cancer risk by stimulation of insulin receptors or through
insulin-like growth factor I (IGF-I)-mediated mitogenesis. Insulin response to
carbohydrate intake is increased in insulin-resistant states such as obesity.
OBJECTIVE: We sought to evaluate carbohydrate intake, glycemic index (GI), and
glycemic load (GL) and subsequent overall and hormone-receptor-defined breast
cancer risk among postmenopausal women. DESIGN: A prospective cohort analysis
of dietary carbohydrate and fiber intakes was conducted among 62 739
postmenopausal women from the E3N French study who had completed a validated
dietary history questionnaire in 1993. During a 9-y period, 1812 cases of
pathology-confirmed breast cancer were documented through follow-up
questionnaires. Nutrients were categorized into quartiles and energy-adjusted
with the regression-residual method. Cox model-derived relative risks (RRs)
were adjusted for known determinants in breast cancer. RESULTS: Dietary
carbohydrate and fiber intakes were not associated with overall breast cancer
risk. Among overweight women, we observed an association between GI and breast
cancer (RR(Q1-Q4): 1.35; 95% CI: 1.00, 1.82; P for trend = 0.04). For women in
the highest category of waist circumference, the RR(Q1-Q4) was 1.28 (95% CI:
0.98, 1.67; P for trend = 0.10) for carbohydrates, 1.35 (95% CI: 1.04, 1.75; P
for trend = 0.01) for GI, and 1.37 (95% CI: 1.05, 1.77; P for trend = 0.003)
for GL. We also observed a direct association between carbohydrate intake, GL,
and estrogen receptor-negative breast cancer risk. CONCLUSIONS: Rapidly
absorbed carbohydrates are associated with postmenopausal breast cancer risk
among overweight women and women with large waist circumference. Carbohydrate
intake may also be associated with estrogen receptor-negative breast cancer.
Am J Clin Nutr. 2008
May;87(5):1567S-1570S.
Amount and type of protein influences bone health.
Many factors influence bone
mass. Protein has been identified as being both detrimental and beneficial to
bone health, depending on a variety of factors, including the level of protein
in the diet, the protein source, calcium intake, weight loss, and the acid/base
balance of the diet. This review aims to briefly describe these factors and
their relation to bone health. Loss of bone mass (osteopenia) and loss of
muscle mass (sarcopenia) that occur with age are closely related. Factors that
affect muscle anabolism, including protein intake, also affect bone mass.
Changes in bone mass, muscle mass, and strength track together over the life
span. Bone health is a multifactorial musculoskeletal issue. Calcium and
protein intake interact constructively to affect bone health. Intakes of both
calcium and protein must be adequate to fully realize the benefit of each
nutrient on bone. Optimal protein intake for bone health is likely higher than
current recommended intakes, particularly in the elderly. Concerns about
dietary protein increasing urinary calcium appear to be offset by increases in
absorption. Likewise, concerns about the impact of protein on acid production
appear to be minor compared with the alkalinizing effects of fruits and
vegetables. Perhaps more concern should be focused on increasing fruit and
vegetable intake rather than reducing protein sources. The issue for public
health professionals is whether recommended protein intakes should be increased,
given the prevalence of osteoporosis and sarcopenia.
Am J Clin Nutr. 2008
May;87(5):1400-4.
Multivitamin-multimineral supplement use and mammographic breast
density.
Bérubé
S, Diorio C, Brisson J.
Unité de Recherche en Santé des
Populations, Centre Hospitalier Affilié Universitaire de Québec,
Québec, Canada.
BACKGROUND: The effect of
multivitamin-multimineral supplements on the occurrence of chronic diseases,
such as breast cancer, is unclear. Breast density is increasingly used as a
biomarker of breast cancer risk. OBJECTIVE: The present study evaluated the
association of multivitamin-multimineral supplement use with breast density.
DESIGN: Premenopausal (n = 777) and postmenopausal (n = 783) women were
recruited at the time of screening mammography. Anthropometric measurements
were taken at recruitment. Demographic characteristics, behavioral factors, and
health conditions were documented by telephone interview. Diet and
multivitamin-multimineral and individual vitamin and mineral supplement use
were assessed with a self-administered food-frequency questionnaire. Breast
density from screening mammograms was measured using a computer-assisted
method. Crude and adjusted means in breast density were evaluated according to
multivitamin-multimineral supplement use using generalized linear models.
RESULTS: Current multivitamin-multimineral supplement use was reported by 21.7%
of women (20.7% and 22.6% of premenopausal and postmenopausal women,
respectively). Premenopausal women who were currently using
multivitamin-multimineral supplements had higher adjusted mean breast density
(45.5%) than past (42.9%) or never (40.2%) users (P for heterogeneity = 0.03, P
for trend = 0.009). Of the current users, breast density was not related to
duration of multivitamin-multimineral supplement use. In postmenopausal women,
multivitamin-multimineral supplement use was not associated with breast density
(P for heterogeneity = 0.53, P for trend = 0.40). CONCLUSION: Regular use of
multivitamin-multimineral supplements may be associated with higher mean breast
density among premenopausal women. The relations of multivitamin-multimineral
supplement use to breast density and breast cancer risk need to be clarified.
BioDrugs. 2008;22(3):137-44.
Calcitonin - A Drug of the Past or for the Future? : Physiologic
Inhibition of Bone Resorption while Sustaining Osteoclast Numbers Improves Bone
Quality.
Karsdal MA, Henriksen
K, Arnold M, Christiansen
C.
Pharmacology Department,
Nordic Bioscience A/S,
Postmenopausal osteoporosis
results from a continuous imbalance between bone resorption and bone formation,
favoring bone resorption. An increasing number of treatments for osteoporosis
are in development and on the market. A range of differences and similarities
are found between these treatment options, and these need to be carefully
evaluated before the initiation of treatment. This article summarizes data from
in vitro and animal studies, as well as clinical trials, on the effect of
calcitonin on bone turnover.Calcitonin was found to exert its antiresorptive
effects via directly reducing osteoclastic resorption, and thus leads to an
increase in bone mineral density and bone strength. Furthermore, calcitonin
appears to mainly target the most active osteoclasts, and in contrast to most
other antiresorptive agents it does not reduce the number of osteoclasts.
Finally, in humans, while attenuating resorption, calcitonin treatment does not
interfere markedly with bone formation, in contrast to other currently
available antiresorptive agents. Thus, we speculate that calcitonin treatment
will lead to a continuously positive bone balance in contrast with other
antiresorptive agents currently on the market and thereby, in a physiologic
manner, result in improved bone quality.Calcitonin is currently only available
in injectable and nasal formulations. An oral formulation may, however, improve
patient acceptance and compliance. Currently, several different routes are
being pursued to identify an optimal oral formulation, of which the technology
based on 5-CNAC is the most advanced. There are promising clinical data
available for this formulation from both osteoarthritis and osteoporosis
clinical trials, although the antifracture efficacy is not yet known.
Menopause. 2008 May 13. [Epub
ahead of print]
Aromatase inhibitors and mammographic breast density in postmenopausal
women receiving hormone therapy.
Mousa NA, Crystal P, Wolfman WL, Bedaiwy MA, Casper RF.
OBJECTIVE:: One of the main
concerns regarding long-term use of hormone therapy (HT) in symptomatic
menopausal women is the perceived increased risk of breast cancer. A method to
reduce breast cancer risk in this population of women is urgently needed. We
hypothesized that adding aromatase inhibitors (AIs) to HT would reduce local
breast estrogen exposure and breast cancer risk without altering the beneficial
systemic effects of HT on menopausal symptoms or bone density. The aim of this
study was to investigate the effect of AIs and HT on mammographic breast
density (MBD) as a surrogate marker of breast cancer risk in postmenopausal
women receiving low-dose HT. DESIGN:: This was a retrospective cohort study
conducted at private clinics affiliated with a university hospital. One group
of postmenopausal women (n = 28) received low-dose HT daily plus letrozole 2.5
mg three times weekly. Postmenopausal women receiving HT alone (n = 28) served
as controls. MBD, the primary outcome, was measured using quantitative image
analysis software as well as by visual analysis by a radiologist.
Hypoestrogenic effects, adverse reactions, and bone mineral densities were
secondary outcome measures. RESULTS:: The mammograms of 18 women in the study
group and 22 women in the control group were suitable for comparison. A
statistically significant reduction in MBD occurred in the women who received
HT plus an AI, whereas no significant change was observed in the women
receiving HT alone. There was no significant increase in hypoestrogenic
symptoms during the use of AIs, and bone mineral densities were not
significantly reduced. CONCLUSIONS:: Adding an AI to HT may lower MBD in
postmenopausal women. AIs could be good candidates for primary chemoprevention
of breast cancer in postmenopausal women using HT.
Ann Fr Anesth Reanim. 2008 May 7. [Epub
ahead of print]
Oral contraception and hormone replacement therapy: Management of their
thromboembolic risk in the perioperative period
Chalhoub V, Edelman P, Staiti G, Benhamou D.
Département
d’anesthésie-réanimation, hôpital de Bicêtre,
78, Le Kremlin-Bicêtre cedex, France.
OBJECTIVES: Many women scheduled
for surgery are using either oral contraception (OC) or hormone replacement
therapy (HRT). These two treatments are associated with a significant albeit
moderately increased risk of venous thromboembolic events which might increase
the risk associated with surgery. DATA SOURCE: Record of French and English
references from Medline((R)) database. DATA EXTRACTION: Data were selected
including prospective and retrospective studies, reviews, and case reports.
DATA SYNTHESIS: Thromboembolism induced by these two pharmacologic classes is
similar and close to that produced by pregnancy. The increased risk is usually
small, especially after the first year of administration of either class of
drug, for progestogen-only contraception drugs and for transdermal HRT. The
increased risk should be compared with the occurrence of undesired pregnancy
after discontinuation of OC or the occurrence of climateric symptoms after
discontinuation of HRT. Maintaining OC during the perioperative period is
legitimate and strengthening prophylaxis is justified during the first year of
combined OC administration. Stressful climateric symptoms can lead to maintain
HRT and strengthening prophylaxis is justified during the first year of oral
HRT. Transdermal HRT may not need to be stopped and probably does not require
any additional antithrombotic measure. CONCLUSION: The increased thromboembolic
risk is to be compared with the risks of stopping either treatment. In most
cases, these two treatments can be maintained and antithrombotic prophylaxis is
moderately strengthened in particular cases.
J Clin Epidemiol. 2008 May 9. [Epub
ahead of print]
Self-reported data on reproductive variables were reliable among
postmenopausal women.
Department of Hygiene and
Epidemiology, University of
OBJECTIVE: We aimed to assess
the reliability of self-reported reproductive variables in postmenopausal
women. STUDY DESIGN AND SETTING: We evaluated 535 women in two interviews, as
part of the recruitment and first follow-up of a cohort of Portuguese adults.
Median time between evaluations was 5 years. Women were inquired about
sociodemographic characteristics, cognitive status, and reproductive history:
gravidity, parity, lifetime use of oral contraceptives, menopausal status, age
at menopause, hysterectomy, oophorectomy, and lifetime use of hormone
replacement therapy (HRT). RESULTS: Age at menopause was consistent within 1
year for 66% of women and agreement was higher in women reporting surgical
menopause. Reliability regarding age at menopause decreased with time since
menopause. Gravidity was consistent for 81% of women, whereas parity was
consistent for 94%. The proportion of different answers regarding number of
pregnancies and number of live births was higher in women with high gravidity
and parity, respectively. Agreement was 96% for hysterectomy and 92% for
oophorectomy. The proportion of consistent reports was 90% for oral
contraceptives and 93% for HRT. Women with higher education reported parity and
HRT more reliably. CONCLUSION: Agreement was over 90% for self-reported parity,
hysterectomy, oophorectomy, and HRT, which supports their use in analytical
studies.
Selección de Resúmenes de
Menopausia
Semana del 7 al 13 de Mayo de 2008
Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile
Menopause. 2008 May 2 [Epub
ahead of print]
Oophorectomy, hormone therapy, and subclinical coronary artery disease
in women with hysterectomy: the Women's Health Initiative coronary artery
calcium study.
Allison MA, Manson JE, Langer RD, for the
Women's Health Initiative and Women's Health Initiative Coronary Artery Calcium
Study Investigators.
From the 1University of
OBJECTIVE:: Surgical menopause
has been associated with an increased risk of coronary heart disease events. In
this study, we aimed to determine the associations between coronary artery
calcium (CAC) and hysterectomy, oophorectomy, and hormone therapy use with a
focus on the duration of menopause for which there was no hormone therapy use. DESIGN::
In a substudy of the Women's Health Initiative placebo-controlled trial of
conjugated equine estrogens (0.625 mg/d), we measured CAC by computed
tomography 1.3 years after the trial was stopped. Participants included 1,064
women with previous hysterectomy, aged 50 to 59 years at baseline. The mean
trial period was 7.4 years. Imaging was performed at a mean of 1.3 years after
the trial was stopped. RESULTS:: Mean age was 55.1 years at randomization and
64.8 years at CAC measurement. In the overall cohort, there were no significant
associations between bilateral oophorectomy, years since hysterectomy, years
since hysterectomy without taking hormone therapy (HT), years since bilateral
oophorectomy, and years of HT use before Women's Health Initiative enrollment
and the presence of CAC. However, there was a significant interaction between
bilateral oophorectomy and prerandomization HT use for the presence of any CAC
(P = 0.05). When multivariable analyses were restricted to women who reported
no previous HT use, those with bilateral oophorectomy had an odds ratio of 2.0
(95% CI: 1.2-3.4) for any CAC compared with women with no history of
oophorectomy, whereas among women with unilateral or partial oophorectomy, the
odds of any CAC was 1.7 (95% CI: 1.0-2.8). Among women with bilateral
oophorectomy, HT use within 5 years of oophorectomy was associated with a lower
prevalence of CAC. CONCLUSIONS:: Among women with previous hysterectomy,
subclinical coronary artery disease was more prevalent among those with oophorectomy
and no prerandomization HT use, independent of traditional cardiovascular
disease risk factors. The results suggest that factors related to oophorectomy
and the absence of estrogen treatment in oophorectomized women may be related
to coronary heart disease.
Menopause. 2008 May 8 [Epub
ahead of print
Understanding how personality factors may influence quality of life:
development and validation of the Cervantes Personality Scale.
Castelo-Branco
C, Palacios S, Ferrer-Barriendos
J, Parrilla
JJ, Manubens M, Alberich X, Martí
A; The
Cervantes Study Group.
OBJECTIVE:: To develop and
validate a simple personality scale to be used as a complementary tool for
menopause-specific quality-of-life instruments. DESIGN:: A population-based
random sample of 2,274 Spanish women stratified by age groups and education
level was used in the validation phase. The initial 94-item questionnaire was
reduced to 20 items by examining the frequency and variability with which women
were responding to each of the items. The measurement properties were tested by
conducting reliability (internal consistency and test-retest) and validation
analyses (correlations, and factor analysis). RESULTS:: The final 20-item scale
consisted of three domains: introversion (seven items), emotional instability
(seven items), and insincerity (control subscale, six items). Cronbach's alpha
coefficients for the subscales of emotional instability, introversion, and
insincerity were 0.7966, 0.7135, and 0.7042, respectively. The test-retest
correlation was r = 0.763 for introversion, r = 0.720 for emotional
instability, and r = 0.680 for insincerity (P < 0.001). The Cervantes
Personality Scale is short and easy to administer. Scores range from 0 (the most
extraverted personality) to 35 (the most introverted personality) for the
introversion domain, from 0 (the most emotionally stable personality) to 35
(the most emotionally unstable personality) for the emotional instability
domain, and from 0 (the most sincere response) to 30 (the most insincere
response) for the insincerity domain. CONCLUSIONS:: A novel self-report 20-item
scale for assessing three stable personality traits (introversion, emotional
instability, and insincerity) in peri- and postmenopausal women is presented.
We provide preliminary evidence that the Cervantes Personality Scale is a
useful psychometric tool for studying personality in women going through the
menopausal transition.
Menopause. 2008
May-Jun;15(3):524-9
Postmenopausal status according to years since menopause as an
independent risk factor for the metabolic syndrome.
Joon Cho G, Hyun Lee J, Tae Park H, Ho Shin J, Cheol Hong
S, Kim T, Young Hur
J, et al.
Department of Obstetrics and
Gynecology,
OBJECTIVE:: Features of the
metabolic syndrome such as abdominal adiposity, insulin resistance, and dyslipidemia
develop with the transition from pre- to postmenopausal status in women. We
investigated the effects of postmenopausal status on the prevalence of the
metabolic syndrome according to years since menopause. DESIGN:: We studied
1,002 women, 618 premenopausal and 384 postmenopausal, who participated in
annual health examinations at
Acta Oncol. 2008;47(4):747-54.
Adverse bone effects during pharmacological breast cancer therapy.
Bjarnason
NH, Hitz M, Jorgensen
NR, Vestergaard
P.
Institute for Rational
Pharmacotherapy,
The improved survival and cure
rate of breast cancer patients leads to increased diagnosis of later occurring
side effects to therapy such as osteoporosis. Conventional chemotherapies such
as CMF and CEF are known to induce premature menopause, which increases bone
loss but these therapies have additional detrimental effects on bone. The loss
in bone mass during chemotherapy is substantial and may lead to increased
fracture risk. The influence of taxanes on bone is less well known. Whereas
tamoxifen has a slight protective effect on bone loss the opposite is true for
aromatase inhibitors. Adverse effect reportings show, that adjuvant treatment
with aromatase inhibitors in postmenopausal women increases the risk of
clinical fractures as compared to tamoxifen. The Danish Bone Society suggests
that all women with operable breast cancer have their fracture risk evaluated
including a BMD measurement prior to initiation of adjuvant aromatase inhibitor
therapy as a part of the standard examination program. If osteoporosis is
diagnosed, anti-osteoporosis therapies should be considered. Moreover, all
women undergoing adjuvant chemotherapy and endocrine therapy should be informed
of the risk of bone loss and should receive life style advice of how to
preserve bone. Adjuvant regimens in breast cancer patients improve survival and
cure rates. Therefore it is preferable to use such therapies although they
increase risk of side effects such as osteoporosis.
Endocr Pract. 2008
Apr;14(3):293-7.
Increase in bone mass after correction of vitamin d insufficiency in
bisphosphonate-treated patients.
Geller JL, Hu B, Reed S, Mirocha J, Adams JS.
Objective: To assess the
relative contribution of vitamin D insufficiency to loss of bone mineral
density (BMD) in patients taking bisphosphonates.Methods: Patients were
eligible for inclusion if they had osteoporosis or osteopenia and demonstrated
a decline in BMD during the preceding year while taking stable doses of
alendronate or risedronate, plus supplemental calcium and vitamin D. Patients
with previously known secondary causes of osteoporosis were excluded from the
study. Eligible patients underwent prospective measurement of bilateral hip and
lumbar spine BMD by dual-energy x-ray absorptiometry, serum 25-hydroxyvitamin D
(25-OHD), 1,25-dihydroxyvitamin D, intact parathyroid hormone, osteocalcin, and
thyroid-stimulating hormone (thyrotropin), and urinary calcium:creatinine
ratio.Results: Annual BMD was assessed in 175 previously
bisphosphonate-responsive patients with low BMD. Of the 175 patients, 136 (78%)
had either a significant interval increase or no change in BMD, whereas 39
(22%) had a significant decrease. Of the 39 patients who lost BMD, 20 (51%) had
vitamin D insufficiency (25-OHD <30 ng/mL). After a single course of orally
administered vitamin D2 (500,000 IU during a 5-week period), the 25-OHD level
returned to normal in 17 of the 20 vitamin D-insufficient patients and was
associated with significant (P<.02) 3.0% and 2.7% increases in BMD at the
lumbar spine and the femoral neck, respectively. Failure to normalize the serum
25-OHD level was associated with further loss of BMD.Conclusion: Vitamin D
insufficiency was the most frequently identified cause of bone loss in patients
with declining BMD during bisphosphonate therapy. Correction of vitamin D
insufficiency in these patients led to a significant rebound in BMD.
Expert Opin Drug Saf. 2008
May;7(3):259-70
Raloxifene in breast cancer prevention.
Gennari L, Merlotti D, Paola VD, Nuti R.
BACKGROUND: Raloxifene is a
benzothiophene, selective estrogen receptor modulator with estrogen-agonist
effects in the skeleton and the cardiovascular system but estrogen-antagonist
effects in the uterus and the mammary gland. This compound was first approved
in different countries for the prevention and treatment of osteoporosis.
OBJECTIVE/METHODS: We performed a literature search to review available
preclinical and clinical data that has led to the recent FDA approval of
raloxifene as a chemopreventive agent for breast cancer in postmenopausal
women. RESULTS/CONCLUSIONS: Different placebo-controlled trials indicated that
raloxifene is effective in reducing invasive breast cancer risk in
postmenopausal women. In a recent comparative study, a similar efficacy between
raloxifene and tamoxifen for breast cancer prevention was demonstrated, but
raloxifene showed a more favorable safety profile.
J Neuroendocrinol. 2008 May;20 Suppl
1:69-74
Endocannabinoids and the regulation of bone metabolism.
Bab I, Ofek O, Tam J, Rehnelt J, Zimmer A.
Bone Laboratory, The Hebrew
In mammals, including humans,
bone metabolism is manifested as an ongoing modelling/remodelling process
whereby the bone mineralised matrix is being continuously renewed. Recently, the
main components of the endocannabinoid system have been reported in the
skeleton. Osteoblasts, the bone forming cells, and other cells of the
osteoblastic lineage, as well as osteoclasts, the bone resorbing cells, and
their precursors, synthesise the endocannabinoids anandamide and
2-arachidonoylglycerol (2-AG). CB(1) cannabinoid receptors are present in
sympathetic nerve terminals in close proximity to osteoblasts. Activation of
these CB(1) receptors by elevated bone 2-AG levels communicates brain-to-bone
signals as exemplified by traumatic brain injury-induced stimulation of bone
formation. In this process, the retrograde CB(1) signalling inhibits
noradrenaline release and alleviates the tonic sympathetic restrain of bone
formation. CB(2) receptors are expressed by osteoblasts and osteoclasts. Their
activation stimulates bone formation and suppresses bone resorption.
CB(2)-deficient mice display a markedly accelerated age-related bone loss.
Ovariectomy-induced bone loss can be both prevented and rescued by a CB(2)
specific agonist. Hence, synthetic CB(2) ligands, which are stable and orally
available, provide a basis for developing novel anti-osteoporotic therapies,
free of psychotropic effects. The CNR2 gene (encoding CB(2)) in women is
associated with low bone mineral density, offering an assay for identifying
females at risk of developing osteoporosis.
J Clin Endocrinol Metab. 2008 May 6 [Epub
ahead of print
Serial assessment of serum bone metabolism markers identifies women with
the highest rate of bone loss and osteoporosis risk.
Ivaska KK, Lenora J, Gerdhem P, Akesson K, Väänänen
HK, Obrant KJ.
Clinical and Molecular
Osteoporosis Research Unit, Lund University, Department of Orthopaedics,
Malmö University Hospital, SE-20502 Malmö, Sweden; University of
Turku, Institute of Biomedicine, Department of Anatomy, FI-20520 Turku,
Finland; Karolinska Institute, Department of Orthopaedics, Karolinska
University Hospital, SE-14186 Stockholm, Sweden.
Context: One of the important
challenges in the management of osteoporosis is to identify women who are at
high risk of developing osteoporosis and fragility fractures. Objective: To
evaluate if assessment of bone metabolism at multiple occasions can identify
women with the highest risk for bone loss. Design: The Malmö OPRA study is
an ongoing longitudinal study. Participants have been evaluated at baseline and
after 1, 3 and 5 years. Setting: Population-based study. Participants: 1044
women, all 75 years old at baseline. Main outcome measures: Seven bone turnover
markers were assessed at baseline, 1, 3 and 5 years (n=573). Five year change
in areal bone mineral density (aBMD) was also determined. Results: Baseline
markers correlated weakly to change in total body aBMD. The associations were
more pronounced when the average of the baseline and 1-year measurements was
used (standardized regression coefficients -0.12 to -0.23, p<0.01). Adding the
3-year and 5-year measurement further strengthened the correlation (regression
coefficients up to -0.30 (p<0.001)). Women with constantly high turnover
lost significantly more bone at total body (-2.6%) than women with intermediate
(-1.6%) or low turnover (-0.2%, p for trend <0.001). They also had a greater
decrease in hip BMD (-8.3%, -6.0% and -5.1%, respectively, p=0.010). Results
were similar also in the subgroup of women with osteopenia. Conclusions: Our
results suggest that serial assessment of bone turnover improves the
identification of women with the highest rate of bone loss and osteoporosis
risk.
Ann Intern Med. 2008 May
6;148(9):637-46
Relative effectiveness of osteoporosis drugs for preventing nonvertebral
fracture.
Cadarette
SM, Katz JN, Brookhart
MA, Stürmer
T, Stedman MR, Solomon DH.
Division of
Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital,
Harvard Medical School, and Boston University, Boston, Massachusetts 02120,
USA.
BACKGROUND: Little information
is available on the comparative effectiveness of osteoporosis
pharmacotherapies. OBJECTIVE: To compare the relative effectiveness of
osteoporosis treatments to reduce nonvertebral fracture risk among older
adults. DESIGN: Cohort study. SETTING: Enrollees in 2 statewide pharmaceutical
benefit programs for persons age 65 years or older. PATIENTS: 43,135 new
recipients of oral bisphosphonates, nasal calcitonin, and raloxifene who began
treatment from 2000 to 2005. The mean age was 79 years (SD, 6.9), and 96% were
women. MEASUREMENTS: The primary outcome was nonvertebral fracture (hip,
humerus, or radius or ulna) within 12 months of treatment initiation. Cox
proportional hazard models stratified by state and adjusted for risk factors
for fracture were used to compare fracture rates. Alendronate was the reference
category in all analyses. RESULTS: A total of 1051 nonvertebral fractures were
observed within 12 months (2.62 fractures per 100 person-years). No large
differences in fracture risk were found between risedronate (hazard ratio [HR],
1.01 [95% CI, 0.85 to 1.21]) or raloxifene (HR, 1.18 [CI, 0.96 to 1.46]) and
alendronate. However, among those with a fracture history, raloxifene
recipients experienced more nonvertebral fractures within 12 months (HR, 1.78
[CI, 1.20 to 2.63]) compared with alendronate recipients. Patients who received
calcitonin experienced more nonvertebral fractures than those who received
alendronate (HR, 1.40, [CI, 1.20 to 1.63]). Results were similar in sensitivity
analyses that examined different lengths of follow-up (6 months and 24 months),
were restricted to hip fracture as the outcome, and were completed in various
subgroups. LIMITATION: Confounder adjustment was limited to health care
utilization data, and the confidence bounds of some comparisons were too wide
to rule out potential clinically important differences between agents.
CONCLUSION: Differences in fracture risk between risedronate or raloxifene and
alendronate were small. Nasal calcitonin recipients may have a higher risk for
nonvertebral fractures compared with alendronate recipients. Future studies
that can better adjust for possible confounding may further clarify these
relationships.
Selección de Resúmenes de
Menopausia
Semana del 30 de Abril al 6 de Mayo de 2008
Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile
Arch Intern Med. 2008 Apr
28;168(8):861-6
Postmenopausal hormone therapy and stroke: role of time since menopause and
age at initiation of hormone therapy.
Grodstein F, Manson JE, Stampfer MJ, Rexrode K.
Channing Laboratory, Brigham
and Women's Hospital,
BACKGROUND: We evaluated
stroke risk associated with hormone therapy (HT) in younger women, in recently
menopausal women, and in older women. METHODS: Prospective, observational
analyses were performed in postmenopausal participants of the Nurses' Health
Study, from 1976 to 2004, with biennial mailed questionnaires. Proportional
hazards models were used to calculate multivariable-adjusted relative risks
(RRs) and 95% confidence intervals (CIs). RESULTS: We found a significantly
increased risk of stroke for women currently taking HT (estrogen alone: RR,
1.39; 95% CI, 1.18-1.63; and estrogen with progestin: RR, 1.27; 95% CI,
1.04-1.56), a finding that is nearly identical to that of the Women's Health
Initiative. This increased risk was observed for women initiating HT at young
ages or near menopause and at older ages or more than 10 years after menopause.
Short-term (<5 years) HT initiated at younger ages was not associated with a
clear increase in stroke; however, this apparently null result was based on a
small number of cases. The incidence of stroke was relatively low in younger
women, and the attributable risk in women aged 50 through 54 years indicated
approximately an additional 2 cases of stroke per 10 000 women per year taking
hormones. We found a strong relationship between dose of oral conjugated
estrogen and stroke, with RRs of 0.93, 1.54, and 1.62 for doses of 0.3, 0.625,
and 1.25 mg, respectively (P for trend, <.001). CONCLUSIONS: Hormone therapy
is associated with an increased risk of stroke, and this increased risk does
not appear to be related to the timing of the initiation of HT. In younger
women, with lower stroke risk, the attributable risk of stroke owing to hormone
use is modest and might be minimized by lower doses and shorter treatment
duration.
P R Health Sci J. 2008
Mar;27(1):85-91.
Relationship between loss of libido and signs and symptoms of depression
in a sample of Puerto Rican middle-aged women.
Avellanet
YR, Ortiz AP, Pando JR, Romaguera
J.
Department of Obstetrics and
Gynecology, Medical Sciences Campus, University of Puerto Rico, PO Box 355067,
San Juan, Puerto Rico 00936-5067.
Female sexual dysfunction is a
multi-causal and multidimensional problem combining sexual, physiological,
physical, psychological, and interpersonal determinants. Loss of libido or loss
of sexual desire, as a symptom of one of the primary sexual dysfunctions
described in females, is highly prevalent in the general female population.
Research on the psychological aspect associated with loss of libido among
Hispanic female populations is limited. The objective of this study was to
determine how the loss of libido is affected by signs and symptoms of
depression, once potential confounders are controlled. Nine-hundred and
nineteen Puerto Rican women ages 40 to 59 years living in
Arch Intern Med. 2008 Apr
28;168(8):840-6
Persistent hot flushes in older postmenopausal women.
Huang AJ, Grady D, Jacoby VL, Blackwell
TL, Bauer DC, Sawaya GF.
MPhil,
OBJECTIVE: To examine the
prevalence, natural history, and predictors of hot flushes in older
postmenopausal women. METHODS: Prevalence, severity, and 3-year change in
severity of hot flushes were assessed by questionnaire in 3167 older
postmenopausal women with osteoporosis. Logistic regression was used to
identify characteristics associated with symptoms at baseline and after 3 years
of follow-up. RESULTS: At baseline, 375 women (11.8%) reported bothersome hot
flushes. Women were more likely to have baseline symptoms if they were less
educated (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.06-1.53 per
4-year decrease), more recently menopausal (OR, 1.44; 95% CI, 1.34-1.56 per
5-year decrease), had previously used estrogen (OR, 1.57; 95% CI, 1.23-2.00),
or had undergone hysterectomy (OR, 1.51; 95% CI, 1.14-1.99). Hot flushes were also
associated with higher body mass index (OR, 1.22; 95% CI, 1.08-1.38 per 1 SD),
higher follicle-stimulating hormone levels (OR, 1.34; 95% CI, 1.20-1.51 per 1
SD), lower high-density lipoprotein levels (OR, 1.17; 95% CI, 1.03-1.34 per 1
SD decrease), vaginal dryness (OR, 1.52; 95% CI, 1.19-1.93), and trouble
sleeping (OR, 2.48; 95% CI, 1.94-3.16), but not estradiol levels. Of the 375
women with baseline symptoms, 278 contributed 3-year data, and 157 (56.5%) of
these women reported persistent symptoms after 3 years. Fewer years since
menopause (OR, 1.15; 95% CI, 1.01-1.32 per 5-year decrease) and trouble
sleeping (OR, 1.97; 95% CI, 1.19-3.26) were associated with symptom
persistence. CONCLUSIONS: For a substantial minority of women, hot flushes are
a persistent source of discomfort into the late postmenopausal years.
Identification of risk factors for hot flushes may help guide evaluation and
treatment in this population.
Am J Epidemiol. 2008 Apr 29 [Epub
ahead of print
Conjugated Equine Estrogens and Breast Cancer Risk in the Women's Health
Initiative Clinical Trial and Observational Study.
Prentice RL, Chlebowski RT, Stefanick ML, Manson JE, Langer RD, Pettinger M, Hendrix SL, Hubbell FA, Kooperberg C, Kuller LH, Lane DS, McTiernan A, O'Sullivan MJ, Rossouw JE, Anderson GL.
Division of Public Health
Sciences,
The Women's Health Initiative
randomized controlled trial found a trend (p = 0.09) toward a lower breast
cancer risk among women assigned to daily 0.625-mg conjugated equine estrogens
(CEEs) compared with placebo, in contrast to an observational literature that
mostly reports a moderate increase in risk with estrogen-alone preparations. In
1993-2004 at 40
J Bone Joint Surg Am. 2008
May;90(5):953-61
Improving evaluation and treatment for osteoporosis following distal radial
fractures. A prospective randomized intervention.
Rozental
TD, Makhni EC, Day CS, Bouxsein
ML.
Department of Orthopaedic
Surgery,
BACKGROUND: Fragility
fractures are associated with a significant increase in the risk of future
fracture, but the rates of evaluation to identify osteoporosis after such injuries
are low. The purpose of this study was to determine the rates of evaluation and
treatment of osteoporosis following distal radial fractures and to test two
interventions in the outpatient clinic to improve evaluation and treatment
rates. METHODS: In the first part of the study, the medical records of 298
consecutive patients treated for a fragility fracture of the distal part of the
radius were reviewed. Primary outcome measures were a bone mineral density
examination and treatment with osteoporosis medication within six months after
the fracture. In the second part of the study, fifty patients with a fragility
fracture of the distal part of the radius were prospectively randomized to
receive one of two interventions. These consisted of (1) the orthopaedic
surgeon ordering a bone mineral density examination and forwarding the results
to the primary care physician or (2) the orthopaedic surgeon sending a letter
to the primary care physician outlining guidelines for osteoporosis screening.
Patients were contacted at six months after the fracture to determine the rates
of evaluation and treatment for osteoporosis. RESULTS: The first part of the
study revealed that, following a distal radial fracture, 21.3% of 240 patients
had a bone mineral density examination and 78.7% were never screened.
Osteopenia was the most common diagnosis among those screened (57%). Most
(72.5%) of the 240 patients received no medication, whereas 6.7% received
calcium and vitamin D; 11.3%, bisphosphonates; 2.5%, hormone replacement
therapy; and 7.1%, a combination regimen. The treatment rate for the patients
who had undergone a bone mineral density examination was 2.5-fold higher than
the rate for those who had not had bone mineral density testing (53% compared
with 21%, p < 0.001). In the second part of the study, the patients
randomized to Intervention 1 had two to threefold greater rates of bone mineral
density testing (93% compared with 30%, p < 0.001), discussion of
osteoporosis with their primary care physician (89% compared with 35%, p <
0.001), and initiation of osteoporosis therapy (74% compared with 26%, p <
0.001) compared with patients randomized to Intervention 2. CONCLUSIONS: Rates
of evaluation and treatment for osteoporosis after fragility fractures remain
low (21.3% and 27.5%, respectively). Patients who undergo a bone mineral
density examination are more likely to receive treatment. Ordering a bone
mineral density examination in the orthopaedic clinic can dramatically improve
osteoporosis evaluation and treatment rates following fragility fractures of
the distal part of the radius.
Maturitas. 2008 Apr 28 [Epub
ahead of print
Does a short cessation of HRT decrease mammographic density?
Weaver K, Kataoka M, Murray J, Muir B, Anderson E, Warren R, Warsi I, Highnam R, Glasier A.
Reproductive Healthcare, Dean
Terrace Family Planning Clinic, 18 Dean Terrace,
BACKGROUND: Hormone
replacement therapy (HRT) is known to increase breast density, thus decreasing
the sensitivity of cancer screening by mammography. Some authors recommend
short cessation of HRT before mammography, but evidence showing the effect of
such short cessation is limited. The purpose of this study is to examine
whether a short cessation of HRT changes mammographic density. METHODS:
Forty-eight women taking HRT agreed to have mammograms taken before and after
stopping HRT for 4 weeks. Mammographic density was measured by Wolfe's
four-point classification, six-categorical visual scale and two different
computer methods (interactive-thresholding and SMF). Density values of
mammography before and after the cessation of HRT were compared using Wilcoxon
signed-rank test for categorical variables and paired t-test for continuous
variables. Changes in breast pain and tenderness during mammography, radiation
dose, compression force, and breast thickness were also recorded. RESULTS: No
significant changes in mammographic density were observed by either visual or
computer methods. There were no significant changes in breast pain or in
tenderness on mammograms before and after the month's cessation of HRT.
Radiographic measurements were not significantly altered by the 4-week
cessation of HRT. CONCLUSION: In this screening population, a 4-week cessation
of HRT before mammograms did not significantly alter mammographic density.
Clin Rheumatol. 2008 Apr 29 [Epub
ahead of print
Effects of physical training on bone mineral density in fertile women
with idiopathic osteoporosis.
Bergström I, Brinck J, Sääf M.
Department of Endocrinology,
Metabolism and Diabetes,
The aim of this study was to
investigate whether moderate physical training can improve the bone mineral
density (BMD) in women with idiopathic osteoporosis. Ten pre-menopausal women
aged 24-44 years diagnosed with idiopathic osteoporosis were included in the
study. The physical training program consisted of three fast 30-min walks plus
one or two sessions of 1-h training per week during 1 year at a training centre
separate from the hospital. All patients were given supplements of vitamin D
and calcium. Bone mineral density was measured in the femoral neck area and the
lumbar spine by dual energy X-ray absorptiometry. The measurements were
performed at baseline and after 12 months of training and compared with the
measurements at the time of diagnosis, 1-3 years before the study. Eight women
fulfilled the 12-month training period, and their mean (SD) BMD at start was
0.88 (0.08) g/cm(2) in the spine and 0.76 (0.13) g/cm(2) in the femoral neck.
The mean spine BMD increase was 0.031 g/cm(2) (3.5%) after 1 year of training,
which was significant (Wilcoxon's non-parametric test, p = 0.018). The mean
increment in BMD in the femoral neck was insignificant, 0.007 g/cm(2) (0.9%)
after the intervention (p = 0.74). However, the bone loss during the 1- to
3-year period from diagnosis to study start was, on average, 0.045 g/cm(2) or
5.0% in the femoral neck (p = 0.042), thus indicating a positive indirect
effect of the intervention. There is no evidence-based therapy for women with
idiopathic osteoporosis. It is therefore of importance to elucidate the impact
of moderate physical activity in this group of patients. A 1-year training
program was sufficient to induce a small but significant change in the spine
BMD.
Chem Res Toxicol. 2008 May 1 [Epub
ahead of print
Oxidative DNA Damage in XPC-Knockout and Its Wild Mice Treated with
Equine Estrogen.
Okamoto Y, Chou PH, Kim SY, Suzuki N, Laxmi YR, Okamoto K, Liu X, Matsuda T, Shibutani
S.
Long-term hormone replacement
therapy with equine estrogens is associated with a higher risk of breast,
ovarian, and endometrial cancers. Reactive oxygen species generated through
redox cycling of equine estrogen metabolites may damage cellular DNA. Such
oxidative stress may be linked to the development of cancers in reproductive
organs. Xeroderma pigmentosa complementation group C-knockout ( Xpc-KO) and
wild-type mice were treated with equilenin (EN), and the formation of
7,8-dihydro-8-oxodeoxyguanosine (8-oxodG) was determined as a marker of typical
oxidative DNA damage, using liquid chromatography electrospray tandem mass
spectrometry. The level of hepatic 8-oxodG in wild-type mice treated with EN (5
or 50 mg/kg/day) was significantly increased by approximately 220% after 1
week, as compared with mice treated with vehicle. In the uterus also, the level
of 8-oxodG was significantly increased by more than 150% after 2 weeks. Similar
results were observed with Xpc-KO mice, indicating that Xpc does not
significantly contribute to the repair of oxidative damage. Oxidative DNA
damage generated by equine estrogens may be involved in equine estrogen
carcinogenesis.
Aesthetic Plast Surg. 2008 Apr 30 [Epub
ahead of print
Do Cosmetic Surgeons Consider Estrogen-Containing Drugs to Be of
Significant Risk in the Development of Thromboembolism?
Johnson RL, Hemington-Gorse
SJ, Dhital SK.
Department of Plastic Surgery,
The Countess of
BACKGROUND: Well-documented
evidence shows that estrogen increases the risk of deep vein thrombosis (DVT),
and that the effects of DVT are compounded by the stress of surgery and an
anesthetic. METHODS: This study sought to determine the current views and
practice of plastic surgeons regarding combined oral contraceptive and surgery.
In the