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