Selección de Resúmenes de Menopausia
Semana del 4 al 10 de Marzo de 2009
Juan
Enrique Blümel. Departamento Medicina Sur. Universidad de
Chile
Gynecol Endocrinol. 2009 Feb;25(2):130-5
Quality of life impairment during the female menopausal transition is
related to personal and partner factors.
Chedraui P, San Miguel
G, Avila C.
Collaborative
Group for Research of the Climacteric in Latin America (REDLINC, Ecuador Group
1),
OBJECTIVE: To
assess the female quality of life (QoL) during the
menopausal transition and determine factors (personal and partner) related to
its impairment. The frequency of menopausal symptoms was also assessed.
METHODS: In this cross-sectional study, healthy women aged 40-59 years were
asked to fill out the Menopause Rating Scale (MRS) and a questionnaire
assessing personal and partner demographic data. RESULTS: During the study
period, a total of 409 women were surveyed. Mean age was 47 +/- 5.3 years
(median 46). Mean educational level was 13.2 +/- 4.1 years (median 14), with
28.1% having 12 or less years of schooling; premenopausal (42.1%), perimenopausal (24.4%) and postmenopausal (33.5%). At the
time of the survey, 9.8% were receiving hormonal therapy (HT) for the
menopause, 1.5% were on psychotropic drugs and 1.2% on alternative treatments
for the menopausal. Regarding partner profile, 10.3% had erectile dysfunction,
11.2% had precocious ejaculation and 7.3% had abused alcohol. Mean total MRS
score was 9.1 +/- 6.4 (median 9); for the somatic subscale, 4 +/- 2.7; the
psychological subscale, 3 +/- 2.8 and the urogenital
subscale, 2.1 +/- 2.5. Of the surveyed women, 50.6% presented a total MRS
scoring of 9 or more (moderate to severe intensity).
The four most frequently found symptoms of those composing the MRS were hot
flushes (68.9%), sleeping problems (68.4%), depressive mood (55.2%) and
irritability (51.6%). After adjusting for confounding factors, logistic
regression analysis determined that female age, menopause and partner precocious
ejaculation increased the risk for presenting higher total MRS scores (impaired
female QoL) whereas HT use, church assistance and
partner faithfulness decreased this risk. CONCLUSIONS: A high rate of
middle-aged women in this series presented impaired QoL
associated to female age and hormonal status and additionally to partner's
health and sexual behavior.
Eur Heart J. 2009 Feb 26. [Epub ahead of print
Effect of hormone replacement therapy on vasomotor function of the
coronary microcirculation in post-menopausal women with medically treated
cardiovascular risk factors.
Schindler
TH, Campisi R, Dorsey D, Prior JO, Olschewski M, Sayre J, Schelbert HR.
Department of
Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA,
University of California at Los Angeles, 10833 Le Conte Ave, 23-120 CHS, Box
173517, Los Angeles, CA 90095-1735, USA.
Aims The aim of this study was to evaluate the effect of hormone
replacement therapy (HRT) on coronary vasomotor function in post-menopausal
women (PM) with medically treated cardiovascular risk factors (RFs) in a cross-sectional and a longitudinal follow-up (FU)
study. Methods and results Myocardial blood flow (MBF) response to cold pressor testing (CPT) and during pharmacologically induced
hyperaemia was measured with positron emission tomography in pre-menopausal
women (CON), in PM with HRT and without HRT, and repeated in PM after a mean FU
of 24 +/- 14 months. When compared with CON at baseline, the endothelium-related
change in MBF (DeltaMBF) to CPT progressively
declined in PM with HRT and without HRT (0.35 +/- 0.23 vs. 0.24 +/- 0.20 and
0.16 +/- 0.12 mL/g/min; P = 0.171 and P = 0.021). In
PM without HRT and in those with HRT at baseline but with discontinuation of HRT
during FU, the endothelium-related DeltaMBF to CPT
was significantly less at FU than at baseline (0.05 +/- 0.19 vs. 0.16 +/- 0.12
and -0.03 +/- 0.14 vs. 0.25 +/- 0.18 mL/g/min; P =
0.023 and P = 0.001), whereas no significant change was observed in PM with HRT
(0.19 +/- 0.22 vs. 0.23 +/- 0.22 mL/g/min; P =
0.453). Impaired hyperaemic MBFs when compared with
CON were not significantly altered from those at baseline exam. Conclusion
Long-term administration of oestrogen may contribute to maintain endothelium-dependent
coronary function in PM with medically treated cardiovascular RFs.
Menopause. 2009
Feb 26. [Epub ahead of print
Twice-weekly synthetic conjugated estrogens vaginal cream for the
treatment of vaginal atrophy.
Freedman M, Kaunitz AM, Reape KZ, Hait H, Shu H.
From the
1Department of Obstetrics and Gynecology, Medical
College of Georgia, Augusta, GA; 2Department of Obstetrics and Gynecology, University of Florida College of
Medicine-Jacksonville, Jacksonville, FL; and 3Duramed Research, Inc., Bala Cynwyd, PA.
OBJECTIVE:: The aim of this study was to evaluate low-dose synthetic
conjugated estrogens A (SCE-A) cream administered twice weekly for the treatment
of moderate to severe vulvovaginal atrophy (VVA) in a
symptomatic postmenopausal population. METHODS:: In a
multicenter, double-blind, randomized, placebo-controlled study, 305 women with
symptoms of VVA were treated with either 1 g SCE-A cream (n = 150) or matching
placebo (n = 155) for a period of up to 12 weeks. Participants had to have a
vaginal pH of greater than 5, less than or equal to 5% superficial cells on a
vaginal smear, and at least one of five symptoms of VVA (dryness, soreness,
irritation, pain with intercourse, and bleeding after intercourse) that was
moderate or severe in intensity. Women had to select one moderate or severe
symptom as the most bothersome. RESULTS:: Efficacy was
assessed at 2, 3, 4, 8, and 12 weeks and included the change from baseline in
the severity of the most bothersome symptom (MBS), maturation index, and pH.
Most women identified vaginal dryness as the MBS (48%) followed by pain with
intercourse (31.3%). A statistically significant increase in the maturation
index and significant decreases in pH and severity of the MBS were observed for
those treated with SCE-A vaginal cream compared with placebo. CONCLUSIONS:: A low dose (1 g = 0.625 mg) of SCE-A vaginal cream
administered twice weekly was shown to be effective compared with placebo in
treating VVA in postmenopausal women for the three coprimary
efficacy measures of maturation index, pH, and severity of the MBS.
Maturitas. 2009
Feb 26. [Epub ahead of print
Safety of testosterone use in women.
Department of
Medicine,
Female sexual
desire appears to be in part androgen dependent, which has lead to the use of
testosterone in women for low libido. Despite this benefit, the long-term
safety of testosterone as a hormone replacement or therapy has not been well
established. Side effects of testosterone therapy include mild and reversible
acne and hirsuitism, as well as changes to the lipid
profile with oral, but not transdermal testosterone.
Short-term studies, up to 2 years, have shown that for serum plasma
testosterone levels at the upper portion or slightly above the reference range
for reproductive-aged women, testosterone does not increase the risk of hepatotoxicity, endometrial hyperplasia, or behavioral hostility. No adverse cardiovascular effects
including changes in blood pressure, blood viscosity, arterial vascular
reactivity, hypercoagulable states, and polycythemia have been shown. Data is mixed with outcomes
of breast cancer risk, with some experimental studies suggesting a decrease in estrogen-induced breast epithelial proliferation with low
dose testosterone. Additionally, models of superphysiologic
testosterone levels, such as polycystic ovarian disease, have not shown an
increased risk of breast cancer. As with all hormone therapy in postmenopausal
women, testosterone therapy should be individualized and requires that each
woman weigh the risk and benefits. Nevertheless, only long-term safety studies
will provide conclusive evidence as to testosterone safety in women.
Osteoporos Int. 2009 Mar 6. [Epub ahead of print
Comparative gastrointestinal safety of
weekly oral bisphosphonates.
Cadarette SM, Katz JN, Brookhart MA, Stürmer T, Stedman MR, Levin R, Solomon DH.
Division
of Pharmacoepidemiology and Pharmacoeconomics,
Brigham and Women's Hospital,
Weekly bisphosphonates are the primary agents used to treat
osteoporosis. Although these agents are generally well tolerated, serious
gastrointestinal adverse events, including hospitalization for gastrointestinal
bleed, may arise. We compared the gastrointestinal safety between weekly alendronate and weekly risedronate
and found no important difference between new users of these agents.
INTRODUCTION: Weekly bisphosphonates are the primary
agents prescribed for osteoporosis. We examined the comparative
gastrointestinal safety between weekly bisphosphonates.
METHODS: We studied new users of weekly alendronate
and weekly risedronate from June 2002 to August 2005
among enrollees in a state-wide pharmaceutical
benefit program for seniors. Our primary outcome was hospitalization for upper
gastrointestinal bleed. Secondary outcomes included outpatient diagnoses for
upper gastrointestinal disease, symptoms, endoscopic procedures, use of gastroprotective agents, and switching between therapies.
We used Cox proportional hazard models to compare outcomes between agents
within 120 days of treatment initiation, adjusting for propensity score
quintiles. We also examined composite safety outcomes and stratified results by
age and prior gastrointestinal history. RESULTS: A total of 10,420 new users
were studied, mean age = 79 years (SD, 6.9), and 95% women. We observed 31
hospitalizations for upper gastrointestinal bleed (0.91 per 100 person-years)
within 120 days of treatment initiation. Adjusting for covariates, there was no
difference in hospitalization for upper gastrointestinal bleed among those
treated with risedronate compared with alendronate (HR, 1.12; 95%CI, 0.55 to 2.28). Risedronate switching rates were lower; otherwise, no
differences were observed for secondary or composite outcomes. CONCLUSIONS: We
found no important difference in gastrointestinal safety between weekly oral bisphosphonates.
Menopause. 2009 Mar 4. [Epub ahead of print
Mammary gland and endometrial effects of
testosterone in combination with oral estradiol and
progesterone.
OBJECTIVE:: The goal of this pilot study was to evaluate the effects
of testosterone (T) cotherapy on mammary gland and endometrial
measures in a postmenopausal primate model. METHODS:: Twenty-five surgically
postmenopausal cynomolgus monkeys were randomized by
social group to receive daily treatment with (1) placebo, (2) oral micronized
17beta-estradiol (1 mg/d equivalent in women) + progesterone (200 mg/d
equivalent in women) (E + P), or (3) E + P with T administered via subcutaneous
pellets for 8 weeks at a high dose (15 mg) followed by 8 weeks at a low dose
(1.5 mg) (E + P + T). The main outcome measures were breast and endometrial
epithelial proliferation, as measured by Ki67/MIB1 immunolabeling.
RESULTS:: Intralobular
breast proliferation did not differ significantly among groups after 8 weeks of
treatment but was marginally higher (P = 0.03) in the E + P + T group after 16
weeks of treatment. No significant increase in proliferation was seen for E + P
alone. Comparable changes in mammary gland markers of estrogen-receptor
activity were seen for the E + P and E + P + T groups. In the endometrium, the addition of T did not increase endometrial
glandular proliferation or estrogen-receptor activity
or result in any distinct histologic changes.
CONCLUSIONS:: The findings of this study do not
support the idea that T antagonizes the effects of combined hormone therapy on
breast proliferation or markers of estrogen-receptor
activity. Overall, the short-term effects of T cotherapy
on the mammary gland and endometrium were minimal.
Immun Ageing. 2009 Mar 5;6(1):1. [Epub ahead of print
Alterations of T cell activation signalling and cytokine production by
postmenopausal estrogen levels.
Ku LT, Gercel-Taylor C, Nakajima
ST, Taylor DD.
ABSTRACT:
BACKGROUND: Immunosenescence is an age-associated
disorder occurring primarily in T cell compartments, including altered subset
composition, functions, and activation. In women, evidence implicates
diminished estrogen in the postmenopausal period as a
contributing factor to diminished T cell responsiveness. Since hypoestrogenism is present in postmenopausal women, our
objective focused on whether T cell activation, defined as signalling molecule
expressions and activation, and function, identified as IL-2 production, were
affected by low estrogen. METHODS: Using Jurkat 6.1 T cells, consequences of 4pg/ml (corresponding
to postmenopausal levels) or 40pg/ml (premenopausal levels) of estradiol (E2) were analyzed on signalling proteins,
CD3-zeta, JAK2, and JAK3, determined by Western immunoblotting.
These consequences were correlated with corresponding gene expressions,
quantified by real time-polymerase chain reaction. Tyrosine phosphorylation
of CD3-zeta was defined by immunoprecipitation and western
immunoblotting following activation by T cell
receptor (TcR) cross-linking. CD3-zeta expression and
modulation was also confirmed in T cells from pre- and postmenopausal women. To
assess functional consequences, IL-2 production, induced by PMA and ionomycin, was determined using enzyme-linked immunosorbent spot assay (ELISpot).
RESULTS: At 40pg/ml E2, the level of signalling protein CD3-zeta was elevated
1.57-fold, compared with cells exposed to 4pg/ml E2. The CD3-zeta proteins also
exhibited altered levels of activation-induced phosphorylation
in the presence of 40pg/ml E2 versus 4pg/ml: 23kD phosphorylated
form increased 2.64-fold and the 21kD form was elevated 2.95-fold. Examination
of kinases associated with activation signalling also
demonstrated that, in the presence of 40pg/ml E2, JAK2 protein expression was
increased 1.64-fold (p<0.001) and JAK3 enhanced 1.79-fold (p<0.001)
compared to 4pg/ml. mRNA levels for CD3-zeta, JAK2, and JAK3 were significantly
increased following exposure to 40pg/ml E2 (2.39, 2.01, and 2.21 fold,
respectively) versus 4pg/ml. These findings were confirmed in vivo, since T
cells from postmenopausal women exhibited 7.2-fold diminished CD3-zeta
expression, compared to pre-menopausal controls and this expression was elevated
3.8-fold by addition of 40pg/ml E2. Functionally, Jurkat
cells exposed to 40pg/ml E2 and activated exhibited significantly elevated
numbers of IL-2 producing colonies compared to 4pg/ml (75.3+/-2.2 versus
55.7+/-2.1 colonies, p<0.0001). CONCLUSIONS: Jurkat
T cells exposed to 4pg/ml E2 expressed significantly diminished activation
signalling proteins, correlating with reduced IL-2 production. Lower signalling
protein levels appear to result from decreased CD3-zeta, JAK2, and JAK3 gene
expressions. These findings may provide a molecular basis for immunosenescence associated with the postmenopausal state.
Bone. 2009
Feb 27. [Epub ahead of print
Bazedoxifene reduces vertebral and clinical fractures
in postmenopausal women at high risk assessed with FRAX((R)).
Kanis JA, Johansson
H, Oden A, McCloskey
EV.
WHO Collaborating
Centre for Metabolic Bone Diseases,
Introduction Bazedoxifene has been shown to significantly decrease the
risk of vertebral fractures in postmenopausal women. No significant effect was
noted on the risk of clinical fractures, but fracture risk reduction was
reported in a post hoc subgroup analysis in a high risk group categorised on
the basis of BMD and prior fracture. Aims The aim of
this study was to re-evaluate the efficacy of bazedoxifene
on fracture outcomes avoiding subgroup analysis by examining the efficacy of
intervention as a function of fracture risk. Methods The phase III study was a doubleblind, randomized, placebo and raloxifenecontrolled
randomised 3-year multinational study that enrolled 7492 osteoporotic women
aged 55 years or more (mean age= 66 years). For the present analysis, women
taking raloxifene were excluded (n=1849), and we
compared the effects of two doses of bazedoxifene (20
and 40 mg daily combined) with placebo on the risk of all clinical fractures as
well as the risk of morphometric vertebral fracture.
The risk of a major osteoporotic fracture was assessed using region specific
FRAX((R)) algorithms, and the relationship between pre hoc 10 year fracture
probabilities and efficacy examined by Poisson regression. Results Overall, bazedoxifene was associated with a significant 39% decrease
in incident morphometric vertebral fractures (hazard
ratio HR= 0.61; 95% CI= 0.43-0.86; p= 0.005) and a non-statistically
significant 16% decrease in all clinical fractures (hazard ratio HR= 0.84; 95%
CI= 0.67-1.06; p= 0.14) compared to placebo. Hazard ratios for the effect of bazedoxifene on all clinical fractures decreased with
increasing fracture probability. In patients with 10-year fracture
probabilities at or above 16%, bazedoxifene was
associated with a significant decrease in the risk of all clinical fractures.
The 16% probability threshold corresponded to the 80(th) percentile of the study population. Hazard ratios
for the effect of bazedoxifene on morphometric
vertebral fractures also decreased with increasing fracture probability. In
patients with 10-year fracture probabilities above 6.9% (corresponding to the
41(st) percentile), bazedoxifene
was associated with a significant decrease in the risk of morphometric
vertebral fractures. At equivalent fracture probability percentiles, the
treatment effect of bazedoxifene was greater on
vertebral fracture risk than on the risk of all clinical fractures. For
example, at the 90(th) percentile of FRAX((R)) probability, bazedoxifene
was associated with a relative risk reduction of 33% (95% CI= 7-51%) for all
clinical fractures and 51% reduction (95% CI= 21-69%) for morphometric
vertebral fractures. The findings were robust to several sensitivity analyses.
Conclusion Bazedoxifene (20 and 40 mg doses combined)
significantly decreased the risk of all clinical fractures and morphometric vertebral fractures in women at or above a FRAX( based fracture probability threshold. These results,
consistent with the previous sub group analysis, suggest that bazedoxifene should be targeted prefentially
to women at high fracture risk.
Selección de Resúmenes
de Menopausia
Semana del 11 al 17 de Marzo de
2009
Juan Enrique Blümel.
Departamento Medicina Sur. Universidad de
Chile
J
Natl Cancer Inst. 2009 Mar 10. [Epub ahead of print
Prevention of
Breast Cancer in Postmenopausal Women: Approaches to Estimating and Reducing
Risk.
Cummings
SR, Tice JA, Bauer S, Browner WS, Cuzick J, Ziv E, et al.
Background It is uncertain whether evidence supports routinely
estimating a postmenopausal woman's risk of breast cancer and intervening to
reduce risk. Methods We systematically reviewed prospective studies about
models and sex hormone levels to assess breast cancer risk and used
meta-analysis with random effects models to summarize the predictive accuracy
of breast density. We also reviewed prospective studies of the effects of
exercise, weight management, healthy diet, moderate alcohol consumption, and
fruit and vegetable intake on breast cancer risk, and used random effects
models for a meta-analyses of tamoxifen
and raloxifene for primary prevention of breast
cancer. All studies reviewed were published before June 2008, and all
statistical tests were two-sided. Results Risk models that are based on
demographic characteristics and medical history had modest discriminatory
accuracy for estimating breast cancer risk (c-statistics range = 0.58-0.63).
Breast density was strongly associated with breast cancer (relative risk [RR] =
4.03, 95% confidence interval [CI] = 3.10 to 5.26, for Breast Imaging Reporting
and Data System category IV vs category I; RR = 4.20,
95% CI = 3.61 to 4.89, for >75% vs <5% of dense
area), and adding breast density to models improved discriminatory accuracy
(c-statistics range = 0.63-0.66). Estradiol was also
associated with breast cancer (RR range = 2.0-2.9, comparing the highest vs lowest quintile of estradiol,
P < .01). Most studies found that exercise, weight reduction, low-fat diet,
and reduced alcohol intake were associated with a decreased risk of breast
cancer. Tamoxifen and raloxifene
reduced the risk of estrogen receptor-positive
invasive breast cancer and invasive breast cancer overall. Conclusions Evidence
from this study supports screening for breast cancer risk in all postmenopausal
women by use of risk factors and breast density and considering chemoprevention
for those found to be at high risk. Several lifestyle changes with the
potential to prevent breast cancer should be recommended regardless of risk.
Arch Neurol. 2009 Mar;66(3):324-8
The
metabolic syndrome and development of cognitive impairment among older women.
Yaffe K, Weston AL, Blackwell
T, Krueger KA.
Department of
Psychiatry, University of California, San Francisco, the San Francisco
Veterans' Affairs Medical Center, 94121, USA. Kristine.yaffe@ucsf.edu
BACKGROUND:
Several studies support a role for cardiovascular risk factors in cognitive
aging. The metabolic syndrome, a constellation of cardiovascular risk factors,
is common in elderly people. A growing but conflicting body of literature
suggests that the metabolic syndrome may be associated with cognitive
impairment. OBJECTIVE: To investigate the association between the metabolic
syndrome and its components and incident cognitive impairment in older women.
DESIGN: We prospectively determined if the metabolic syndrome and its
components were associated with a 4-year risk of developing cognitive impairment
(dementia, mild cognitive impairment, or low global cognitive test score).
SETTING: The study was conducted at 180 clinical centers
in 25 countries. PARTICIPANTS: A total of 4895 older women (mean age, 66.2
years) with osteoporosis who were part of an ancillary study to determine
clinically relevant cognitive impairment were included in this study. These
women were free of baseline cognitive impairment and had metabolic syndrome
component measures. MAIN OUTCOME MEASURES: Clinically significant cognitive
impairment was defined to include women with clinically adjudicated dementia or
MCI and women who had a Short Blessed test score greater than 6 (consistent
with impairment), but whose cases were not clinically adjudicated. Logistic
regression analysis was used to examine the association between presence of the
metabolic syndrome and development of clinically significant cognitive
impairment. RESULTS: A total of 497 women (10.2%) had the metabolic syndrome
and, of these, 36 (7.2%) developed cognitive impairment compared with 181 (of
4398 or 4.1%) without the syndrome (age-adjusted odds ratio, 1.66; 95%
confidence interval, 1.14-2.41). The mean (SD) number of metabolic syndrome
components for all women was 1.0 (1.1); 518 women (10.6%) were obese, 895 (18.3%)
had hypertriglyceridemia, 1200 (24.5%) had low
high-density lipoprotein cholesterol levels, 1944 (39.7%) had high blood
pressure, and 381 (7.8%) had high fasting blood glucose levels. There was a
23.0% age-adjusted increase in the risk of developing cognitive impairment
(odds ratio, 1.23; 95% confidence interval, 1.09-1.39) per unit increase in the
number of components. Further multivariable adjustment somewhat reduced the
effect. CONCLUSION: We found an association between the metabolic syndrome and
the number of components and risk of developing cognitive impairment in older
women. Additional studies are needed to determine if screening and close
management of these at-risk elderly women would diminish the incidence of
cognitive impairment.
J Gen Intern Med. 2009 Mar
11. [Epub ahead of print]
Obesity and
Mammography: A Systematic Review and Meta-Analysis.
Maruthur NM, Bolen S, Brancati FL, Clark JM.
Division of
General Internal Medicine, The
BACKGROUND: Obese
women experience higher postmenopausal breast cancer risk, morbidity, and mortality
and may be less likely to undergo mammography. OBJECTIVES: To quantify the
relationship between body weight and mammography in white and black women. DATA
SOURCES AND REVIEW METHODS: We identified original articles evaluating the
relationship between weight and mammography in the
Osteoporos Int. 2009 Mar
7. [Epub ahead of print
Weight loss and
distal forearm fractures in postmenopausal women : The Nord-Trřndelag
health study,
Omsland TK, Schei B, Grřnskag AB, Langhammer A, Forsén L, Gjesdal CG, Meyer HE.
Section for
Preventive Medicine and Epidemiology,
Weight loss is a
risk factor for hip fractures, but few studies have evaluated the effect of
weight loss on distal forearm fracture risk. In this longitudinal study
including 7,871 postmenopausal women, weight loss of 5% or more was associated
with an increased risk of distal forearm fractures. INTRODUCTION: Weight loss
is an established risk factor for hip fractures, but little is known about
weight loss and distal forearm fractures risk. METHODS: The study included
7,871 women aged 65 years or more in the Nord-Trřndelag
health study (HUNT) in 1994-1995 (HUNT II) who also had their height and weight
measured in 1984-1986 (HUNT I). Forearm bone mineral density (BMD) by single energy
x-ray absorptiometry was available for 5,688 women
(HUNT II). Fractures sustained after HUNT II were registered during an average
of 5.8 years. RESULTS: A total of 536 women sustained a distal forearm
fracture. After adjustments for age and body mass index (BMI) at HUNT I, women
who lost >/=5% of their weight between HUNT I and HUNT II had a relative
risk of fractures of 1.33 (95% confidence interval: 1.09, 1.62) compared with
the rest of the women. The higher risk of forearm fracture among women with weight
loss was at least partially explained by their lower forearm BMD. CONCLUSION:
Weight loss of 5% or more was associated with a 33% increased risk of distal
forearm fractures.
Calcif Tissue Int. 2009 Mar
11. [Epub ahead of print
Addition of Aerobic
Exercise to a Weight Loss Program Increases BMD, with an Associated Reduction
in Inflammation in Overweight Postmenopausal Women.
Silverman
NE, Nicklas BJ, Ryan AS.
Increased
inflammation and weight loss are associated with a reduction in bone mineral
density (BMD). Aerobic exercise may minimize the loss of bone and weight loss
may contribute to a decrease in cytokines. We tested the hypothesis that
aerobic exercise in combination with a weight loss program would decrease
circulating concentrations of inflammatory markers, thus mediating changes in
BMD. This was a nonrandomized controlled trial. Eighty-six overweight and obese
postmenopausal women (50-70 years of age; BMI, 25-40 kg/m(2)) participated in a
weight loss (WL; n = 40) or weight loss plus walking (WL + AEX; n = 46)
program. Outcome measures included BMD and bone mineral content of the femoral
neck and lumbar spine measured by dual energy X-ray absorptiometry,
interleukin-6, tumor necrosis factor-alpha, soluble
receptors of IL-6, and TNF-alpha (sTNFR1 and sTNFR2; receptors in a subset of
the population), VO(2) max, fat mass, and lean mass. Weight decreased in the WL
(p < 0.001) and WL + AEX (p < 0.001) groups. VO(2) max increased (p <
0.001) after WL + AEX. There was a 2% increase in femoral neck BMD in the WL +
AEX group (p = 0.001), which was significantly different from the WL group. The
change in sTNFR1 was significantly associated with the change in femoral neck
BMD (p < 0.05). The change in VO(2) max was an independent predictor of the
change in femoral neck BMD. Our findings suggest that the addition of aerobic
exercise is recommended to decrease inflammation and increase BMD during weight
loss in overweight postmenopausal women.
Menopause. 2009 Mar
6. [Epub ahead of print]
Memory complaints
and memory performance in the menopausal transition.
From the
Departments of 1Physical Medicine and Rehabilitation and 2Neurology, The
University of
OBJECTIVE:: The
aim of this study was to examine the relationship between perimenopausal
memory complaints and performance on objective neuropsychological tests. A
secondary aim was to determine if putative deficits are related to other
relevant factors, such as hormone levels, mood state, or sleep quality.
METHODS:: Twenty-four perimenopausal women were
enrolled. Participants completed questionnaires assessing mood, anxiety,
menopausal symptoms, health, and subjective memory function. They also
underwent comprehensive cognitive testing, which included measures of
attention, working memory, verbal memory, verbal fluency, visuospatial
skill, and fine motor dexterity. We obtained serum estradiol
and follicle-stimulating hormone levels on the day of testing. RESULTS:: We
found no association between memory complaints and performance on tests of
retentive memory. However, memory complaints were associated with poorer memory
encoding and increased depressive symptoms. Regression analyses revealed that
memory complaints were best predicted by depressive symptoms, whereas encoding
performance was predicted by depressive symptoms and estrogen
level. Women with significant memory complaints performed worse on tests of
encoding, after controlling for depression and sleep disturbance. CONCLUSIONS::
These results suggest a complex relationship between mood, memory, and hormones
that may underlie perimenopausal memory complaints.
Furthermore, they suggest that some women may be particularly vulnerable to the
subjective experience of memory problems and relative decreases in attentionally mediated cognitive function.
Menopause. 2009 Mar
6. [Epub ahead of print
Association between
serum 25-hydroxyvitamin D levels and body composition in postmenopausal women:
the Postmenopausal Health Study.
Moschonis
G, Tanagra S, Koutsikas
K, Nikolaidou
A, Androutsos
O, Manios Y.
From the
Department of Nutrition and Dietetics, Harokopio
OBJECTIVE:: The
present study examined the association between body composition measurements,
using dual-energy x-ray absorptiometry and
anthropometry, with serum 25-hydroxyvitamin D levels in nonosteoporotic,
postmenopausal women. METHODS:: Serum 25-hydroxyvitamin D, intact parathyroid
hormone, insulin-like growth factor I levels, dual-energy x-ray absorptiometry measurements of fat and fat-free mass,
anthropometric and handgrip strength measurements, dietary intake estimations,
ultraviolet B radiation exposure, and physical activity levels were collected
from 112 nonosteoporotic, postmenopausal women (age,
60.3 +/- 5.0 y; body mass index, 29.5 +/- 4.8 kg/m). RESULTS:: At a bivariate level, serum 25-hydroxyvitamin D levels were
inversely associated with regional and total body fat mass (P < 0.05),
whereas positive associations were observed with regional and total body fat-free
mass (P < 0.05). After controlling for age, serum intact parathyroid
hormone, insulin-like growth factor I levels, ultraviolet B radiation exposure,
and physical activity levels, most of the associations observed at a bivariate level between serum 25-hydroxyvitamin D levels
and body composition indices (as obtained by dual-energy x-ray absorptiometry) remained significant. No significant
associations were observed between anthropometric indices of body mass and
serum 25-hydroxyvitamin D levels. CONCLUSIONS:: An independent inverse
association between serum 25-hydroxyvitamin D levels and dual-energy x-ray absorptiometry measurements of total body and regional fat
mass was observed in nonosteoporotic, overweight,
postmenopausal women. Further clinical trials are required to come to safe
conclusions on whether it is the fat mass that affects serum 25-hydroxyvitamin
D levels or vice versa and whether there is a need to also take into account
body composition when providing recommendations for vitamin D intake in
postmenopausal women.
Lupus. 2009;18(4):313-7
Hormone replacement
therapy in women with systemic lupus erythematosus
and risk of cardiovascular disease.
Hochman J, Urowitz M, Ibańez D, Gladman D.
We sought to determine
the impact of hormone replacement therapy (HRT) on the occurrence of coronary
artery disease (CAD) in women with systemic lupus erythematosus
(SLE). Women in the
Selección de Resúmenes
de Menopausia
Semana del 18 al 24 de Marzo de
2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de Chile
Osteoporos Int. 2009 Mar 20. [Epub ahead of print
Chronic obstructive pulmonary disease is associated with osteoporosis
and low levels of vitamin D.
Franco CB, Paz-Filho G, Gomes PE, Nascimento VB, Kulak CA, Boguszewski CL, Borba VZ.
Serviço de
Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do
Paraná (SEMPR), Rua. Agostinho Leăo Junior, 285,
We did a
cross-sectional analysis of chronic pulmonary obstructive disease (COPD)
patients without chronic use of systemic glucocorticoids
(CUG). Osteoporosis was found in 51% and bone mineral density (BMD) was
correlated with severity of disease. Low levels of vitamin D were found in 94%.
All COPD patients may benefit from vitamin D supplementation and screening for
low BMD. INTRODUCTION: Patients with chronic pulmonary obstructive disease have
low bone mineral density, caused by chronic use of systemic glucocorticoids
and hypovitaminosis D. However, patients without CUG
may also have low BMD. METHODS: We performed a cross-sectional analysis in 49
patients (21 men, 28 postmenopausal women), with COPD without CUG, from
Curr Opin Endocrinol Diabetes Obes. 2009
Apr;16(2):125-31
Bone metabolism in type 2 diabetes and role of thiazolidinediones.
Department of
Endocrinology and Metabolism C,
PURPOSE OF REVIEW:
To assess bone turnover both at the biochemical and organ level in patients
with type 2 diabetes (T2D) and the effects of the thiazolidinediones.
RECENT FINDINGS: Studies have shown a decreased bone formation and an increased
risk of fractures in patients with T2D. Changes in bone strength from glycation of collagen and negative calcium balance from
calcium loss in the urine due to hyperglycaemia may also be seen. The thiazolidinediones affect bone turnover by increasing the
formation of adipocytes instead of the bone-forming osteoblasts from the common mesenchymal
stem cell. A decreased bone formation with decreased bone density and an
increased risk of fractures has been observed among users of thiazolidinediones. Differences exist between type 1
diabetes (T1D) and T2D with a much higher increase in the risk of hip fractures
in T1D than in T2D compared with the general population. The often higher body
mass index in T2D than in T1D appears to explain some of the differences in
risk of fractures. SUMMARY: Diabetes is a hitherto overlooked risk factor for
osteoporosis and fractures. Thiazolidinediones may
increase risk of fractures and should not be used by patients at risk of
fractures. More research is needed.
Clin Breast Cancer. 2009 Feb;9(1):45-50.
Incidence of invasive breast cancer in postmenopausal women after
discontinuation of long-term raloxifene
administration.
Vogel VG, Qu Y, Wong M, Mitchell B, Mershon JL.
Department of
Research, American Cancer Society.
Background:
Postmenopausal women with osteoporosis had a 66% relative risk reduction for
invasive breast cancer over 8 years of raloxifene
therapy in the randomized, placebo-controlled 4-year MORE (Multiple Outcomes of
Raloxifene Evaluation) trial and the CORE (Continuing
Outcomes Relevant to Evista) trial, a 4-year
follow-up to MORE. Patients and Methods: The first post hoc analysis examined
the effects of raloxifene on the cumulative incidence
of invasive breast cancer on a yearly basis. Another analysis compared the
incidence of invasive breast cancer in 3967 patients who continued raloxifene for 8 years (RLX-C, n = 2280), discontinued raloxifene after 4 years in MORE (RLX-D, n = 401), or took
placebo (n = 1286) for a mean 2.9 years' treatment duration (57,338
patient-years). Results: The unadjusted breast cancer incidence rate was 5.39
per 1000 patient-years in the placebo group compared with 2.26 in the RLX-C
group (hazard ratio [HR], 0.41 [95% CI 0.21-0.81]) and 3.59 in the RLX-D group
(HR, 0.69 [95% CI 0.23-2.01]). Because the choice of taking the study drug was
not randomized in CORE, propensity scores were used to adjust for potential
imbalances in baseline characteristics before CORE. Results after adjustment by
the propensity score method were similar to the unadjusted results. Conclusion:
This analysis suggests a persistent effect for breast cancer risk reduction in
patients who discontinued raloxifene, although this
conclusion is limited by the small sample size.
Joint Bone Spine. 2009 Mar 16. [Epub ahead of print
Prevalence and features of osteoporosis in the French general
population: The Instant study.
Lespessailles E, Cotté FE, Roux C, Fardellone P, Mercier F, Gaudin AF.
Rheumatology
Department,
OBJECTIVES: To
determine the prevalence of diagnosed osteoporosis, the extent of treatment use
and the incidence of fracture in a representative sample of the French general
population. METHODS: A cross-sectional epidemiological survey of osteoporosis
in 2613 women over 45 years in the general population was conducted using a
stratified random sampling method and face-to-face interviews. Information was
collected on the diagnosis of osteoporosis, fracture history, treatments,
clinical and sociodemographic variables. Variables potentially
associated with fracture were evaluated using stepwise multivariate logistic
regression analysis. RESULTS: The overall prevalence of diagnosed osteoporosis
was 9.7% [8.6%; 10.9%] and prevalence increased linearly with age. Overall, 155
women (61.0%) received osteoporosis treatment and treatment rates also
increased with age. The most frequently prescribed treatments were bisphosphonates, in 50.3% of treated women. The treatment
duration was over 2 years for 72.9% of treated women. Overall, 115 (45.3%)
reported at least one previous fracture. Vertebral fractures were reported by
101 women (39.8%) and limb fractures by 41 women (16.1%). Multivariate logistic
regression analysis identified fracture before the age of 40, menopause before
the age of 40, use of sleeping pills, consultation with an eye specialist and
history of cardiovascular disease as variables independently associated with
fracture. CONCLUSIONS: Osteoporosis in
Menopause. 2009 Mar 17. [Epub
ahead of print
Newer antidepressants and gabapentin for hot
flashes: a discussion of trial duration.
Loprinzi CL, Diekmann B, Novotny PJ, Stearns V, Sloan JA.
From the 1Mayo
Clinic,
OBJECTIVE::
Information regarding the ideal length of hot flash trials is scarce. In the
literature, hot flash trial durations have commonly varied from
Am J Prev
Med. 2009
Apr;36(4):366-75
Screening for osteoporosis in the adult
Lim LS, Hoeksema LJ, Sherin K; ACPM Prevention Practice Committee.
Department of
Internal Medicine,
CONTEXT:
Osteoporosis is a common and costly disease that is associated with high
morbidity and mortality. There is a lack of direct evidence supporting the
benefits of bone mineral density (BMD) screening on osteoporosis outcomes.
However, there is indirect evidence to support screening for osteoporosis given
the availability of medications with good antifracture
efficacy. This paper addresses the position of the
Selección de Resúmenes
de Menopausia
Semana del 25 al 31 de Marzo de
2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de Chile
Int J Cancer. 2009 Jan 22. [Epub ahead of print
A population-based cohort study on the use of hormone treatment and
endometrial cancer in southern
Epstein E, Lindqvist PG, Olsson H.
Institute of
Clinical Sciences Lund, Department of Obstetrics and Gynaecology, Lund
University Hospital, University of Lund, Lund, Sweden.
Our aim was to
determine the risk of endometrial cancer associated with long-term use of combined
hormone therapy (HT) and low-potency estrogens. In this prospective
population-based cohort, 40,000 women aged 25-64 years, without prior cancer or
hysterectomy, were included. The women answered 2 questionnaires at a 10-year
interval regarding HT use and personal details. Women were followed up for an
average of 15.5 years through the National Cancer and Causes of Death Registry,
representing 236,611 women years. Among the 17,822 postmenopausal women
included, 166 cases of endometrial cancer were diagnosed. Only use of combined
HT was related to a decreased risk of endometrial cancer (OR 0.3, 95% CI
0.1-0.8), the protective effect was found after 2 years, and increased with
extended duration of use. "Only use" of low-potency estrogens increased
the risk of endometrial cancer almost to the same extent as use of high-potency
estrogens (OR 2.0, 95% CI 1.1-3.6 vs. OR 2.5, 95% CI 1.3-4.8), the increased
risk was confined to non-obese women in both groups. The risk was significantly
increased for oral but not for local low-potency estrogen
users (OR 2.1, 95% CI 1.1-3.6 vs. OR 1.5, 95% CI 0.4-6.2, respectively). In
long-term estrogen users the risk was highest during
the first 2 years, dropping slightly thereafter. Since low-potency estrogen use increases the risk of endometrial cancer
almost as much as high-potency estrogen use, they
should only be given if medically indicated.
Menopause. 2009 Mar 26. [Epub
ahead of print
Hot flushes, coronary heart disease, and hormone therapy in
postmenopausal women.
Huang AJ, Sawaya GF, Vittinghoff E, Lin F, Grady D.
Departments of
Medicine,
OBJECTIVE:: The
aim of this study was to examine interactions between hot flushes, estrogen plus progestogen therapy
(EPT), and coronary heart disease (CHD) events in postmenopausal women with
CHD. METHODS:: We analyzed data from the Heart and Estrogen/Progestin
Replacement Study, a randomized, placebo-controlled trial of 0.625 mg
conjugated equine estrogens plus 2.5 mg medroxyprogesterone
acetate in 2,763 postmenopausal women with CHD. Hot flushes were assessed at
baseline using self-administered questionnaires; women reporting bothersome hot
flushes "some" to "all" of the time were considered to have
clinically significant flushing. Cox regression models were used to examine the
effect of EPT on risk of CHD events among women with and without significant
flushing at baseline. RESULTS:: The mean age of participants was 66.7 +/- 6.8
years, and 89% (n = 2,448) were white. Sixteen percent (n = 434) of
participants reported clinically significant hot flushes at baseline. Among
women with baseline flushing, EPT increased risk of CHD events nine-fold in the
first year compared with placebo (hazard ratio = 9.01; 95% CI, 1.15-70.35);
among women without baseline flushing, treatment did not significantly affect
CHD event risk in the first year (hazard ratio = 1.32; 95% CI, 0.86-2.03; P =
0.07 for interaction of hot flushes with treatment). The trend toward
differential effects of EPT on risk for CHD among women with and without
baseline flushing did not persist after the first year of treatment.
CONCLUSIONS:: Among older postmenopausal women with CHD, EPT may increase risk
of CHD events substantially in the first year of treatment among women with
clinically significant hot flushes but not among those without hot flushes.
Menopause. 2009 Mar 26. [Epub
ahead of print
Hot flushes, coronary heart disease, and hormone therapy in
postmenopausal women.
Huang AJ, Sawaya GF, Vittinghoff E, Lin F, Grady D.
From the
1Departments of Medicine, 2Obstetrics, Gynecology,
and Reproductive Sciences, and 3Epidemiology and Biostatistics, University of
California, San Francisco, CA; and 4General Internal Medicine Section, San
Francisco Veterans Affairs Medical Center, San
Francisco, CA.
OBJECTIVE:: The
aim of this study was to examine interactions between hot flushes, estrogen plus progestogen therapy
(EPT), and coronary heart disease (CHD) events in postmenopausal women with
CHD. METHODS:: We analyzed data from the Heart and Estrogen/Progestin
Replacement Study, a randomized, placebo-controlled trial of 0.625 mg
conjugated equine estrogens plus 2.5 mg medroxyprogesterone
acetate in 2,763 postmenopausal women with CHD. Hot flushes were assessed at
baseline using self-administered questionnaires; women reporting bothersome hot
flushes "some" to "all" of the time were considered to have
clinically significant flushing. Cox regression models were used to examine the
effect of EPT on risk of CHD events among women with and without significant
flushing at baseline. RESULTS:: The mean age of participants was 66.7 +/- 6.8
years, and 89% (n = 2,448) were white. Sixteen percent (n = 434) of
participants reported clinically significant hot flushes at baseline. Among
women with baseline flushing, EPT increased risk of CHD events nine-fold in the
first year compared with placebo (hazard ratio = 9.01; 95% CI, 1.15-70.35);
among women without baseline flushing, treatment did not significantly affect
CHD event risk in the first year (hazard ratio = 1.32; 95% CI, 0.86-2.03; P =
0.07 for interaction of hot flushes with treatment). The trend toward
differential effects of EPT on risk for CHD among women with and without
baseline flushing did not persist after the first year of treatment.
CONCLUSIONS:: Among older postmenopausal women with CHD, EPT may increase risk
of CHD events substantially in the first year of treatment among women with
clinically significant hot flushes but not among those without hot flushes.
Eur J Endocrinol. 2009 Mar 25. [Epub ahead of print
Hormone therapy protects from diabetes: the
Pentti K, Tuppurainen M, Honkanen R, Sandini L, Kroger H, Alhava E, Saarikoski S.
K Pentti, Department of Obstetrics and Gynaecology,
Objectives: The
purpose of this population-based prospective cohort study was to examine the
effect of hormone therapy (HT) on incidence of diabetes (DM). Design and
Methods: 8483 DM free postmenopausal women aged 52-62 from the population-based
OSTPRE-study were followed for 5 years in 1994-1999. Information about use of
HT and health events was obtained from three repeated questionnaires in 1989,
1994 and 1999. DM morbidity before and during the follow-up was obtained from
the Registry of Specially Refunded Drugs of the Finnish Social Insurance
Institution (SII). Kaplan-Meyer survival curves and Cox's proportional-hazards
models were used to estimate the risk of incident DM in relation to the use of
HT. Results: During the follow-up, 40.8 % DM free postmenopausal women had
never used HT, 27.3 % women were HT past users and 31.9 % women had used HT
currently during the follow-up. During the follow-up 162 incident DM cases were
recorded. Compared with never users of HT, the adjusted hazard ratio (HR) of DM
was 0.81 (95% confidence interval (CI) 0.57 to 1.16) for only in the past
users, 0.53 (95% CI 0.24 to 1.15) in part-time (during the follow-up <2.5
years) users and 0.31 (95% CI 0.16 to 0.60) in continuous (during the follow-up
2.5-5.0 years) users of HT. Conclusions: HT use decreases the incidence of
diabetes in postmenopausal women.
Clin Endocrinol
(Oxf). 2009 Mar 6. [Epub
ahead of print
Increased C-reactive protein levels in overweight and obese women taking
exogenous hormones: the
Kwok S, Canoy D, Ashton WD, Lowe GD, Wood D, Humphries SE, Charlton-Menys
V, Durrington PN.
Cardiovascular
Research Group,
Summary Objective:
Women's cardiovascular risk factors, including inflammatory markers such as
C-reactive protein (CRP) which is emerging as a major association with CVD
risk, can be influenced by the oral contraceptive (OC) pill in premenopausal
and hormone replacement (HR) in postmenopausal women and by central adiposity
which is associated with a heightened inflammatory state. The interaction
between central obesity and different hormone use in both pre- and
post-menopausal women has not previously been reported in a study spanning the
whole age range associated with hormone use. Design: Observational,
cross-sectional study. Patients: Healthy women only. Measurements: 21,310 women
aged 30-64 employed by Marks & Spencer participated. They completed a
health questionnaire and were screened for cardiovascular disease (CVD) risk
factors including blood pressure, weight, height, waist and hip circumference,
lipids and lipoproteins, C-reactive protein (CRP) and fibrinogen. Results:
Compared with non-users, women who took the OC or HR had significantly higher
CRP levels. This was more marked than effects on other CVD risk factors. It was
further compounded by the independent effect of increased waist circumference.
The CRP increase was greatest (more than twice that of non-hormone-users) in
premenopausal women with the highest quartile of waist circumference who took
the combined contraceptive pill. Conclusions: Women who received first the
combined OC and then HR may be exposed over much of their life to high CRP
levels aggravated by central obesity. The health consequences of this require
further investigation.
Med Care. 2009 Mar 23. [Epub
ahead of print]
Hormone Replacement Therapy and Cardiovascular Health in the
Shetty KD, Vogt WB, Bhattacharya J.
Veteran's Affairs
Palo Alto, Palo Alto, California. USA
BACKGROUND::
Hormone replacement therapy (HRT) was widely used among postmenopausal women
until 2002 because observational studies suggested that HRT reduced
cardiovascular risk. The Womens' Health Initiative
randomized trial reported opposite results in 2002, which caused HRT use to
drop sharply. OBJECTIVE:: We examine the relationship between HRT use and
cardiovascular outcomes (deaths and nonfatal hospitalizations) in the entire
Obstet Gynecol. 2009
Apr;113(4):902-908
Evidence for a Role of Hot Flushes in Vascular Function in Recently
Postmenopausal Women.
Tuomikoski P, Ebert P, Groop PH, Haapalahti P, Hautamäki H, Rönnback M, Ylikorkala O, Mikkola TS.
Department of
Obstetrics and Gynecology,
OBJECTIVE:
Observational studies indicate that postmenopausal hormone therapy (HT)
prevents cardiovascular disease, but randomized clinical trials have not
confirmed this effect. Hot flushes were more likely to be present in women
starting HT in observational studies, whereas these symptoms were mild or
absent among women attending randomized clinical trials. We hypothesized that
vascular function may differ in women with and without vasomotor hot flushes.
METHODS: One hundred forty-three recently postmenopausal women showing a broad
range of variation in hot flushes were studied with radial artery tonometry. Pulse wave analyses were assessed at baseline
and after nitroglycerin and salbutamol
challenges. Wilcoxon signed rank test was used for
paired comparisons after challenges with nitroglycerin
and salbutamol. RESULTS: Neither baseline arterial
stiffness nor endothelial function differed between women without or with mild,
moderate, or severe hot flushes. However, after nitroglycerin
challenge, the time to the onset of the reflected wave (dependent on pulse wave
velocity) was 9.5% longer (P=.014), and the time to the first systolic peak
(dependent on the rapid phase of ventricular ejection) was 13.9% longer
(P=.025) in women with severe hot flushes as compared with asymptomatic women.
CONCLUSION: Women with severe vasomotor hot flushes show greater vascular
responsiveness to nitroglycerin than women without
hot flushes. This may partially explain the conflicting data between
observational and randomized HT studies.