Selección de Resúmenes de Menopausia
Semana del 2 al 8 de Septiembre
de 2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de
Chile
Climacteric. 2009 Sep 2:1-8. [Epub
ahead of print]
Risk of hypoactive
sexual desire disorder and associated factors in a cohort of oophorectomized women.
Castelo-Branco C, Palacios S, Combalia J, Ferrer M, Traveria G.
Hospital
Clinic, Faculty of Medicine, University of
Background
Women with surgical menopause are at high risk of developing hypoactive sexual
desire disorder (HSDD), which may cause sexual and emotional discomfort. Aim To
determine the prevalence of HSDD and related risk factors in Spanish surgically
postmenopausal women.
Climacteric. 2009 Sep 1:1-11. [Epub
ahead of print]
Risk of gynecological cancers in users of estradiol/dydrogesterone
or other HRT preparations.
Schneider C, Jick SS, Meier CR.
Objectives
Use of postmenopausal hormone replacement therapy (HRT) has been associated
with an elevated risk of gynecological cancers. There
is evidence that the effect differs with the type of hormone used. Dydrogesterone is pharmacologically very similar to
progesterone. Methods We used the UK-based General
Practice Research Database (GPRD) to conduct a follow-up study with a nested
case-control analysis. We assessed and compared the risk of developing breast,
ovarian, endometrial/uterine or cervical cancer in estradiol/dydrogesterone
(E/D) users, users of other HRT, or non-users of HRT. Results The breast cancer incidence rates were 2.41 (95% confidence
interval (CI) 1.81-3.15), 3.28 (95% CI 3.01-3.55) and 3.16 (95% CI 2.92-3.42)
per 1000 person-years for E/D users, users of other HRT or non-users,
respectively. In a direct comparison, the breast cancer risk for E/D users was
lower than for users of other HRT (odds ratio 0.76, 95% CI 0.56-1.05). The
incidence rates of other gynecological cancers were
similar or also slightly lower for E/D users than for users of other HRT.
Conclusion This study provides evidence that the risk of developing gynecological cancers with E/D use of several months to a
few years is similar to the risks of developing gynecological
cancer without HRT or use of other HRT.
Climacteric. 2009 Sep 1:1-10. [Epub ahead of print]
Comparative effects of conventional hormone
replacement therapy and tibolone on climacteric
symptoms and sexual dysfunction in postmenopausal women.
Ziaei S, Moghasemi M, Faghihzadeh S.
Departments
of Obstetrics & Gynecology.
Objective
To compare the effects of tibolone with those of
conventional hormone replacement therapy on climacteric symptoms and sexual
function in postmenopausal women. Materials and methods In a randomized,
controlled trial, 140 postmenopausal women were allocated into three groups. Of
the subjects included, 47 women received 2.5 mg tibolone
+ one Cal+D tablet (500 mg calcium and 200 IU vitamin
D) daily; 46 women received 0.625 mg conjugated equine estrogen
+ 2.5 mg medroxyprogesterone (CEE/MPA) + one Cal+D tablet daily; and 47 women received only one Cal+D tablet as the control group. The Greene Climacteric
Scale (GCS) questionnaire was used to detect the efficacy of treatment on
climacteric symptoms. Rosen's Female Sexual Function Index (FSFI) was used for
sexual function evaluation. Sex hormone binding globulin (SHBG), free estradiol index (FEI) and free testosterone index (FTI)
were measured before and after treatment. The women were followed up for 6
months Results After treatment, all subscores in the
GCS improved in the tibolone and CEE/MPA groups (p
< 0.01), except the sexual subscore in the CEE/MPA
group, compared with baseline. There were significant differences in the FSFI
in the tibolone and CEE/MPA groups in comparison to
the control group after treatment. Tibolone, in
comparison to CEE/MPA, significantly lowered SHBG levels and increased the FTI
and FEI and improved the desire, arousal and orgasm sexual domains of the FSFI
(p < 0.001). Conclusion Tibolone may be an
alternative to conventional hormone replacement therapy in the treatment of
climacteric symptoms and sexual dysfunction in postmenopausal women.
Arch Womens Ment Health. 2009 Sep 4. [Epub ahead of print]
Association between depressive symptoms and
reproductive variables in a group of perimenopausal
women attending a menopause clinic in
Flores-Ramos M, Heinze G, Silvestri-Tomassoni R.
Psychiatry and Mental Health Department, Universidad Nacional Autónoma de México (UNAM),
Soledad 25-2, Col. Florida, CP 01030, México, D.F,
México, flores_ramos@hotmail.com.
The aim
of this study was to explore the association between depressive symptoms and
some variables related to the reproductive life, such as history of
premenstrual dysphoric disorder, antecedent of
postpartum depression, previous use of hormonal contraceptives, and current hot
flushes, in a group of perimenopausal women attending
a menopause clinic. Perimenopausal women, 45 to 55
years old, who had not received hormonal replacement therapy and/or
psychotropic medication, were invited to participate in this study. 141 perimenopausal women were included; we obtained their
psychiatric and gynecological data, and we evaluated
their depressive symptomatology using the CES-D
scale. There were a significantly higher number of cases of previous depressive
episodes, PMDD and PPD history in depressed patients compared with
non-depressed women; current hot flushes prevalence was similar between
depressed and non-depressed women. Patients with a PMDD history were more
likely to have experienced previous depressive episodes, a PPD history, and
high levels of depression. Variables associated with the level of depression
were a previous history of PMDD, current hot flushes, and previous depressive
episodes. The occurrence of perimenopausal depression
is related to a previous history of PMDD, PPD, and depressive episodes; hot
flushes only increase the severity of the depressive episode.
Menopause. 2009 Aug 27. [Epub ahead of print]
Burden associated with chronic sleep
maintenance insomnia characterized by nighttime
awakenings among women with menopausal symptoms.
Bolge SC, Balkrishnan R, Kannan H, Seal B, Drake CL.
From
the 1Consumer Health Sciences, Princeton, NJ; 2Schools of Pharmacy and Public
Health, The University of Michigan, Ann Arbor, MI;
3Sanofi-Aventis, Bridgewater, NJ; and 4Henry Ford Hospital Sleep Center and Psychiatry and Behavioral
Neurosciences, Wayne State College of Medicine, Detroit, MI.
OBJECTIVE::
The aim of this study was to quantify the burden associated with chronic sleep
maintenance insomnia characterized by nighttime
awakenings (CINA) among women with menopausal symptoms. METHODS:: Data were
obtained from the 2006 US National Health and Wellness Survey, an annual
cross-sectional study of US adults 18 years or older. Analyses were limited to
female respondents currently experiencing symptoms of menopause. The definition
of CINA was experiencing nighttime awakenings at
least twice per week for more than 1 month that have moderate to severe impact
on daily life and not experiencing difficulty falling asleep. No insomnia was
defined as not self-reporting insomnia, sleep difficulties, or sleep symptoms.
Outcomes included resource utilization in the past 6 months, Work Productivity
and Activity Impairment questionnaire, and Medical Outcomes Study Short-Form
Health Survey (SF-8). Linear regression models were developed to assess the
independent associations of CINA on outcomes, while adjusting for demographics
and comorbidity. RESULTS:: Among women with
menopausal symptoms, 141 met the criteria for CINA and 1,305 met the criteria
for no insomnia. Adjusting for demographics and comorbidity,
those experiencing CINA had 0.1 (P = 0.041) more emergency department visits,
20.8% (P < 0.001) greater activity impairment, and SF-8 physical and mental
summary scores that were 4.7 (P < 0.001) and 5.4 (P < 0.001) points,
respectively, lower than those of women who are not experiencing insomnia.
Among women with menopausal symptoms employed full-time, those experiencing
CINA had greater impairment while working (presenteeism;
17.3%, P < 0.001) and overall (16.1%, P < 0.001) than did those who are
not experiencing insomnia. CONCLUSIONS:: Among women with menopausal symptoms,
CINA in relative isolation was associated with a significant negative impact on
healthcare utilization and its associated costs, health-related quality of
life, and work productivity.
Arch Womens Ment Health. 2009 Sep 3. [Epub ahead of print]
Neuroactive
steroids after estrogen exposure in depressed
postmenopausal women treated with sertraline and
asymptomatic postmenopausal women.
Morgan ML, Rapkin AJ, Biggio G, Serra M, Pisu MG, Rasgon N.
Department
of Obstetrics and Gynecology, David Geffen School of
Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA, 90095-1740, USA.
Neuroactive steroids (NAS) allopregnanolone
(ALLO), Allotetrahydrodeoxycorticosterone (THDOC) and
dehydroepiandrosterone (DHEA) are important in the
regulation of mood and behavior. Knowledge
about these steroids in postmenopausal depression and the effect of estrogen on NAS is lacking. We elected to determine if
there were differences in NAS between postmenopausal depressed women and age
matched controls. We also investigated the effect of estradiol
on NAS in post menopausal depressed women receiving a selective serotonin
reuptake inhibitor (SSRI), and in non-depressed postmenopausal controls. As
part of a previously published double blind study on estrogen
acceleration of antidepressant action, post menopausal women with major
depression receiving sertraline and healthy non
depressed controls were randomized to transdermal estrogen patch 0.1 mg or placebo. NAS were measured at
baseline and after 10 weeks of treatment. Depressed subjects were treated with sertraline 50 mg/day to 100 mg/day for 9 weeks. At the
baseline and after treatment ALLO and DHEA were significantly lower in
depressed women compared to controls. Although all depressed subjects
experienced a positive clinical response, estrogen
administration was not associated with changes in NAS in either the depressed
or the asymptomatic postmenopausal women. The lower ALLO and DHEA in
postmenopausal depressed women suggests that symptoms of depression may be
influenced by the synthesis or fluctuation of these NAS. Estradiol
exposure did not alter ALLO, DHEA, or THDOC, implying these NAS are unlikely to
play a role in any mood changes in post menopausal women given estrogen therapy.
Osteoporos Int. 2009 Sep 1. [Epub ahead of print]
Impact of supplementation with bicarbonate
on lower-extremity muscle performance in older men and women.
Dawson-Hughes B, Castaneda-Sceppa C, Harris SS, Palermo NJ, Cloutier G, Ceglia L, Dallal GE.
Jean
Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, USA,
Bess.Dawson-Hughes@Tufts.edu.
This
study describes the impact of bicarbonate treatment for 3 months on net acid
excretion (NAE), nitrogen excretion, and muscle performance in older men and
women. Bicarbonate reduced NAE, and the decrement was associated with a
decrease in nitrogen excretion. Treatment also improved muscle power and
endurance in the women. INTRODUCTION: Bicarbonate enhances muscle performance
during strenuous exercise, but its effect on performance during normal activity
in older subjects is unknown. METHODS: In this trial, healthy subjects age 50
and older were randomized to 67.5 mmol of bicarbonate
or to no bicarbonate daily for 3 months. Changes in lower-extremity muscle
power, endurance, urinary nitrogen, and NAE were compared across treatment
groups in the 162 participants included in the analyses. RESULTS: In the men
and the women, bicarbonate was well tolerated, and as expected, it
significantly decreased NAE. The change in NAE correlated with change in
nitrogen excretion in women (r = 0.32, P = 0.002) with a similar trend in men
(r = 0.23, P = 0.052). In the women, bicarbonate increased double leg press
power at 70% one repetition maximum by 13% (P = 0.003) compared with no
bicarbonate and improved other performance measures. Treatment with bicarbonate
had no significant effect on muscle performance in the men. CONCLUSIONS:
Ingestion of bicarbonate decreased nitrogen excretion and improved muscle
performance in healthy postmenopausal women. The bicarbonate-induced decline in
NAE was associated with reduced nitrogen excretion in both men and women. These
findings suggest that bicarbonate merits further evaluation as a safe, low-cost
intervention that may attenuate age-related loss of muscle performance and mass
in the elderly.
Selección de Resúmenes
de Menopausia
Semana del 9 al 15 de Septiembre
de 2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de Chile
Clin Endocrinol
(Oxf). 2009 Sep 10. [Epub
ahead of print]
Reducing fracture risk with calcium and vitamin D.
Lips P, Bouillon R, van
Department of Endocrinology and EMGO
Institute for Health and Care Research, VU
SUMMARY Studies of vitamin D and calcium
for fracture prevention have produced inconsistent results, due to different
vitamin D status and calcium intake at baseline, different doses and poor to
adequate compliance. This article tries to define the types of patients, both
at risk of osteoporosis and with established disease, who may benefit from
calcium and vitamin D supplementation. The importance of adequate compliance in
these individuals is also discussed. Calcium and vitamin D therapy has been
recommended for older persons, either frail and institutionalized or
independent, with key risk factors including decreased bone mineral density,
osteoporotic fractures, increased bone remodeling due to secondary
hyperparathyroidism and increased propensity to falls. In addition, treatment of
osteoporosis with a bisphosphonate was less effective
in patients with vitamin D deficiency. Calcium and vitamin D supplementation is
a key component of prevention and treatment of osteoporosis unless calcium
intake and vitamin D status are optimal. For primary disease prevention,
supplementation should be targeted to those with dietary insufficiencies.
Several serum 25-hydroxyvitamin D (25(OH)D) cut-offs have been proposed to
define vitamin D insufficiency (as opposed to adequate vitamin D status), ranging
from 30 to 100 nmol/l. Based on the relationship
between serum 25(OH)D, bone mineral density, bone turnover, lower extremity
function and falls, we suggest that 50 nmol/l is the
appropriate serum 25(OH)D threshold to define vitamin D insufficiency. Supplementation
should therefore generally aim to increase 25(OH)D levels within the 50-75 nmol/l range. This level can be achieved with a dose of 800
IU/day vitamin D, the dose that was used in succesfull
fracture prevention studies to date; a randomized clinical trial assessing
whether higher vitamin D doses achieve a greater reduction of fracture
incidence would be of considerable interest. As calcium balance is not only
affected by vitamin D status but also by calcium intake, recommendations for
adequate calcium intake should also be met. The findings of community-based
clinical trials with vitamin D and calcium supplementation in which compliance
was moderate or less have often been negative, whereas studies in
institutionalized patients in whom medication administration was supervised
ensuring adequate compliance demonstrated significant benefits.
Menopause. 2009 Sep 9. [Epub
ahead of print]
Hyperinsulinemia in nonobese
women reporting a moderate weight gain at the beginning of menopause: a useful
early measure of susceptibility to insulin resistance.
OBJECTIVE:: At menopause, the frequent
weight gain excess could be related to insulin resistance. This study evaluated
the prevalence of hyperinsulinemia in nonobese women reporting a moderate increase in weight at
the beginning of menopause. METHODS:: Women who were postmenopausal for 1 to 5
years and reporting a weight gain of 5 to 15 kg were evaluated for weight,
eating habits, physical activity, body circumferences, fasting blood glucose
level, insulin level, and lipid profile. An oral glucose tolerance test was
performed in subgroups of 21 hyperinsulinemic women
and 21 normoinsulinemic women matched for age,
weight, height, body mass index, and hysterectomy. RESULTS:: Among 279
postmenopausal women reporting a weight gain of 8.7 +/- 4.4 kg, insulin level
was increased in 49 (17.6%) women as compared with normoinsulinemic
women (108.53 +/- 31.35 vs 58.96 +/- 14.52 pmol/L, respectively; P < 0.001). Differences were also
found for glucose (5.24 +/- 0.37 vs 5.05 +/- 0.42 mmol/L, respectively; P = 0.003), insulin resistance as
estimated by homeostasis model assessment HOMA-2-IR (2.01 +/- 0.53 vs 1.10 +/- 0.27, respectively; P < 0.001), weight (72.6
+/- 8.0 vs 69.9 +/- 7.1 kg, respectively; P = 0.023),
body mass index (28.3 +/- 2.3 vs 27.2 +/- 2.3 kg/m,
respectively; P = 0.003), and waist circumference (89.8 +/- 5.8 vs 86.0 +/- 6.5 cm, respectively; P < 0.001).
Triglyceride levels were higher (1.47 +/- 0.66 vs
1.17 +/- 0.61 mmol/L, respectively; P = 0.002) and
high-density lipoprotein cholesterol level was lower (1.54 +/- 0.35 vs 1.72 +/- 0.42 mmol/L,
respectively; P = 0.007) in the hyperinsulinemic and normoinsulinemic groups. Although insulin levels were
higher in 21 hyperinsulinemic women at all times that
oral glucose tolerance tests were performed, levels of glucose were also above
those of 21 matched normoinsulinemic women at 1 and 2
hours and remained greater than 6.0 mmol/L at 2
hours. CONCLUSIONS:: Because insulin resistance is frequently associated with
weight gain in nonobese women at menopause, the
measurement of fasting insulin, along with glucose, lipids, and waist
circumference, may help to identify those who are at higher risk of developing
glucose intolerance, metabolic syndrome, diabetes, and cardiovascular diseases
and to implement early preventive measures.
Ann Rheum Dis. 2009 Sep 9. [Epub
ahead of print]
Hormonal replacement therapy may reduce the risk for
RA in women with early arthritis who carry HLA-DRB1 *01 and/or *04 alleles by
protecting against the production of anti-CCP: Results from the ESPOIR cohort.
Salliot C, Bombardier C, Saraux A, Combe B, Dougados M.
Rheumatology B,
OBJECTIVE: To assess the effect of
reproductive factors, especially hormonal replacement therapy (HRT) and its
interaction with HLA-DRB1 *01 and/or *04 alleles on the diagnosis of RA and the
presence of anti-CCP in women included in the ESPOIR cohort (early arthritis
cohort). METHODS: 568 patients were included in the analyses. Analyses were
performed using logistic regression. RESULTS: HRT would reduce the risk for RA
due to the HLA-DRB1 *01 and/or *04 alleles: from OR=1.88 (95%CI 1.32-2.68,
p<0.000) for HLA-DRB1 *01 and/or *04 alleles alone to OR=1.07 (0.51-2.26,
p=0.85) in women who carry HLA-DRB1 *01 and/or *04 alleles and who received a
HRT. One explanation would be the protective effect of HRT on the presence of
anti-CCP (OR=0.43, 95%CI 0.24-0.77, p<0.006). Other reproductive factors
such as the number of pregnancies, menopause, and age of the menopause, age of
the menarche and a history of pregnancy with poor outcome were not associated
with the diagnosis of RA and the presence of anti-CCP. CONCLUSION: HRT may
reduce the risk of RA due to HLA-DRB1 *01 and/or *04 alleles by protecting
against the production of anti-CCP.
Med J Aust. 2009 Sep 7;191(5):263-6.
Is reflexology an effective intervention? A systematic
review of randomised controlled trials.
Ernst E.
Complementary Medicine,
OBJECTIVE: To evaluate the evidence for
and against the effectiveness of reflexology for treating any medical
condition. DATA SOURCES: Six electronic databases were searched from their
inception to February 2009 to identify all relevant randomised
controlled trials (RCTs). No language restrictions
were applied. STUDY SELECTION AND DATA EXTRACTION: RCTs
of reflexology delivered by trained reflexologists to
patients with specific medical conditions. Condition studied, study design and
controls, primary outcome measures, follow-up, and main results were extracted.
DATA SYNTHESIS: 18 RCTs met all the inclusion
criteria. The studies examined a range of conditions: anovulation,
asthma, back pain, dementia, diabetes, cancer, foot oedema
in pregnancy, headache, irritable bowel syndrome, menopause, multiple
sclerosis, the postoperative state and premenstrual syndrome. There were > 1
studies for asthma, the postoperative state, cancer palliation and multiple
sclerosis. Five RCTs yielded positive results.
Methodological quality was evaluated using the Jadad
scale. The methodological quality was often poor, and sample sizes were
generally low. Most higher-quality trials did not generate positive findings.
CONCLUSION: The best evidence available to date does not demonstrate
convincingly that reflexology is an effective treatment for any medical
condition.
Maturitas. 2009 Sep 4. [Epub
ahead of print]
Premature menopause or early menopause: Long-term
health consequences.
Shuster LT, Rhodes DJ, Gostout
BS, Grossardt BR, Rocca WA.
Womens Health Clinic,
Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester,
MN 55905, USA.
OBJECTIVE: To review and summarize current
evidence on the health consequences of premature menopause and early menopause.
METHODS: We reviewed existing literature and combined graphically some results
from the Mayo Clinic Cohort Study of Oophorectomy and
Aging. RESULTS: Premature menopause or early menopause may be either
spontaneous or induced. Women who experience premature menopause (before age 40
years) or early menopause (between ages 40 and 45 years) experience an
increased risk of overall mortality, cardiovascular diseases, neurological
diseases, psychiatric diseases, osteoporosis, and other sequelae.
The risk of adverse outcomes increases with earlier age at the time of
menopause. Some of the adverse outcomes may be prevented by estrogen treatment
initiated after the onset of menopause. However, estrogen alone does not
prevent all long-term consequences, and other hormonal mechanisms are likely
involved. CONCLUSIONS: Regardless of the cause, women who experience hormonal
menopause and estrogen deficiency before reaching the median age of natural
menopause are at increased risk for morbidity and mortality. Estrogen treatment
should be considered for these women, but may not eliminate all of the adverse
outcomes.
J Clin
Densitom. 2009 Sep 4. [Epub
ahead of print]
25-Hydroxyvitamin D Measurement, 2009: A Review for
Clinicians.
Binkley N, Krueger D, Lensmeyer
G.
Osteoporosis Clinical Center and Research
Program,
As clinicians are more widely appreciating
the endemic nature of low vitamin D status, measurement of serum
25-hydroxyvitamin D (25(OH)D), the accepted measure of vitamin D status, has
increased. Challenges to 25(OH)D measurement include the presence of 2 forms of
vitamin D-ergocalciferol and cholecalciferol
(vitamin D(2) and vitamin D(3), respectively)- and the hydrophobic nature of
vitamin D. The current state of 25(OH)D measurement is reviewed; modest
differences between methodologies persist and confound the application of a
single cut point (e.g., 30ng/mL/75nmol/L) for the diagnosis of low vitamin D
status. The absence of standard calibrators contributes to between-laboratory
differences in 25(OH)D measurement. Until there is improved assay
standardization and subsequent evidence-based consensus, it seems premature to
recommend widespread screening 25(OH)D measurement. Selectively obtaining
25(OH)D measurement in individuals at clinical risk for vitamin D deficiency
and/or those most likely to promptly experience benefits from supplementation
seems appropriate.
Selección de Resúmenes
de Menopausia
Semana del 16 al 22 de
Septiembre de 2009
Juan Enrique
Blümel. Departamento Medicina Sur. Universidad de Chile
Obesity
(Silver Spring). 2009 Sep 17. [Epub
ahead of print]
Estrogen Reduces
11beta-Hydroxysteroid Dehydrogenase Type 1 in Liver
and Visceral, but Not Subcutaneous, Adipose Tissue in Rats.
Andersson T, Söderström I, Simonyté K, Olsson T.
Department of Public Health and
Clinical Medicine, Medicine,
Following menopause, body fat is
redistributed from peripheral to central depots. This may be linked to the age
related decrease in estrogen levels. We hypothesized that estrogen
supplementation could counteract this fat redistribution through
tissue-specific modulation of glucocorticoid
exposure. We measured fat depot masses and the expression and activity of the glucocorticoid-activating enzyme 11beta-hydroxysteroid dehydrogenase type 1 (11betaHSD1) in fat and liver of ovariectomized female rats treated with or without
17beta-estradiol. 11betaHSD1 converts inert cortisone, or
11-dehydrocorticosterone in rats into active cortisol
and corticosterone. Estradiol-treated
rats gained less weight and had significantly lower visceral adipose tissue
weight than nontreated rats (P < 0.01);
subcutaneous adipose weight was unaltered. In addition, 11betaHSD1
activity/expression was downregulated in liver and
visceral, but not subcutaneous, fat of estradiol-treated
rats (P < 0.001 for both). This downregulation
altered the balance of 11betaHSD1 expression and activity between adipose
tissue depots, with higher levels in subcutaneous than visceral adipose tissue
of estradiol-treated animals (P < 0.05 for both),
opposite the pattern in ovariectomized rats not
treated with estradiol (P < 0.001 for mRNA
expression). Thus, estrogen modulates fat distribution, at least in part,
through effects on tissue-specific glucocorticoid
metabolism, suggesting that estrogen replacement therapy could influence
obesity related morbidity in postmenopausal women.
Nutr Res. 2009 Aug;29(8):525-530.Links
Low serum
25-hydroxyvitamin D concentrations are associated with greater all-cause
mortality in older community-dwelling women.
Department of
Ophthalmology and the Department of Medicine, The Johns Hopkins University
School of Medicine, Baltimore, Maryland, MD 21287, USA; Section on Gerontology
and Geriatric Medicine, Department of Internal Medicine, Wake Forest
University, Winston-Salem, NC 27157, USA; Longitudinal Studies Section,
National Institute on Aging, Baltimore, MD 21225, USA; Division of Endocrinology,
Diabetes, and Metabolism, University of Pennsylvania School of Medicine,
Philadelphia, PA 19104, USA; Epidemiology and Demography Section, Laboratory of
Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda,
MD 20892, USA; Mailman School of Public Health, Columbia University, New York,
NY 10032, USA.
Vitamin D
deficiency is associated with osteoporosis, poor muscle strength, falls, and
fractures. The relationship between serum vitamin D concentrations and
mortality in older community-dwelling women has not been well characterized. We
hypothesized that women with lower 25-hydroxyvitamin D (25[OH]D) concentrations
were at higher risk of mortality. We examined the association between serum
25[OH]D concentrations and all-cause mortality in a prospective,
population-based study of 714 community-dwelling women, aged 70 to 79 years,
the Women's Health and Aging Studies I and II in
Menopause. 2009 Sep 11. [Epub ahead of
print]
Submaximal exercise coronary artery flow increases in
postmenopausal women without coronary artery disease after estrogen and atorvastatin.
Puntawangkoon C, Morgan TM, Herrington DM, Hamilton CA, Hundley WG.
From the
Departments of 1Internal Medicine, Cardiology Section, 2Public Health Sciences,
3Biomedical Engineering, and 4Radiology,
OBJECTIVE:: The
aim of this study was to determine the effect of statins
and hormone therapy on submaximal exercise-induced
coronary artery blood flow in postmenopausal women without a history of
coronary artery disease. Hormone therapy or statin
therapy in early postmenopausal women without coronary artery disease has been
shown to enhance arterial endothelial function; we hypothesized that these
agents would improve submaximal exercise-induced
coronary artery blood flow. METHODS:: Sixty-four postmenopausal women, aged 50
to 65 years without documented coronary artery disease, were randomized in a
double-blind, crossover fashion to receive 8 weeks of hormone therapy versus
placebo, with or without 80 mg/day of atorvastatin.
Before receipt of any therapy and after each treatment period, each woman
underwent measures of coronary artery blood flow at rest and stress. RESULTS::
The combination of hormone therapy and atorvastatin
increased submaximal exercise-induced coronary artery
blood flow (P = 0.04). In the subgroups of women compliant with treatment,
resting coronary artery blood flow increased in those receiving hormone therapy
(P = 0.03) or statin therapy (P = 0.02). CONCLUSIONS::
In postmenopausal women aged 50 to 65 years without documented coronary artery
disease, resting and submaximal exercise-induced
coronary artery blood flow improves after receipt of high-dose atorvastatin and conjugated estrogens therapy.
Urol Int. 2009;83(2):226-9. Epub 2009
Sep 10.
Alendronate reduces the excretion of risk factors for
calcium phosphate stone formation in postmenopausal women with osteoporosis.
Yasui T, Itoh Y, Okada A, Hamamoto S, Hirose M, Kobayashi T, Tozawa K, Kohri K.
Department of Nephro-urology, Nagoya City University Graduate School of
Medical Sciences,
OBJECTIVE:
Osteoporosis is associated with the pathogenesis and risk of urolithiasis, which is higher among postmenopausal women
(as opposed to premenopausal). Bisphosphonates
potently inhibit bone resorption, and are used in the
management of bone disease. We investigated the ability of a bisphosphonate to prevent calcium stone formation. METHODS:
We studied 12 postmenopausal women (63.8 +/- 7.3 years) who were not receiving
osteoporosis therapy, and had stones comprised of calcium phosphate (CaP; n = 3), calcium oxalate (CaOx;
n = 3) and CaP + CaOx (n =
6). We measured bone mineral density (BMD), serum and urinary values in 24-hour
urine specimens before and 3 months after the oral administration of 5 mg/day
of alendronate (ALN). The indexes of the ionic
activity product of calcium oxalate, AP(CaOx), and of
calcium phosphate, AP(CaP), were estimated using the Tiselius method. RESULTS: ALN significantly reduced the AP(CaP) index (1.53 +/- 1.37 to 0.89 +/- 0.81, p <0.05).
Urinary calcium, oxalate, phosphate and the AP(CaOx)
index did not significantly change. BMD improved in 11 of the 12 patients.
Urinary stones did not develop in any of the patients during the course of the
study. CONCLUSION: The results suggested that ALN not only improves BMD and
osteoporosis, but also reduces the risk of calcium phosphate stone formation in
postmenopausal women.
J Clin Oncol. 2009 Sep 14. [Epub ahead of
print]
Estrogen-Progestagen Menopausal Hormone Therapy and Breast Cancer:
Does Delay From Menopause Onset to Treatment Initiation Influence Risks?
Fournier A, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F.
Institut National
de la Santé et de la Recherche
Médicale; Université Paris-Sud, Villejuif, France.
PURPOSE: To
investigate whether the relation between estrogen-progestagen
menopausal hormone therapy (EP-MHT) and breast cancer risk varies according to
the delay between menopause onset and treatment initiation. Participants and
METHODS: Between 1992 and 2005, 1,726 invasive breast cancers were identified
among 53,310 postmenopausal women from the French E3N cohort (mean duration of
follow-up, 8.1 years). Hazard ratios (HRs) and CIs were estimated using Cox models, with MHT never users
as the reference. RESULTS: Among recent users of EP-MHT, the risk of breast
cancer varied according to the timing of treatment initiation. This variation
was confined to short durations of use (</= 2 years): the HR was 1.54 (95%
CI, 1.28 to 1.86) for short treatments initiated in the 3-year period following
menopause onset and 1.00 (95% CI, 0.68 to 1.47) for short treatments initiated
later (P = .04 for homogeneity). However, this pattern of risks was not
observed in users of EP-MHT containing progesterone, among whom there was no
significantly increased risk associated with short duration of use (HR was 0.87
[95% CI, 0.57 to 1.32] for treatments initiated </= 3 years after menopause,
and HR was 0.90 [95% CI, 0.45 to 1.81] for treatments initiated later). Longer
durations of EP-MHT use were generally associated with increases in breast
cancer risk, whatever the gap time. CONCLUSION: Our results suggest that, for
some EP-MHT, the timing of treatment initiation transiently modulates the risk
of breast cancer and that, when initiated close to menopause, even short
durations of use are associated with an increased breast cancer risk. Estrogen
+ progesterone combinations might be an exception in this regard.
Fertil Steril. 2009 Sep 10. [Epub
ahead of print]
Discontinuation of
hormone therapy in the French GAZEL cohort 1990-2006.
Ringa V, Fritel X, Varnoux N, Zins M, Quelen C, Bouyer J.
Institut National d'Etudes Démographiques (INED),
Le Kremlin-Bicêtre, France; Institut
National de la Santé et de la Recherche Médicale (INSERM), Le Kremlin-Bicêtre,
France; University Paris-Sud 11, Faculté
de médecine Paris-Sud, Bicêtre Hospital, Le Kremlin-Bicêtre,
France.
OBJECTIVE: To
analyze changes in hormone therapy (HT) use after the publication of the
Women's Health Initiative (WHI) results, in a country (
Lancet. 2009 Sep 18. [Epub
ahead of print]
Oestrogen plus progestin and
lung cancer in postmenopausal women (Women's Health Initiative trial): a
post-hoc analysis of a randomised controlled trial.
Chlebowski RT, Schwartz
AG, Wakelee H, Anderson
GL, Stefanick ML, Manson JE, Rodabough RJ, Chien JW, Wactawski-Wende J, Gass M, Kotchen JM, Johnson KC, O'Sullivan
MJ, Ockene JK, Chen C, Hubbell FA; for the
Women's Health Initiative Investigators.
BACKGROUND: In the post-intervention
period of the Women's Health Initiative (WHI) trial, women assigned to
treatment with oestrogen plus progestin had a higher
risk of cancer than did those assigned to placebo. Results also suggested that
the combined hormone therapy might increase mortality from lung cancer. To
assess whether such an association exists, we undertook a post-hoc analysis of
lung cancers diagnosed in the trial over the entire follow-up period. METHODS:
The WHI study was a randomised, double-blind, placebo-controlled
trial undertaken in 40 centres in the