Osteoporosis and Coronary Atherosclerosis in Asymptomatic Postmenopausal Women

Estrogen deficiency is a risk factor for osteoporosis and coronary artery disease. Osteoporosis can be evaluated by measuring bone mineral density (BMD). Coronary atherosclerotic burden can be evaluated by measuring coronary calcium using electron beam computed tomography (EBT) of the heart. We compared coronary calcium scores in 45 asymptomatic postmenopausal women with normal and low BMD. BMD of the lumbar spine and proximal femur was measured by dual X-ray absorptiometry (DXA), and coronary calcium was measured quantitatively by EBT. Women were divided into control, osteopenia, and osteoporosis groups based on the T score of the lumbar spine. Women were similar in age, years since menopause, height, weight, and body mass index (BMI). BMD ± SD (g/cm²) of L1–L4 was 0.96 ± 0.11, 0.83 ± 0.03, and 0.73 ± 0.05, in control, osteopenia, and osteoporosis group, respectively. The total coronary calcium score ± SD (relative units) was 41.9 ± 83.1, 115.1 ± 181.9, and 221.7 ± 355.4 for control, osteopenia, and osteoporosis group, respectively; the score was significantly higher in the osteoporosis than in the control group. This study provides initial data suggesting that women with osteoporosis may have a higher risk of developing coronary atherosclerosis.     

绝经后阴道出血的相关因素分析

目的探讨绝经后阴道出血的病因及相关因素。方法对129例绝经后阴道出血患者的临床资料进行回顾性分析。结果因良性疾病引起的出血占51.16%,非器质性疾病占25.58%,恶性肿瘤占23.26%,患者出血时年龄大,绝经年限长恶性肿瘤发生率高。结论绝经后阴道出血的主要原因是良性疾病和非器质性病变,但恶性肿瘤仍占一定比例。因此对绝经后阴道出血患者应采取综合的检查手段,明确病因,对因治疗。     

Effects of tibolone on body composition in postmenopausal women: a 1-year follow up study

Objective: We investigated the effects of 1-year tibolone treatment on body weight, body composition and indices of android obesity in postmenopausal women.

Methods: Forty-four postmenopausal women participated in this open-label controlled study; mean age was 51.8 ± 2.21 years and all women were menopausal for 3.8 ± 1.40 years. Twenty-two of them started taking 2.5 mg tibolone (TIB) daily for 1 year, whereas the remaining 22 served as age-matched controls. All subjects underwent a structured interview, physical examination, body composition measurements performed by dual-energy X-ray absorptiometry (DXA) — Hologic QDR 4500 A, as well as bioelectrical body impedance analysis (BI) — Tanita TBF-215, Japan.

Results: The TIB group did not significantly increase their weight (+0.4 kg), while the non-treated controls increased their mean weight by 1.4 kg (p = 0.046). In the TIB group, DXA showed a non-significant body fat decrease by a mean of 0.5 kg and a non-significant lean mass increase by 0.8 kg, while in the control group, fat mass increased by 1.7 kg (p = 0.032) and lean mass did not change. BI revealed that the TIB group had lost some fat (≈0.6 kg, n.s.) and put some free-fat mass (≈1.0 kg, p = 0.048) without changes in total body water. The control group put on some fat (≈1.1 kg, p = 0.042) and lost some body water (≈0.4 kg, n.s.).

Conclusion: Results from both methods of measuring body composition show a similar trend: a decrease in fat mass and an increase in lean mass in TIB treated subjects. From the body composition perspective, tibolone may be regarded as a preferential alternative to conventional hormonal therapy (HT) in postmenopausal women.     

Association between Osteoporotic Vertebral Compression Fractures and Age,Bone Mineral Density,and European Quality of Life-5 Dimensions in Korean Postmenopausal Women: A Nationwide Cross-sectional Observational Study

BackgroudThe purpose of this study was to investigate the characteristics of osteoporotic vertebral compression fractures (OVCFs) in Korean postmenopausal women and the association between OVCFs and clinical factors such as age, bone mineral density (BMD), and quality of life.MethodsAccording to the population distribution in four regions in Korea, 1,281 postmenopausal female patients were recruited from nationwide orthopedic outpatient clinics. Radiologic, asymptomatic, and within 3 months of OVCF groups were analyzed based on age, fracture location, and prevalence according to BMD. In addition, BMD, T-score, body mass index, and European Quality of Life-5 Dimensions (EQ-5D) were investigated in the three groups, and the differences between groups were compared and analyzed.ResultsThe prevalence of radiologic OVCFs at the T11–L1 was 3.7 times higher in the 70s group (44.0%) than in the 50s group (11.9%). Femur and total hip BMD were significantly lower in patients with thoracolumbar junction fractures than in patients with L2–5 fractures, whereas no difference was observed in lumbar spine BMD. Of the three OVCF groups, the within 3 months of OVCF group had the lowest lumbar spine T-score of −2.445. The asymptomatic OVCF group also showed significantly lower lumbar spine T-score than did the group without radiologic OVCFs (p < 0.001). The EQ-5D showed a significant decrease in the radiologic OVCF group (p < 0.001) and within 3 months of OVCF group (p < 0.001).ConclusionsThe prevalence of OVCFs in the thoracolumbar junction rapidly increases with old age and low BMD in Korean postmenopausal women. Femur and total hip BMD are more predictive of thoracolumbar junction fractures than lumbar spine BMD. Patients with radiologic OVCFs had a significantly lower quality of life than no OVCF group. Therefore, this study shows it is important to treat and prevent osteoporosis before an OVCF occurs.     

绝经后阴道出血242例临床及病理分析

目的 探讨绝经后阴道出血的病因。方法 分析２４２例绝经后阴道出血并行诊断性乔宫的临床和病理资料。结果 绝经后阴道出血的主要病理诊断分另是功能性子宫内膜（６０．７３％）、炎症（２８．９２％）和恶性肿瘤（１０．３５％）。结论 内分泌紊乱性疾病是绝经后出血的常见病因,年老妇女恶性肿瘤发生率高。     

绝经后阴道出血患者诊断性刮宫前B超检测子宫内膜的价值

目的：评估绝经后阴道出血患者应用Ｂ超检测子宫内膜，以减少不必要的诊断性刮宫术（诊刮术）的价值。方法：对１９２例绝经后阴道出血患者，于诊刮术前行Ｂ超检查，测量子宫大小及子宫内膜厚度，然后进行分段诊刮术，标本送病理检查。结果：７７例内膜厚度≤４ｍｍ者中，７４例（９６．１％）子宫内膜属生理性改变，３例为内膜癌；１１５例子宫内膜厚度≥５ｍｍ者中，９２例（８０．０％）子宫内膜属病理性改变，其中５９例（５１．３％）为内膜癌。结论：高分辨阴道Ｂ超检测，可作为绝经后出血患者进行诊刮术前的一种筛选手段，当超声检测内膜厚度≤４ｍｍ时，可考虑避免诊刮术。     

血清CA125结合B超对绝经后妇女卵巢恶性病变的预测价值

目的 通过了解绝经后妇女卵巢肿物的临床特点，探讨早期发现绝经后妇女卵巢恶性肿瘤的可行方法。方法 回顾分析302例经手术后病理证实为卵巢肿物的自然绝经后妇女的临床特点，采用B超结合血CA125的定量测定。结果 71．2％的绝经后卵巢肿物患者无自觉症状，38．7％为卵巢恶性肿瘤，BUS结合血CA125对卵巢恶性病变预测的敏感性为98．4％，特异性为57．9％，阳性预测值62．6％，阴性预测值98．1％。结论 对绝经后妇女实施妇科检查及B超的筛查结合血CA125的定量测定，有助于临床医生及时发现卵巢恶性肿瘤。     

尼尔雌醇在绝经后取宫内节育器中的应用

目的:探讨绝经后取宫内节育器前服用尼尔雌醇片的价值。方法:148例绝经后要求取出宫内节育器的妇女,随机分成两组,一组为直接取器组73例,按常规方法直接取出宫内节育器;另一组为服药组75例,顿服4 mg尼尔雌醇片1周后再取出宫内节育器,2组均在B超监测下取器。结果:直接取器组取器成功率为85%,用药组取器成功率为100%,两组有显著性差异(P<0.05)。结论:对于绝经后妇女,直接取器易造成IUD取出困难及失败,通过术前服用尼尔雌醇改善宫颈条件,可以提高取环的成功率。     

Effects of Alendronate and Calcitonin on Bone Mineral Density in Postmenopausal Osteoporotic Women. An Observational Study

Objective: Alendronate and calcitonin are antiresorptive drugs that were used for the treatment of postmenopausal osteoporosis and were shown to increase bone mineral density (BMD). However, the effect of both drugs in daily clinical practice may differ from that observed in clinical trials.Method: About 50 postmenopausal osteoporotic women were observed during their first year of treatment. Among them, 32 patients used alendronate and 18 used calcitonin. Lumbar spine and femoral neck BMD were measured by dual energy X-ray absorptiometry (DXA) at baseline and after 1 year of therapy. Biochemical markers (B-ALP – bone-specific alkaline phosphatase, OTC – osteocalcin and DPD/UCr – deoxypyridinoline/creatinine ratio) of bone metabolism were measured at baseline and 6 months later. Patient compliance was assumed by tablet counting and verified at interview. Each patient was further questioned about her attitude towards the treatment, as well as her dairy product intake, physical activity, use of other medications, smoking and social status.Main outcome measure: (1) Annual percent change in BMD in lumbar spine and femoral neck after the one-year treatment with either alendronate or calcitonin. (2) The change in biochemical markers of bone turnover.Results: The lumbar spine BMD significantly increased by 7.0% (P < 0.001), the femoral neck BMD by 4.3% (P < 0.01). OTC, B-ALP and DPD/UCr decreased significantly during the therapy with alendronate. Compliance with therapy was 79% (95% CI 68–90%). In the calcitonin-treated group, the lumbar spine BMD significantly increased by 3.1 % (P < 0.05), while the femoral neck BMD remained unchanged. OTC, B-ALP and DPD/UCr did not change significantly during the treatment with calcitonin. Compliance with calcitonin therapy was 87% (95% CI 63–110%). The annual change of BMD in both treatment groups was independent on all questioned factors.Conclusion: In daily practice, alendronate enhanced significantly BMD both in lumbar spine and femoral neck. Calcitonin showed increase only in the lumbar spine BMD.