Precedence of bone loss over changes in body composition and body fat distribution within a few years after menopause

OBJECTIVE: The present study investigated the sequence of certain phenomena with a few years after menopause: bone mineral loss, decrease in lean body mass, increase in body fat mass, or the shift toward upper body fat distribution. METHODS: Subjects were 64 postmenopausal women aged 50-53 years with right side dominance (mean age+/-S.D., 51.4+/-1.1 years), and 59 age-matched regularly menstruating premenopausal women (51.7+/-1.2 years) serving as controls. Height, weight, body mass index (BMI, wt./ht.(2)), age at menopause (in postmenopausal women), and years since menopause (YSM) were recorded. Anthropometries, bone mineral density (BMD), and body fat distribution were assessed by dual-energy X-ray absorptiometry. RESULTS: Age at menopause and YSM in postmenopausal women were 51.7+/-1.2 and 2.3+/-1.7 years, respectively. Age, height, weight, BMI did not differ between the two groups. BMD of the bilateral arm, lumbar spine (L2-4), pelvis, and total body were significantly lower in postmenopausal women. However, leg BMD, trunk-leg fat ratio, body fat mass, and the lean body mass did not differ between the two groups. CONCLUSION: Within a few years after menopause, bone mineral loss precedes lean mass loss, increase in body fat mass, and a shift toward upper body fat distribution. We can say that bone tissue is more sensitive to hypogonadism than lean and fat tissues are.     

Relationship of ultrasonographic endometrial thickness and uterine size to bone mineral density in postmenopausal women

OBJECTIVES: The aim of the present study was to investigate the relations of ultrasonographic endometrial thickness and uterine size to bone mineral density (BMD). METHODS: Subjects were 200 postmenopausal women (mean age +/- S.D., 57.4 +/- 7.7 years; range, 46-75 years). Age, age at menopause, years since menopause (YSM), height, weight, and body mass index (BMI, weight/height2) were recorded. Endometrial thickness and uterine size (i.e. uterine volume and cross-sectional area) were measured by transvaginal ultrasonography. BMD of the nondominant forearm (one-tenth of the distance from the distal end of the radius) was measured by dual-energy X-ray absorptiometry. Relations of these variables to BMD were investigated. RESULTS: BMD was inversely correlated with age and YSM (r = -0.69, P < 0.0001; r = -0.56, P < 0.001, respectively), while was positively correlated with uterine volume, uterine cross-sectional area, and endometrial thickness (r = 0.52, P < 0.001; r = 0.45, P < 0.01; r = 0.32, P < 0.05, respectively). After adjusting for age, YSM, and BMI, BMD was still correlated with uterine volume and uterine cross-section (P < 0.01 and 0.05, respectively), while correlation of endometrial thickness with BMD disappeared. CONCLUSION: Ultrasonographic uterine size shows higher correlation with BMD than endometrial thickness in postmenopausal women. This may be attributable to the fact that uterine size rather than endometrial thickness reflects the duration of estrogen deficiency after menopause.     

Lean body mass and bone mineral density in physically exercising postmenopausal women

OBJECTIVES: To investigate whether the relative contribution of body composition (lean and fat mass component) to postmenopausal bone mineral density (BMD) differs between women participating in physical exercise and sedentary women. METHODS: Subjects were 45 postmenopausal women participating in regular physical exercise and 89 sedentary controls aged 50-60 years. Baseline characteristics included age, height, weight, body mass index (BMI, Wt/Ht(2)), age at menopause, and years since menopause (YSM). Body fat mass, percentage of body fat, lean body mass, and lumbar spine BMD (L2-4) were measured by dual-energy X-ray absorptiometry. RESULTS: Although age, height, weight, BMI, and YSM did not differ between the two groups, lean body mass and lumbar spine BMD were significantly higher (P<0.05 and <0.001, respectively), while body fat mass and percentage of body fat mass were significantly lower in exercising women than in sedentary controls (P<0.05 and <0.05, respectively). In exercising women, BMD was positively correlated with lean body mass (r=0.415, P<0.01) but not with body fat mass (r=0.155, NS). Conversely, in sedentary controls, BMD was correlated with body fat mass (r=0.251, P<0.05) and lean body mass (r=0.228, P<0.05). CONCLUSIONS: Lean body mass is a more significant determinant of postmenopausal BMD in physically exercising women than in sedentary women.     

Estrogen receptor alpha polymorphism as a genetic marker for bone loss, vertebral fractures and susceptibility to estrogen

OBJECTIVE: The purpose of the present study was to investigate the possible roles of PvuII and XbaI polymorphisms of the estrogen receptor alpha (ER(alpha)) in bone mineral density (BMD), vertebral fracture, bone loss rate after menopause and response to hormone replacement therapy (HRT). METHODS: All 286 women were grouped according to the genotypes of PvuII or XbaI polymorphisms of the ER(alpha) gene. We compared the BMD Z-score, incidence of vertebral fracture, changes in Z-score after menopause and response of BMD to HRT among the genotypes. RESULTS: Subjects with the PPxx genotype had significantly (P<0.05) lower Z-scores than did subjects with the other genotypes. A negative correlation was observed between the length of time after menopause and the decrease of the Z-score only in women with the pp genotype, suggesting faster bone loss in this group. In the analysis of the ER(alpha) polymorphism with regard to the effect of HRT on BMD, there appears to be a significantly greater increase of BMD (P<0.01 and 0.05) in women with the pp genotype than in those with the Pp or PP genotype. CONCLUSIONS: PvuII and XbaI polymorphisms of the ER(alpha) gene were associated with BMD in postmenopausal Japanese women. Also, the polymorphisms may be useful genetic markers for predicting vertebral fracture in relatively young postmenopausal women. The PvuII polymorphism may be associated with susceptibility to changes in estrogen level.     

Bone mineral density in postmenopausal women with endometrial cancer

OBJECTIVE: The aim of the study was to investigate the relationship between endometrial cancer and bone mineral density (BMD). MATERIALS AND METHODS: A total of 55 postmenopausal Japanese women with well-differentiated adenocarcinoma and 284 age-matched healthy women were studied. Baseline characteristics including age, age at menopause, years since menopause (YSM), weight, height, body mass index (BMI), prior menstrual history, parity, and fertility were recorded for each subject. Lumbar spine BMD (L2-4), and body fat indices including body fat mass amount and percent body fat were measured by dual-energy X-ray absorptiometry. These variables were compared between the two groups. In all subjects (n = 339), correlations of BMD with the presence of endometrial cancer, baseline characteristics, and body fat indices were investigated, using univariate and multiple regression analyses. RESULTS: BMD, weight, BMI, body fat mass amount, and percent body fat were significantly higher in women with endometrial cancer. Other baseline characteristics did not differ between the two groups. Age at menopause, height, weight, BMI, percent body fat, and body fat mass amount were positively correlated with BMD, while age and YSM were inversely correlated with BMD. After adjusting for age, YSM, and height, the presence of endometrial cancer was still correlated with BMD (P < 0.05). However, after adding body fat mass amount to these three adjusted variables, there was no correlation between the presence of endometrial cancer and BMD. CONCLUSION: Women with endometrial cancer have a high BMD. This is attributable to high body fat mass amount in this disease.     

The effects of physical exercise on body fat distribution and bone mineral density in postmenopausal women

OBJECTIVE: The present cross-sectional study investigated the effects of physical exercise on body fat distribution and bone mineral density (BMD). METHODS: Subjects were 57 postmenopausal women (mean age, 60.5+/-6.4 years) who had exercised regularly for at least 2 years. Controls were 130 age-matched sedentary women. Age, years since menopause (YSM), height, weight, and body mass index (BMI, wt./ht.(2)) were recorded. Total fat mass, percentage of body fat, trunk fat mass, leg fat mass, the ratio of trunk fat mass to leg fat mass (trunk-leg fat ratio), total body lean mass, percentage of body lean, and lumbar spine BMD (L2-L4) were measured by dual-energy X-ray absorptiometry. RESULTS: Baseline characteristics and leg fat mass did not differ between the two groups. Total fat mass, percentage of body fat, trunk fat mass, and trunk-leg fat ratio were lower (P<0.05, P<0.01, P<0.01 and P<0.001, respectively), while total body lean mass, percentage of body lean mass, and lumbar spine BMD were higher in exercising women (P<0.05, P<0.05 and P<0.01, respectively). Performing physical exercise was inversely correlated with trunk-leg fat ratio (standardized regression coefficient=-0.178, P<0.01), but positively correlated with BMD (0. 203, P<0.01) irrespective of age, height, YSM, and total fat mass. CONCLUSION: Physical exercise has beneficial effects on body fat distribution and BMD in postmenopausal women. Reduction of upper body fat distribution with physical exercise may be more attributable to the decrease in trunk fat mass.     

Changes in metacarpal bone mineral density with age and menopause using computed X-ray densitometry in Japanese women: cross-sectional and longitudinal study

BACKGROUND: Bone mineral density (BMD) loss with age and menopause is widely accepted in elderly women. However, only a few studies have utilized a multiple regression model that includes physical characteristics to assess comprehensive lifetime changes in BMD. OBJECTIVE: A prospective study was conducted to characterize the normal patterns in metacarpal BMD changes in Japanese women, and to assess the applicability of a fitting model using cross-sectional data compared with longitudinal variability. SUBJECTS AND METHODS: The study consisted of 5422 healthy women in cross-sectional data and a 1-year follow-up of 359 women. The metacarpal BMD was measured by computed X-ray densitometry. Multiple linear and nonlinear regression analyses were performed in cross-sectional subjects. Nonparametric analysis was used to compare percentage rates of BMD changes between actual and estimated values. RESULTS: The cross-sectional data showed that the best-fit equation was a nonlinear change model using the variables of age and height in premenopausal women, and years since menopause (YSM), age and height in postmenopausal women. The results of longitudinal data indicated the following. In premenopausal women, the actual BMD changes were greater in the 30-39 age group than the 20-29 age group and were less in the 50-59 group than the 40-49 group. The rates of annual change in BMD between the actual value and estimated value by change model were very similar. In postmenopausal women, the actual changes in BMD indicated that the rapid rate of reduction observed was over 3% at 0-5 YSM and 1.5% at 6-10 YSM, and thereafter showed a slower rate of decline at 11 YSM. The change model represented the trend of actual change in BMD for postmenopausal women, whereas the rates of estimated BMD loss underestimated the actual changes at 1-10 YSM. CONCLUSION: The change model for premenopausal women using cross-sectional data is beneficial in evaluating the actual metacarpal BMD variability, whereas that for postmenopausal women is insufficient in estimating the longitudinal BMD variability.     

Association between breast cancer and bone mineral density: the Dubbo Osteoporosis Epidemiology Study

BACKGROUND: The association between bone mineral density and breast cancer was investigated in a nested case-control study, involving 30 breast cancer cases and 120 controls, aged 68+/-6 (mean +/-S.D.) years, as part of the Dubbo Osteoporosis Epidemiology Study (Australia). METHODS: Bone mineral density (BMD, g/cm(2)) at the femoral neck and lumbar spine was measured by dual energy X-ray absorptiometry. Anthropometric data and reproductive history were collected by direct interview using a structured questionnaire. RESULTS: In univariate conditional logistic regression analysis, lower age at menarche, longer overall duration of lifetime ovulation and higher bone density were associated with higher risk of breast cancer. Among the breast cancer cases, 20% of subjects had lumbar spine BMD greater than 1.20 g/cm(2) (or 2.5 S.D. above the mean) compared with less than 1% of the controls. After adjusting for the effects of duration of lifetime ovulation and body mass index, each 0.1 g/cm(2) increase in lumbar spine and femoral neck BMD was associated with a 2.1-fold (95% CI: 1.3-3.4) and 1.5-fold (1.0-2.4) respectively, higher risk of breast cancer. Further adjustment for age at menarche, hormone replacement therapy, and parity did not alter the result. Thus, postmenopausal BMD, which is affected by lifetime exposure to estrogen, is also related to risk of breast cancer. Importantly, it is estimated that estrogen therapy in osteoporotic women, even if raising the risk of breast cancer by 70% as suggested by some studies, would not elevate their risk to the level experienced by their non-osteoporotic counterparts. CONCLUSION: While the mechanism of this relationship remains to be explored, these data support the concept that lifetime exposure to estrogen is an indicator of risk of both breast cancer and osteoporosis. However, the use of estrogen in osteoporosis treatment would not elevate the risk of breast cancer in osteoporotic women up to the level experienced by their non-osteoporotic counterparts.     

Relationship of head lean mass to regional bone mineral density in elderly postmenopausal women

OBJECTIVES: This study investigated the relationship of head lean mass to bone mineral density (BMD). METHOD: Subjects were 102 elderly women (> or =65-years-old) and 123 middle-aged postmenopausal women (<65-years-old) with right-side dominance. Age, height, weight, and years since menopause (YSM) were recorded. Lean mass of the head, arm, trunk, leg, and total body were measured by dual-energy X-ray absorptiometry (DEXA). BMD of the same regions were measured by DEXA. RESULTS: In elderly women, head lean mass was positively correlated with BMD of the head (r=0.389, P<0.01), left arm (r=0.235, P<0.05), right arm (r=0.280, P<0.05), lumbar spine (L2-4) (r=0.411, P<0.001), pelvis (r=0.490, P<0.001), left leg (r=0.572, P<0.001), right leg (r=0.558, P<0.001), and total body (r=0.529, P<0.001). These relationships remained significant after adjusting for age, height, and YSM. In addition, the strength of correlation of head lean mass with BMD was higher than those of other regional lean mass with respective BMD. In middle-aged women, strength of correlation of head lean mass with BMD was loose (r< or =0.238), while regional lean mass was more correlated with respective regional BMD. CONCLUSION: Factors related to lifestyle associated with higher (lower) head lean mass may contribute to higher (lower) BMD in elderly postmenopausal women.     

Cross-sectional study of the effects of parturition and lactation on bone mineral density later in life

OBJECTIVE: The present cross-sectional study investigated the effects of parturition and lactation on bone mineral density (BMD) later in life. METHODS: The subjects were 456 premenopausal and 713 postmenopausal Japanese women aged 40-69 years old. They were classified into six subgroups at 5-year increments. Age, height, weight, menopausal status, age at menopause (in postmenopausal women), years since menopause (in postmenopausal women), parity, and total lactation period were recorded. Lumbar spine BMD (L2-4) was measured by dual-energy X-ray absorptiometry (DEXA). In each subgroup, correlations of parturition and lactation with BMD were investigated using Pearson's correlation test and multiple regression analyses. RESULTS: In premenopausal women aged 40-44 years old (n=143), total lactation period was inversely correlated with BMD (r= -0.293, P<0.01). This relationship remained significant after adjusting for age, height, weight, and parity (P<0.05). Although the total lactation period was inversely correlated with BMD in the group aged 60-64 years old (r= -0.194, P<0.05, n=218), this relationship disappeared after adjusting for age, YSM, height, weight, and parity. However, in the other subgroups, there were no significant correlations between total lactation period and BMD. There were no significant correlations observed between parity and BMD in any groups. CONCLUSION: Reproductive history of lactation and parity does not seem to be a major determinant of BMD later in life.     

Relationship between self-reported periodontal status and skeletal bone mineral density in Japanese postmenopausal women

OBJECTIVE: Several investigators have linked periodontal disease progression and low skeletal bone mineral density in postmenopausal women. However, little is known about whether self-reported periodontal status is the reflection of skeletal bone mineral density. We investigated whether self-reported poor periodontal status is associated with low skeletal bone mineral density in postmenopausal women. DESIGN: Relationships among self-reported periodontal status, number of teeth remaining, and bone mineral density of the lumbar spine and the femoral neck were evaluated in 253 Japanese postmenopausal women (mean +/- SD, 56.6 +/- 7.7) recruited from the patients who visited our clinic for bone mineral assessment between 1997 and 2003. Self-reported periodontal symptoms included gingival swelling, gingival bleeding, purulent discharge, and tooth mobility at the time of bone mineral assessment. RESULTS: Analysis of covariance adjusted for age, height, weight, years since menopause, duration of estrogen use, and regular oral care revealed that subjects without periodontal symptoms had significantly higher BMD of the lumbar spine than did those with periodontal symptoms (mean +/- SEM, 0.962 +/- 0.014 vs 0.921 +/- 0.013; P = 0.038); however, there were no significant differences in the number of remaining teeth and bone mineral density of the femoral neck between them. The odds of low spine bone mineral density in subjects with periodontal symptoms was 2.01 (95% CI = 1.15 to 3.50). CONCLUSION: Our results suggest that self-reported poor periodontal status may be associated with low bone mineral density of the lumbar spine in postmenopausal women.     

Difference in the effect of adiposity on bone density between pre- and postmenopausal women

Objectives: Elevated bone mineral density (BMD) in obese women is partially attributable to the higher circulating estrogen levels derived from extraglandular aromatization in adipose tissue. However, it remains unclear whether there is an effect of overall adiposity on BMD in both pre- and postmenopausal women. The difference in the effect of overall adiposity on BMD between pre- and postmenopausal women was investigated. Materials and methods: Subjects were 296 premenopausal women with regular menstruation and 233 postmenopausal women. Age, age at menarche, years since menopause (YSM, in postmenopausal women), weight, height, and body mass index were recorded. Total fat mass amount, lean mass amount, and percentage of body fat were measured by whole body scanning with dual-energy X-ray absorptiometry (DEXA). Lumbar spine BMD (L2–L4) was measured by DEXA. In each group, significant determinants of BMD were investigated using univariate and stepwise multiple regression analysis. Results: In postmenopausal women, YSM, lean mass amount, total fat mass amount, and height were significant determinants of BMD (R²=0.273, P<0.001). In premenopausal women, only two variables including lean mass amount and age at menarche were significant determinants of lumbar spine BMD (R²=0.110, P<0.001), but total fat mass amount and percentage of body fat were not significant determinants of BMD. Conclusion: The effect of overall adiposity on BMD is more prominent in postmenopausal women than in premenopausal women.     

VEGF expression is associated with negative estrogen receptor status in patients with breast cancer

The aim of this study was to analyze the association between vascular endothelial growth factor (VEGF) expression on tumor cells and other clinicopathologic parameters in breast cancer that could give additional information on its prognostic significance. Immunohistochemical analysis of expression of VEGF, estrogen (ER) and progesterone receptor (PR), HER-2/neu, and Ki67 was performed in 233 breast cancers. VEGF expression estimated semiquantitatively was correlated with all the above-mentioned parameters as well as with clinicopathologic characteristics of breast cancer such as menopausal status of patients, tumor size, histologic and nuclear grade, vascular invasion, and lymph node status. Most of the tumor cells and some stromal components expressed VEGF. A higher percentage of VEGF-positive tumor cells was present in premenopausal patients and in ER-negative tumors. In postmenopausal patients tumors with a higher expression of VEGF were associated not only with ER-negative but also with HER-2/neu-positive tumor cells. These ER-negative tumors were characterized by a higher proliferative activity. Angiogenic switch as well as proliferative activity of breast cancer cells probably are unfavorably dependent on estrogen activity. This negative correlation between VEGF expression and ER status may not only shed more light on tumor biology but may also have future therapeutic implications.     

High density lipoproteins (HDL) in women with postmenopausal osteoporosis: a preliminary study.

OBJECTIVE: Since a previous study showed an inverse correlation between high density lipoproteins (HDL) and bone mineral density (BMD), we searched for a possible relationship between HDL level and the presence of postmenopausal osteoporosis. DESIGN: We measured HDL levels in 37 women with postmenopausal osteoporosis, and compared them with a control group of 43 healthy postmenopausal women. The HDL levels were compared between the two groups using Student's t test and were correlated with BMD by Pearson's coefficient. To avoid possible selection bias, we compared patients and controls for body mass index by chi 2 test. The sensitivity and specificity of HDL level higher than 65 mg% (positive test) or lower than 45 mg% (negative test) was compared with double emission x-ray absorptiometry (considered the gold standard in the measurement of BMD). RESULTS: The level of HDL was significantly higher in the osteoporotic patients than in the controls (67.7 +/- 15.5 mg% vs 58.3 +/- 11.6 mg%, p = 0.0039). HDL was inversely correlated with BMD (r = -0.29, p = 0.0083). HDL higher than 65 mg% has a high specificity (77%) for patients with osteoporosis, while HDL lower than 45 mg% has a high sensitivity (97%) in detecting subject without osteoporosis. CONCLUSIONS: Our preliminary data suggest an interesting, as yet unexplained association between HDL and bone mineral density in postmenopausal women.     

The association between postmenopausal vertebral bone mineral density and estrogen receptor gene alleles in ethnic Japanese living in western Japan.

Bone mass and its mineral content has been shown to be under genetic control. Our purpose in this study was to assess whether estrogen receptor genotypes influence changes in bone mass in post menopausal Japanese women and clarify the regional differences in Japanese women. Pvu II and Xba I restriction enzyme fragment length polymorphism of the estrogen receptor gene and its relationship with vertebral bone mineral density were examined in 300 unrelated post menopausal women, aged 42-69 years, from the Kinki region in Japan. Vertebral bone mineral density was evaluated at the lumbar spine (L2-4) by dual energy X-ray absorptiometry. We found no relationship between any single restriction site polymorphism and the Z-score of bone mineral density. However, the allelic haplotype PPXx was found to be associated with a significantly low bone mineral density (Z-score for the lumbar spine -1.118+/-1.270 vs. PPxx 0.04+/-1.150; p<0.01, vs. ppxx 0.387+/-1.226; p<0.05, respectively). We suggest that ER gene polymorphism is associated with low bone mineral density and that this partly explains the cause of post menopausal bone loss in Japanese women. The contradictory conclusions compared with previous studies in the Japanese population regarding the association of BMD with ER RFLPs demands further investigation.     

Influence of Obesity on Bone Mineral Density in Postmenopausal Asthma Patients Undergoing Treatment with Inhaled Corticosteroids

OBJECTIVES:

The etiology of osteoporosis in asthma is complex as various factors contribute to its pathogenesis. The purpose of our study was to investigate the effects of obesity and inhaled steroids, as well as the severity and duration of asthma, on osteoporosis in postmenopausal asthma patients as compared to healthy controls.

METHODS:

A total of 46 patients with asthma and 60 healthy female controls, all postmenopausal, were enrolled in our study. Bone mineral density was assessed at the lumbar spine and hip using a Lunar DPX-L densitometer.

RESULTS:

Bone mineral density (BMD) scores were comparable between the asthmatic and control groups, with average scores of 0.95 ± 0.29 and 0.88 ± 0.14 g/cm², respectively. Likewise, osteoporosis was diagnosed in a similar percentage of patients in the asthmatic (39.1%) and control (43.3%) groups. Bone fracture was identified in four patients with asthma (8.6%) and in six patients from the control group (10%). We could not detect any relationship between BMD and duration of asthma, asthma severity, inhaled steroids or body mass index (BMI). There was no difference between the two groups with respect to age or years since menopause. Although asthma patients were more likely to be overweight and presented higher BMD scores on average than the control subjects, these differences were not statistically significant.

CONCLUSIONS:

There is a slight positive protective effect of high BMI against osteoporosis in asthma patients, but this effect is overcome by time and menopause status. Therefore, the protective effect of obesity against osteoporosis in asthma patients seems to not be significant.     

Interaction between menopausal status and obesity in affecting breast cancer risk

Obesity has a complex relationship to breast cancer risk that differs in premenopausal and postmenopausal women. Before the menopause, the level of adiposity is inversely related to risk, indicative of a protective effect, whereas in postmenopausal women, particularly the elderly, the association is a positive one, consistent with obesity being a risk factor. The importance of high estrogen production in adipose tissue, with consequent elevation of circulating biologically available estradiol, in the promotional effect of obesity on postmenopausal breast carcinogenesis is well established; the resulting tumors express both estrogen and progesterone receptors. The mechanism(s) for the protective effect in premenopausal women is less well understood, but the breast cancers that do develop in the presence of obesity are most often estrogen and progesterone receptor negative, consistent with the selection of non-estrogen-dependent tumor cells which are dependent on growth factors such as insulin, insulin-like growth factor-I and some adipokines. The influence of menopausal status on the relationships between adiposity and breast cancer appears to be modified within each category by age; the protective effect before the menopause may be limited to younger women (<35 years), and the adverse effect was found to apply specifically to older postmenopausal women. Although randomized trials of weight reduction for postmenopausal breast cancer prevention have not been performed, observational studies suggested that risk reduction does occur; in addition, other health benefits of weight control need to be considered regardless of menopausal status.     

Sex steroid hormones in serum and tissue of benign and malignant breast tumor patients

The ability of breast tumors to synthesize sex steroid hormones is well recognized and their local production is thought to play a role in breast cancer development and growth. The aim of this study was to estimate local intra-tumoral and circulating levels of Estrone (E1), Estrone Sulfate (E1S), Estradiol (E2), Estriol (E3), and Testosterone (T) in 33 pre- and postmenopausal women with primary breast cancer in comparison to 12 pre- and postmenopausal women with benign breast tumors. The mean levels of the studied sex hormones were higher in serum and tumor tissue of breast cancer women than those with benign breast tumors apart from Testosterone which showed a significant decrease in pre- and postmenopausal women with breast cancer (P<0.001for follicular phase, P<0.05 for luteal phase, and P<0.005 for postmenopausal). The levels of the five hormones were significantly higher intra-tumoral than in serum of both benign and malignant breast tumor women with E1S as the predominant estrogen. There was only a positive significant correlation between serum and tumor tissue levels of E1 (rs=0.52, P<0.05 for follicular; rs=0.63, P<0.05 for luteal and rs=0.58, P<0.05 for postmenopausal) and a significant correlation between serum and tumor tissue of T (rs=0.64, P<0.05 for follicular; rs=-0.51, P<0.05 for luteal and rs=-0.81, P<0.04 for postmenopausal).     

Relative contribution of aging and menopause to changes in lean and fat mass in segmental regions

Objective: The aim of the study was to investigate the relative contribution of aging and menopause to the changes in lean and fat mass in segmental regions. Materials and methods: Subjects were 365 pre- and 201 postmenopausal Japanese women aged between 20 and 70 years old. Age, height, weight, body mass index (BMI, Wt/Ht²), age at menopause, years since menopause (YSM), and menopausal status were recorded. Lean and fat mass of the arms, trunk, legs, total body, and the ratio of trunk fat mass to leg fat mass amount (trunk–leg fat ratio) were measured by dual-energy X-ray absorptiometry (DEXA). Regional (arms, lumbar spine, pelvis, legs, and total body) bone mineral density (BMD) were measured by DEXA. Results: Total body lean mass and regional BMD decreased (P<0.001), while percentage of body fat, trunk fat mass, and trunk–leg fat ratio increased (P<0.001) with aging and after menopause. On multiple regression analyses, trunk and total body lean mass were inversely correlated with menopausal status (P<0.001 and 0.05, respectively) but not with age. Trunk fat mass, trunk–leg fat ratio, and percentage of body fat were positively correlated with age (P<0.01) but not with menopausal status. Regional BMD were more inversely correlated with menopausal status (P<0.001) than age. Conclusion: Decrease in lean mass and BMD are more menopause-related, while the shift toward upper body fat distribution and overall adiposity are more age-related. Lean tissue is similar to bone tissue from the viewpoint of more undergoing menopausal effect.