Vitamin D Repletion in Korean Postmenopausal Women with Osteoporosis

PurposeUp to 71% of South Korean postmenopausal women have vitamin D deficiency {serum 25-hydroxyvitamin D [25(OH) D] level <50 nmol/L}. Data on vitamin D supplementation was collected during the screening phase of an efficacy/safety study of denosumab in Korean postmenopausal women with osteoporosis. This report describes the effect of vitamin D supplementation on repletion to 25(OH)D levels ≥50 nmol/L in Korean postmenopausal women with osteoporosis.ResultsOf 371 subjects screened, 191 (52%) required vitamin D supplementation, and 88% (168 of 191) were successfully repleted. More than half of the subjects (58%) who were successfully repleted received doses of 2000 IU daily. The mean time to successful repletion was 31 days (standard deviation 8.4 days; range 11–48 days).ConclusionSupplementation with daily median doses of 2000 IU vitamin D successfully repleted 88% of Korean postmenopausal women with osteoporosis within 48 days to a serum vitamin D level of 50 nmol/L.     

Skin contamination by oestradiol gel--a remarkable source of error in plasma oestradiol measurements during percutaneous hormone replacement therapy

Objectives: To study the consequence of skin contamination by oestradiol gel on circulating plasma oestradiol levels. Methods: We studied ten healthy, hysterectomized postmenopausal women who had used percutaneous oestradiol gel for at least 2 years. After wash-out period percutaneous dose of 1.5 mg 17β-oestradiol was administered once a day in the evening. The gel was applied with a bare or gloved hand to an arm or thigh according to the schedule. Blood samples for assay of plasma oestradiol concentrations were collected from both cubital veins 12 h after gel administration, at baseline and every time after using the gel, for 2 weeks. Results: Plasma oestradiol concentrations were significantly higher in the gel-contaminated samples: in the cubital vein of the gel-applying arm and in the cubital vein of the forearm on which the gel had been spread. Conclusions: Skin contamination by topical 17β-oestradiol can distort plasma oestradiol measurements by giving much higher oestradiol concentrations than in reality there are in the systemic circulation. This has an important meaning when tailoring individual oestrogen therapy.     

Cytologic aspects of the nasal respiratory epithelium in postmenopausal women treated with hormone therapy

OBJECTIVE: To investigate the effects of hormone therapy (HT) on nasal respiratory epithelium in postmenopausal women. DESIGN: Prospective open clinical trial. SETTING: Outpatient menopausal clinic. PATIENT(S): One hundred three healthy postmenopausal women, of whom 55 treated with HT, and 48 untreated women (controls). INTERVENTION(S): Different regimens of HT by patch, gel, or oral administration. MAIN OUTCOME MEASURE(S): Cytologic changes of nasal, middle and inferior turbinate cells compared with vaginal cytologic findings by using the maturation index. RESULT(S): Hematoxylin-eosin staining for the maturation index confirmed similar trophic cytologic aspects between the nasal respiratory epithelium and vaginal smears in HT-treated women and controls. Women treated with sequential HT or estrogen therapy (ET) showed better trophic characteristics in the nasal cytological samples compared with women treated with continuous combined HT. CONCLUSION(S): Along with vaginal cells the nasal respiratory epithelium is an estrogen target. The activity of HT in the nasal respiratory epithelium may depend on the type of hormone regimen used.     

Walking trials in postmenopausal women: effect of low doses of exercise and exercise fractionization on coronary risk factors

We studied the fractionization of walking training and searched for the minimum dose to affect coronary risk factors in two randomized controlled trials. Altogether 134 (Study I) and 121 (Study II) healthy, sedentary postmenopausal women started the trials, and 130 (Study I) and 116 (Study II) completed them. In Study I the exercise intensity was 65% of the maximal aerobic power (VO2max) and a total of 300 kcal was expended in one (Group W1) or two (Group W2) daily walking bouts. In Study II the exercise was continuous, and the exercise intensity (% of VO2max) and energy expenditure (kcal session(-1)) were 55% and 300 kcal (Group W3), 45% and 300 kcal (Group W4), 55% and 200 kcal (Group W5) and 45% and 200 kcal (Group W6). All the subjects walked 5 days a week. The outcome measures were blood pressure, serum lipoproteins and blood glucose and plasma insulin in fasting state and also during 2-h oral glucose tolerance test in Study I. There was no change in diastolic pressure in the original study groups, but in the combined exercise group (W1+W2) in Study I, the mean diastolic pressure declined by -3.0 mmHg (95% con-fidence interval (CI) -5.5 to -0.4) (P=0.025) in comparison with that of the controls. The mean blood glucose declined by -0.21 mmol L(-1) (CI -0.33 to -0.09) in Group W1 and -0.13 mmol L(-1) (CI -0.25 to -0.01) in Group W2 compared to controls (P=0.03). Also the 2-h glucose concentration decreased in Groups W1 and W2 compared to controls. Systolic blood pressure, serum lipoproteins and insulin levels did not change in Study I or Study II. We conclude that our training program with the greatest exercise dose, exercise intensity 65% of VO2max and weekly expenditure of 1500 kcal had a minimal, positive effect on diastolic pressure and blood glucose, and the effect was similar in one or two daily exercise session groups. This exercise dose is probably close to the minimum to affect coronary risk factors in healthy postmenopausal women. To get a more pronounced and clinically relevant effect, a greater exercise dose is needed.     

Effects of raloxifene hydrochloride on bone mineral density, bone metabolism and serum lipids in postmenopausal women: a randomized clinical trial in Beijing

Withdiminishedovarianfunctionanddecreasedestrogenlevels,postmenopausalwomenareatriskforosteoporosis ,whichleadstopossibleseriousanddebilitatingfractures Estrogen ,combinedwithprogestininhormonereplacementtherapy (HRT) ,iscommonlyprescribedtowomentoalleviatepostmenopausalvasomotorsymptomsandprotectagainstthedevelopmentofosteoporosis 1,2 　However ,thelong termuseofestrogenisrequiredtopotentiallyrealizethattheseclinicalbenefitsalsoincreasestherisksofendometrialcancerandbreastcancer 2 4 　Thein…     

Associations of resting and peak fat oxidation with sex hormone profile and blood glucose control in middle-aged women

Background and aimsMenopause may reduce fat oxidation. We investigated whether sex hormone profile explains resting fat oxidation (RFO) or peak fat oxidation (PFO) during incremental cycling in middle-aged women. Secondarily, we studied associations of RFO and PFO with glucose regulation.Method and resultsWe measured RFO and PFO of 42 women (age 52–58 years) with indirect calorimetry. Seven participants were pre- or perimenopausal, 26 were postmenopausal, and nine were postmenopausal hormone therapy users. Serum estradiol (E2), follicle-stimulating hormone, progesterone, and testosterone levels were quantified with immunoassays. Insulin sensitivity (Matsuda index) and glucose tolerance (area under the curve) were determined by glucose tolerance testing. Body composition was assessed with dual-energy X-ray absorptiometry; physical activity with self-report and accelerometry; and diet, with food diaries. Menopausal status or sex hormone levels were not associated with the fat oxidation outcomes. RFO determinants were fat mass (β = 0.44, P = 0.006) and preceding energy intake (β = ?0.40, P = 0.019). Cardiorespiratory fitness (β = 0.59, P = 0.002), lean mass (β = 0.49, P = 0.002) and physical activity (self-reported β = 0.37, P = 0.020; accelerometer-measured β = 0.35, P = 0.024) explained PFO. RFO and PFO were not related to insulin sensitivity. Higher RFO was associated with poorer glucose tolerance (β = 0.52, P = 0.002).ConclusionAmong studied middle-aged women, sex hormone profile did not explain RFO or PFO, and higher fat oxidation capacity did not indicate better glucose control.     

激素治疗对围绝经期及绝经期妇女乳腺的病理影响——附乳腺穿刺病理91例分析

目的:探讨应用激素治疗(HT)对围绝经及绝经期妇女乳腺的病理影响。方法:选择91例围绝经及绝经期妇女为研究对象,52例用HT治疗(HT组),予倍美力0.3 mg/d,安宫黄体酮6 mg/d×10天周期用药或2 mg/d连续联合用药,39例无性激素治疗史(对照组),彩超扫描乳腺并测量腺体的厚度、检测血流信号,多普勒超声取样,之后在其引导下对乳腺结节或增生部位进行粗针针芯活检穿刺,对取得的组织进行病理分析。结果:超声检测乳腺腺体厚度及血流阻力指数(P=0.918、P=0.146)、乳腺穿刺组织病理呈增生改变的(P=0.882),两组比较无显著性差异。再将以上妇女分成HT≥5年组、HT<5年组、对照围绝经组、对照绝经组进行分组分析。超声检查腺体厚度依次为:对照围绝经组>HT<5年组>HT≥5年组>对照绝经组,但乳腺腺体的厚度及检出血流比、血流阻力指数、乳腺穿刺组织病理呈增生改变的,四组间比较仍无显著性差异(P>0.05)。91例中无乳腺异常血流及乳腺上皮细胞非典型增生的病例。结论:应用低剂量的激素治疗对乳腺的血流无影响,对乳腺无促其增生作用。     

雌激素的血管作用:快速作用,新的机制和治疗潜力

Although estrogen-dependent effects on thevasculature were first observed more than a centuryago, many of the mechanisms by which estrogensinteract with the vascular wall have been identified onlyin the past 15 years. Estrogens bind to vascularestrogen receptors (ER), including the ERα, the novelERβ as well as to membrane-bound receptors.     

Obesity and fractures in postmenopausal women

Low body mass index (BMI) is a recognized risk factor for fragility fracture, whereas obesity is widely believed to be protective. As part of a clinical audit of guidance from the National Institute of Health and Clinical Excellence (NICE), we have documented the prevalence of obesity and morbid obesity in postmenopausal women younger than 75 years of age presenting to our Fracture Liaison Service (FLS). Between January 2006 and December 2007, 1005 postmenopausal women aged less than 75 years with a low‐trauma fracture were seen in the FLS. Of these women, 805 (80%) underwent assessment of bone mineral density (BMD) by dual energy X‐ray absorptiometry (DXA), and values for BMI were available in 799. The prevalence of obesity (BMI 30 to 34.9 kg/m²) and morbid obesity (BMI ≥ 35 kg/m²) in this cohort was 19.3% and 8.4%, respectively. Normal BMD was reported in 59.1% of obese and 73.1% of morbidly obese women, and only 11.7% and 4.5%, respectively, had osteoporosis (p < .0001). Multiple regression analysis revealed significant negative associations between hip T‐score and age (p < .0001) and significant positive associations with BMI (p < .0001) and previous fracture (p = .001). Our results demonstrate a surprisingly high prevalence of obesity in postmenopausal women presenting to the FLS with low‐trauma fracture. Most of these women had normal BMD, as measured by DXA. Our findings have important public heath implications in view of the rapidly rising increase in obesity in many populations and emphasize the need for further studies to establish the pathogenesis of fractures in obese individuals and to determine appropriate preventive strategies. © 2010 American Society for Bone and Mineral Research