Neuroendocrine and clinical effects of transdermal 17β-estradiol in postmenopausal women

The neuroendocrine and clinical effects of transdermal 17β-estradiol (rated at 50 μg/day; TTS 50) were studied in 40 postmenopausal women; ten additional postmenopausal women did not receive any drugs. The changes in LH and rectal temperature induced by the infusion of the opioid antagonist naloxone (10 mg i.v. bolus plus 10 mg/h for 4 h) were used to evaluate the central activity of endogenous opioid peptides. TTS 50 increased opioid activity, as evidenced by the restoration of the LH response (P < 0.01) and the enhancement of the hypothermic effect (P < 0.05) of naloxone. A greater reduction in hot flushes was observed in TTS 50-treated subjects than in untreated women, with the maximal effect of TTS 50 achieved after 3 months of therapy. TTS 50 did not modify the concentrations of circulating lipids, glucose or liver enzymes but reduced the biochemical parameters indicative of bone reabsorption. Bone density of the distal radius significantly increased during TTS 50 (P < 0.02), reaching its maximum value after 6 months of therapy. Thereafter bone density declined, but more slowly than in untreated women.

Our data suggest that TTS 50 has marked neuroendocrine effects, that it diminishes the incidence of hot flushes and reduces bone demineralization. By contrast, it has a very little, if any, metabolic impact on the liver or on glucose and lipid metabolism.     

雌激素替代治疗与老年痴呆

老年性痴呆症是随年龄增长发生的由于智力和记忆力严重受损而影响到生活不能自理的综合症。随着人口的老龄化，老年性痴呆在许多发达国家已成为严重的社会卫生难题，从而受到重视。近年发现，绝经后妇女雌激素替代治疗（ＥｓｔｒｏｇｅｎＲｅｐｌａｃｅｍｅｎｔＴｈｅｒａ...     

Effects of tibolone on lipoprotein(a) and HDL subfractions

Objective: To determine the effects of tibolone, a synthetic steroid used to alleviate climacteric symptoms and prevent osteoporosis, on lipoprotein metabolism, with particular reference to lipoprotein(a) levels and HDL subfraction profiles.Design: Thirty nine postmenopausal women were treated with tibolone (Livial) 2.5 mg/day for 6 months and fasting serum lipoprotein levels were estimated at 0, 2, 4 and 6 months. Results: Lipoprotein(a) levels were reduced significantly over the 6 months from a median level of 245 (range <60–780) mg/I to 152 (range <60–530) mg/l, a reduction of 39% in the median level. A decrease was observed in approximately two thirds of the women. Reductions were noted in all 6 subjects whose pretreatment levels were high, although concentrations remained at a level associated with increased risk in all but one. There were significant decreases in triglycerides and VLDL cholesterol and no significant change in LDL cholesterol. There was a significant reduction of 18% in HDL cholesterol and a 26% reduction in the HDL₂:HDL₃ ratio. Conclusion: The reduction in lipoprotein(a) levels may have a beneficial effect on cardiovascular risk, which could go some way towards balancing the potentially adverse effect on the cardiovascular system caused by the reduction in HDL cholesterol.     

Site of bone density measurement may affect therapy decision

Summary The purpose of this study was to determine whether bone mineral density (BMD) measurements at the lumbar spine and femoral neck provided comparable information to women planning to use that knowledge to help them make a decision about hormone replacement therapy. Eighty-eight healthy Caucasian women, aged 44–59 and within 0 to 5 years of menopause, participated in the study. BMD measurements were performed at the lumbar spine (L1-L4) and the femoral neck by dual energy X-ray absorptiometry (DXA). Criteria suggested by the National Osteoporosis Foundation were used to categorize women as at risk for osteoporosis, bone density more than one standard deviation (SD) below the young adult mean, or as low risk, bone density at or above this level. The re that 46 women would be classified into the low risk category on the basis of spinal BMD alone. However, 28 of these 46 women would fall into the at risk category when the femoral neck BMD was measured. Sixty-one percent of women informed they were at low risk on the basis of spinal BMD would be considered at risk based on femoral neck BMD. When femoral neck BMD was used as the primary risk indicator, 14% of the women classified as low risk would be at risk if spinal BMD were added. These results suggest that both lumbar spine and proximal femur measurements should be made when women are using bone density measurements as an aid in deciding whether or not to use hormone therapy in their postmenopausal years.     

Re-Evaluating the Medical Risk of Late Childbearing

A critical review of the scientific literature linking advanced maternal age to eight adverse pregnancy outcomes commonly believed to increase with advancing age revealed little support for the pessimistic medical view that late childbearing is necessarily riskier. Most studies (61% of the 104 studies reviewed) were seriously flawed methodologically, primarily by confounding age with other factors; many reached conclusions without statistical verification (29% of the studies reviewed). Results concerning the advantages or disadvantages of late childbearing were inconsistent as well. Evidence from the sound research studies strongly suggests that many of the adverse outcomes found by some researchers to increase at an older maternal age may be reflecting the particular circumstances surrounding late childbearing (altered medical management. pre-existing diseases, subfertility , unplanned pregnancy, high parity birth) rather than a biological condition of aging. Further research must move away from looking at maternal age as an isolated variable because of the temptation to impute causality to the factor when other associated factors are not controlled. A better understanding of the reproductive aging process is urgently needed.     

Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound

SUMMARY: The relationship between osteoporosis risk factors, bone quantitative ultrasound (QUS) and non-spinal fracture risk was estimated in a cohort of 5,201 postmenopausal women from Spain who were prospectively evaluated during three years. Several clinical risk factors and low heel QUS values were independently associated with non-spinal fracture risk. INTRODUCTION: Low-trauma, non-spinal fractures are a growing source of morbidity and mortality in the elderly. The aim of the present study was to examine the association of heel quantitative ultrasound (QUS) and a series of osteoporosis and fracture risk factors, with incident low energy non-spinal fractures in a population of elderly women, and to incorporate them into fracture prediction models. METHODS: 5,201 women aged 65 or older were enrolled in a three-year cohort study. Participants completed an osteoporosis and fracture risk factors questionnaire. QUS was measured at the heel with a gel-coupled device. Cox-proportional hazard analyses were performed to evaluate the association with the first incident low-trauma non-spinal fracture. RESULTS: Three hundred and eleven women (6.0%) sustained a total of 363 low-trauma fractures, including 133 forearm/wrist, 54 hip, 50 humerus, 37 leg and 17 pelvic fractures. For every standard deviation decrease in the quantitative ultrasound index, the adjusted hazard ratios (95% CI) for any non-vertebral, hip, forearm/wrist, and humerus fractures were 1.31 (1.15-1.49), 1.40 (1.01-1.95), 1.50 (1.19-1.89) and 1.35 (0.97-1.87), respectively. Similar results were observed with other QUS variables. The best predictive models indicated that age, a history of falls, a previous low-trauma fracture, a family history of fracture, a calcium intake from dairy products of less than 250 mg/day, and lower values of QUS parameters were independently associated with the risk of non-spinal fractures. CONCLUSIONS: Both clinical risk factors and QUS are independent predictors of risk of fragility non-spinal fractures. A prediction algorithm using these variables was developed to estimate the absolute risk of non-spinal fractures in elderly women in Spain.     

当归黄芪结合心理干预治疗女性更年期焦虑患者临床研究

目的探讨当归黄芪结合心理干预治疗女性更年期焦虑患者的临床疗效。方法将79例合并焦虑的更年期综合征患者随机分为2组，当归黄芪治疗组（以下简称当归组）38例；当归黄芪结合心理干预治疗组（以下简称综合组）41例。观察临床疗效、焦虑状态和雌二醇（E2）、卵泡刺激素（FSH）治疗前后的变化。结果综合治疗组在临床疗效、焦虑状态上优于当归黄芪治疗组（P〈0．05或P〈0．001），2组调整测定E2、FSH水平（P〈0．05或P〈0．001）。结论心理干预联合当归黄芪综合治疗为女性更年期焦虑患者的有效方法，且简单易行，心理干预应得到足够重视和关注。     

中医药治疗更年期高血压研究概况

更年期高血压是国内外近几年研究的一个重要课题,更年期女性高血压病不仅表现在生殖生理变化伴血压升高,而且伴发植物神经系统机能紊乱,如月经紊乱、阵发性潮热、心烦汗出、失眠等症状,严重影响了妇女们的日常生活。通过对近年来中药治疗更年期高血压的临床资料分析,探讨中药治疗更年期高血压的临床疗效和作用机制以及参考国内最近有关的文献和观点,按照中医理论,从平肝潜阳法、滋肾养肝法、补肾扶阳法、调养心脾法为治疗该病的辨证方法,取得了较好的疗效,从而表明在治疗更年期女性高血压病方面中医辨证论治的重要性。