Selección de Resúmenes de Menopausia
Semana del 30 marzo a 5 abril 2022
María Soledad Vallejo. Clínica Quilín. Universidad de Chile
Breast Cancer Res Treat. 2022 Apr 2. doi: 10.1007/s10549-022-06571-x. Online ahead of print.
Multivariate analysis of independent roles of socioeconomic status, occupational physical activity, reproductive factors, and postmenopausal hormonal therapy in risk of breast cancer
Sushmita Katuwal 1, Juha Tapanainen 2 3, Eero Pukkala 4 5
Purpose: This case-control study assesses the independent roles of reproductive history, postmenopausal hormonal therapy (HT), socioeconomic status (SES), and occupational physical activity on the risk of breast cancer (BC). Methods: Odds ratios (OR) were estimated from conditional logistic multivariate regression model in a data set of 19,253 Finnish women diagnosed with BC between 1994 and 2013 and 96,265 age-matched population controls. Results: Both pre- and postmenopausal white-collar workers had significantly increased risk of ductal and lobular BC as compared to manual workers. Moderate occupational physical activity reduced risk of lobular BC by 14%. There was a transient increase in the risk of BC observed after each birth followed by a protective effect starting some years after the delivery. As the number of children increased, the short-term excess risk was lower and protective effect was observed earlier. Continuous estrogen-progestin therapy (EPT) significantly increased the risk of both ductal and lobular BC and the magnitude of risk was directly proportional to duration of use (OR for 5+ years of use 2.26, 95% confidence interval 2.12-2.42). Monthly EPT for 5+ years increased the risk (OR 1.32, 95% CI 1.20-1.45). Users of estradiol plus levonorgestrel intrauterine system devices showed ORs of 1.56 (95% CI 1.45-1.69) and 2.18 (95% CI 1.81-2.64) for ductal and lobular BC, respectively. Conclusion: This study concludes that pregnancy has a dual effect on BC risk, with a transient increase in risk followed by a long-term protective effect. The SES and HT have a large effect on BC risk while occupational physical activity has only a small independent effect.
Ann Palliat Med. 2022 Mar;11(3):972-983. doi: 10.21037/apm-22-201.
Factors affecting sarcopenia in older patients with chronic diseases
Bingqing Xu 1, Zhengli Guo 1, Binxian Jiang 2, Kaiyu Zhang 1, Wenyu Zhu 1, Xiaoyi Lian 1, Yihui Xu 1, et al.
Background: Sarcopenia is an age-related disease characterized by a progressive loss of systemic muscle mass and/or decreased muscle strength and physical function. The occurrence of sarcopenia in patients with chronic diseases will not only cause further deterioration of diseases and adverse clinical outcomes, but also lead to high medical cost, suggesting a necessity and a great significance to explore the associated factors of sarcopenia in chronic patients in order to improve their quality of life. This study aimed to investigate factors affecting sarcopenia among older hospitalized patients with chronic diseases. Methods: A total of 121 older patients with chronic diseases admitted to the Department of Geriatrics of Affiliated Kunshan Hospital of Jiangsu University from May 2019 to April 2021 were enrolled. According to the diagnostic criteria of sarcopenia formulated by the Asian Working Group for Sarcopenia (AWGS), the subjects were divided into a sarcopenia group (n=57) and a non-sarcopenia group (n=64). We analyzed the associated factors including bone mineral density, nutritional biomarkers, hormone levels and inflammatory cytokines. Results: Compared to the non-sarcopenia group, the sarcopenia group was of older average age (P<0.001), exhibited a lower body mass index (BMI) (P<0.001), a lower bone mineral density (BMD) of the femoral neck (P<0.01), and a higher incidence of osteoporosis. In terms of hematology, the sarcopenia group exhibited significantly lower serum iron and zinc levels (both P<0.05), a higher growth hormone (GH) level (P<0.05), a significantly lower IGF-1 level (P<0.01), and a lower level of iron (P<0.01). Poor nutritional status (assessed via measurement of albumin and prealbumin levels) positively correlated with sarcopenia (P<0.01). Conclusions: Sarcopenia is closely associated with aging, and has a close relationship with osteoporosis. Anemia, malnutrition, vitamin and trace element deficiencies, changes in hormone levels, and chronic inflammation are correlated with sarcopenia. Patients with these features above call for the screenig of sarcopenia. Additionally, these characteristics may help providing clues for further research on the pathogenesis and risk factors of sarcopenia, along with disease prevention and intervention.
J Family Med Prim Care. 2022 Feb;11(2):599-602. doi: 10.4103/jfmpc.jfmpc_1006_21. Epub 2022 Feb 16.
Study of Relationship between Bone Mineral Density in Ipsilateral Proximal Femur and Severity of Osteoarthritis of Knee
Vijender Anand 1, Ajay Gupta 1, Satyaranjan Sethi 2, Sushil Kumar 3
Introduction: Osteoarthritis (OA) of the knee is the most common rheumatic disease that is characterized by degradation of articular cartilage, subchondral bone alteration, meniscal degeneration, synovial inflammatory response, and overgrowth of bone and cartilage. In severe OA, the reduced mobility caused by pain can increase bone loss and reduction of bone mineral density leading to osteoporosis. Objective: To examine the possible relationship between severity of osteoarthritis (OA) and bone mineral density (BMD) by evaluating the bone mineral density in ipsilateral proximal femur and radiographic grading of knee OA in the Indian population. Methods: In this cross-sectional observational study, 100 subjects diagnosed with OA knee using ACR criteria were enrolled. Severity of OA knee was assessed using Kellgren-Lawrence scale (1 to 4) on weight-bearing radiographs. The BMD, T-score, and Z-score of the ipsilateral proximal femur was measured by dual-energy X-ray absorptiometry. Pearson's correlation coefficient was used to test the association of severity of OA knee with BMD. Results: Among 100 subjects, there were 51 females and 49 males with mean age 59.94 ± 6.67. Maximum patients were with K-L grade 2 (42%) followed by grade 3 (30%) and grade 4 (22%). There was statistically significant (p < 0.0001) association between BMD and severity of OA knee. BMD decreased as the K-L grade of OA knee increased from 1 to 4. Similar statistically significant association was observed in T-score and Z-score. Conclusion: The study concluded that BMD of ipsilateral proximal femur decreases with severity of OA knee. These data support the fact that the two conditions may be related to each other and primary care physicians must look for these two conditions in coexistence. Primary prevention of either of the two conditions should be advised, if the other condition coexists in the same patient.
Menopause. 2022 Jan 14;29(4):483-490. doi: 10.1097/GME.0000000000001938.
Transdermal estrogen therapy in menopausal women at increased risk for thrombotic events: a scoping review
Talia H Sobel 1, Wen Shen 2
Importance and objective: It is estimated that over 45% of women in the United States are menopausal. Many of these women suffer from vasomotor symptoms of menopause, for which the gold standard treatment is menopause hormone therapy (MHT). However, MHT use has been controversial since the Women's Health Initiative (WHI) study in 2001. Transdermal MHT has been shown to be effective for treatment of vasomotor symptoms and does not increase the risk of venous thromboembolism (VTE) when used in healthy postmenopausal women. However, there is little data on its safety in women at increased risk for VTE such as women with prior VTE, increased body mass index, thrombophilia, tobacco use, autoimmune disease, chronic inflammatory disorders, recent surgery, trauma, or immobilization. This scoping review of the literature provides clinicians with an overview of the evidence on the risk profile of transdermal MHT use in these postmenopausal women at increased risk of VTE. Methods: We searched all published studies from 2000 to 2020 and included 13 primary articles on transdermal MHT use in postmenopausal women at increased risk of VTE. Discussion and conclusion: In women with prior VTE, two studies found a decrease in coagulability and no increased risk of recurrent VTE with transdermal MHT use. In women with increased body mass index, three studies found no increased VTE risk in transdermal MHT users. In women with prothrombotic genetic polymorphisms, three studies found minimal to no increased VTE risk in transdermal MHT users. In women with various proinflammatory comorbidities, five studies found an improved thrombotic profile and no increased VTE risk with transdermal MHT use. This scoping review provides data regarding the safety of transdermal MHT use in postmenopausal women with risk factors for VTE, and clinicians should have risk versus benefit discussions with each patient regarding its use.
Menopause. 2022 Feb 14;29(4):415-420. doi: 10.1097/GME.0000000000001927.
Prevalence of female pattern hair loss in postmenopausal women: a cross-sectional study
Sukanya Chaikittisilpa 1, Nattiya Rattanasirisin 1 2 3 4 5, Ratchathorn Panchaprateep 3, et al.
Objective: To identify the prevalence of female pattern hair loss (FPHL), hair characteristics, and associated factors in healthy postmenopausal women. Methods: Two hundred postmenopausal women aged 50 to 65 years were recruited. Each participant was evaluated for FPHL according to Ludwig's classification using standardized global photography in all six views and trichoscopy for hair density and diameter. Three dermatologists re-evaluated all pictures for confirmation of FPHL. The time since menopause, levels of scalp sebum, serum testosterone, estradiol, thyroid stimulating hormone, and hemoglobin; family history of hair loss, as well as an evaluation of low self-esteem were evaluated. Women who underwent recent hair loss treatments were excluded. We used simple and multivariable logistic regression analysis to identify the factors affecting FPHL. Results: In total, 178 postmenopausal women were evaluated for hair-loss patterns. The average age and time since menopause were 58.8±4.1 and 9.2 ± 5.6 years, respectively. The prevalence of FPHL was 52.2% (95% CI, 44.6-59.8). Severity of FPHL by Ludwig grades I, II, and III was 73.2% (95% CI, 62.9-81.8), 22.6% (95% CI, 14.6-32.4), and 4.3% (95% CI, 1.2-10.7), respectively. Logistic regression analysis revealed that age, time since menopause, and body mass index were all significantly associated with FPHL. After adjusting for age and family history of FPHL, only body mass index ≥25 kg/m2 was significantly associated with FPHL (adjusted OR = 2.65, 95% CI, 1.23-5.70). Conclusion: The prevalence of FPHL was high in postmenopausal women, raising the need for hair loss awareness in menopause clinics. Early detection and proper treatment of FPHL may increase the quality of life in postmenopausal women.
Osteoporos Int. 2022 Mar 29. doi: 10.1007/s00198-022-06383-1. Online ahead of print.
Risk of osteoporosis and fracture after hysterectomies without oophorectomies: a systematic review and pooled analysis
Weifang Xu Xu, Weizhou Wu, Suqing Yang, Tingting Chen, Xiao Teng, Danping Gao, Shankun Zha
The present study provides evidence that women who underwent hysterectomy without oophorectomies are at a higher risk of osteoporosis and bone fractures than the general population. Early interventions for these susceptible women may help to delay or reduce the risk of osteoporosis and bone fractures. Introduction: Mounting studies have shown that patients with hysterectomy are at high risk of developing osteoporosis or bone fractures, but the evidence from all the relevant studies has not been previously synthesized. The present study aims to investigate whether women with hysterectomy without oophorectomies have a prominently higher prevalence of osteoporosis or fractures than healthy subjects. Methods: Four electronic databases were systematically searched to identify the eligible studies. The combined effect was assessed by calculating the relative risk (RR) with a 95% confidence interval (CI). More methodologies for this study were available in the PROSPERO (ID: CRD42021227255). Results: Finally, three observational studies offering osteoporosis cases and two retrospective studies reporting fracture cases were included. One eligible study has provided independent data from three groups of fractures. Synthetic results revealed that hysterectomy without oophorectomies was significantly associated with an increased risk of osteoporosis as compared to the general population (combined RR from three studies = 1.47, 95%CI 1.253 to 1.725, P < 0.001; heterogeneity, I2 = 76.2%, P = 0.015). Consistently, the prevalence of fractures was also significantly higher in patients with hysterectomy without oophorectomies than in healthy controls (pooled RR from four studies = 2.333, 95%CI: 1.314 to 4.144, P = 0.004; heterogeneity, I2 = 92.3%, P < 0.001). Conclusions: This is the first study to quantify the association between hysterectomy without oophorectomies and osteoporosis/fracture risk through a meta-analysis and has subsequently confirmed its positive relationship. Additional large-sample rigorously prospective cohorts are still warranted to validate the present evidence.