Ingrid Bergström

Pregnancy rate and outcome in Swedish women with Turner syndrome

Pregnancies occurred in 57 (12%) of 482 Swedish women with Turner syndrome with a liveborn rate of 54% in 124 pregnancies. Spontaneous pregnancies occurred in 40%, mainly in women with 45,X/46,XX mosaicism, and oocyte donation in 53% where miscarriages were less frequent, odds ratio = 0.43 (95% confidence interval 0.17-1.04).

Adipose tissue and metabolic alterations: regional differences in fat cell size and number matter, but differently: a cross-sectional study.

OBJECTIVE White adipose tissue can expand by increasing the size and/or number of fat cells. Although increased sc and visceral fat cell size associates with an adverse metabolic profile, the relationship with fat cell number in either depot is unknown. We hypothesized that adipocyte number and size displayed different relationships with clinically relevant metabolic variables. METHODS This was a cross-sectional study of 204 patients scheduled for gastric bypass surgery. Fat cell size and number were determined in visceral and abdominal sc adipose tissue and related to insulin sensitivity (by hyperinsulinemic euglycemic clamp), fasting plasma levels of insulin, triglycerides and high-density lipoprotein (HDL) cholesterol. RESULTS Visceral and sc fat cell volumes were positively correlated with insulin and triglyceride levels and negatively with insulin sensitivity and HDL-cholesterol (P = .0020 or better). In contrast, although visceral fat cell number did not associate with any metabolic parameter, sc adipocyte number displayed a positive association with insulin sensitivity and HDL-cholesterol and a negative relationship with insulin and triglyceride levels (P = .0014 or better). All results were independent of body fat mass. CONCLUSIONS Variations in fat cell size and number correlate differently with metabolic parameters in obesity. Increased fat cell size in visceral and sc depots associates with a pernicious metabolic profile, whereas increased sc, but not visceral, fat cell number correlates with a more beneficial phenotype. Whether determination of sc fat cell number, in addition to adipocyte size, may have a predictive value for the risk of type 2 diabetes needs to be demonstrated in prospective or mechanistic studies.

Physical training decreases waist circumference in postmenopausal borderline overweight women

Objective. To examine if healthy borderline overweight postmenopausal women with osteoporosis can improve their waist circumference and lipid profile with a moderate physical training program. Design. Randomized controlled trial. Setting. One hundred and twelve postmenopausal women were randomized to normal sedentary life or one year of physical training consisting of three brisk walks and 1–2 aerobic exercises/week. Main Outcome Measures. Waist circumference reduction, waist circumference reduction in relation to observed level of participation in physical intervention and changes in cholesterol, triglycerides, apolipoproteins B and A1 and high‐sensitivity C‐reactive protein (hs‐CRP). Results. At start the mean (SD) waist circumference was 83.6 (7.7) and 81.8 (7.5) cm in the control and training groups, respectively. In relation to baseline, the 12 months intervention led to a waist reduction of 0.3 cm (2.7) (p = 0.36) and 1.6 cm (4.7) (p = 0.02) in the respective groups but the inter‐group comparison was not significant in an intention‐to‐treat analysis (p = 0.09). The ninety‐two women completing the study intervention were analyzed per protocol. A tendency for better waist reduction in relation to the womens observed physical intensity level was observed (p = 0.07, ANOVA for linear trend across training intensity levels). Training women improved their waist circumference 1.7 cm (p = 0.01) compared to baseline and was borderline significantly better than controls (p = 0.059). No significant changes in response to the intervention were observed for blood pressure, cholesterol, triglycerides, apolipoproteins and hs‐CRP. Conclusions. A moderate physical exercise program for healthy postmenopausal women during one year reduced the waist circumference in a training intensity dependent manner.

Women with anorexia nervosa should not be treated with estrogen or birth control pills in a bone‐sparing effect

Eating disorders are prevalent, serious conditions that affect mainly young women. An early and enduring sign of anorexia is amenorrhea. There is no evidence for benefits of hormone therapy in patients with anorexia; however, hormone medication and oral contraceptives are frequently prescribed for young women with anorexia as a prevention against and treatment for low bone mineral density. The use of estrogens may create a false picture indicating that the skeleton is being protected against osteoporosis. Thus the motivation to regain weight, and adhere to treatment of the eating disorder in itself, may be reduced. The most important intervention is to restore the menstrual periods through increased nutrition. Hormone and oral contraceptive therapy should not be prescribed for young women with amenorrhea and concurrent eating disorders.

Training or EPT in perimenopause on balance and flushes

With advancing age, the postural balance function deteriorates as a consequence of decreased functional capacity. Deteriorating balance is a risk factor for bone fractures due to increased risks of falls. It has been suggested that the loss of estrogen, which occurs in relation to the menopause, may be associated with loss of balance. Regular physical exercise without balance training has, in some studies, been shown to have positive effects on the postural balance. The aim of the present study was to examine balance function during the perimenopausal period, and evaluate the effect of estrogen plus progesterone therapy (EPT) or aerobic training on balance. Sixty perimenopausal women were recruited to the study. The subjects were then randomised to either physical training (n = 20), EPT (n = 20), or to a control group (n = 20). The study period was 18 months. Postural stability was measured every third month using a custom‐made force platform. The women using EPT achieved better results in 3 of 6 parameters, after 18 months.

Observational study of vitamin D levels and pain in pregnant immigrant women living in Sweden

Abstract The aim was to determine the prevalence of vitamin D insufficiency in pregnant immigrant women assessed by the levels of 25-hydroxyvitamin D, parathyroid hormone (PTH) and alkaline phosphatase (ALP) as well as the correlation to musculoskeletal pain. Sixty-eight pregnant immigrant women were included. Fifty-one native Swedish pregnant women served as controls. 25-hydroxyvitamin D, PTH, ALP and musculoskeletal pain, rated on a visual analogue scale, were analyzed in all women in gestational week 12 and in the immigrant women at 6–12 months postpartum. A significantly higher proportion of immigrant women (77.9%) had levels of 25-hydroxyvitamin D <25 nmol/l compared with 3.9% in controls. Of the immigrant women, 29.4% had 25-hydroxyvitamin D levels <12 nmol/l, but none of the controls. Musculoskeletal pain evaluated with a visual analogue scale (VAS) was significantly higher for the immigrant women than for the controls at gestational week 12. However, no within group correlation was seen between 25-hydroxyvitamin D levels, PTH or ALP and pain. A significant negative correlation between changes in 25-hydroxyvitamin D and pain from gestational week 12 to postpartum was observed. Hypovitaminosis D is prevalent in immigrant women living in Sweden. There is an indication that pain might be associated with hypovitaminosis D.

Back extensor training increases muscle strength in postmenopausal women with osteoporosis, kyphosis and vertebral fractures

Abstract We determined the efficacy of a back muscle extensor strengthening program on the back muscle extensor strength, kyphosis, height and thoracic expansion in women with at least one vertebral fracture, kyphosis and osteoporosis. Thirty-six patients were included and randomized to a control or a training group. The training focused on back muscle extensor strengthening program for 1 h, twice a week for 4 months and was performed by a physiotherapist. The main outcome measure was the back muscle extensor strength. In an intention-to-treat analysis no significant effects on back muscle strength in the training group vs. controls could be seen (p = 0.74). In a per-protocol analysis (n = 28), the training group increased back muscle strength from 290 ± 87 to 331 ± 89 N while the control group showed no improvement. After adjusting for the strength at baseline, a significant effect of training could be demonstrated (p = 0.029). When comparing the heights between the groups a significant group × time interaction was observed (p = 0.012) where the training women increased their mean height with 0.3 cm (p = 0.101) and controls decreased 0.44 cm (p = 0.045). The training group improved their thoracic expansion compared with baseline (p = 0.03). No effect of training on kyphosis was seen. In conclusion, a 4-months back extensor training program can improve back strength and seems to maintain height and thoracic expansion.

Empowering the fragile body: Experiences of a back muscle group training program in postmenopausal women with vertebral fractures. A qualitative interview study

Abstract This study was undertaken to explore the experiences of a professionally supervised back muscle exercise group training program (BMTP) in women with osteoporosis-related vertebral fractures and increased thoracic kyphosis. Method: A qualitative interview study was carried out with 11 women, aged 60–93 years (median age 68 years), participating in the BMTP for 4 months. Analysis of the open interviews was supported by qualitative content analysis. Findings: Two categories and four sub-categories were constructed from the analysis: Awareness and experiences of the body through back muscle exercise (sub-categories; Sense and awareness of straightening the back and The usefulness of increased bodily strength and mobility) and Social dimensions of group training (sub-categories: Affinity and support and Sense of trust and safety). The women experienced both bodily and social benefits from participation in the BMTP, including improved mobility, increased strength, physical activity, better sleep, reduced pain and uncertainty as well as positive experiences of training in a group under professional supervision. Conclusion: The study showed that professionally supervised specific back exercise training brought benefits to everyday life, increased well-being and quality of life, and provided an empowering complement to pharmacological therapy in this group of women.

Long‐term follow‐up of bone density, general and reproductive health in female survivors after treatment for haematological malignancies

The purpose of this study was to assess the ovarian function, fertility and bone mineral density in women who previously had treatment for different haematological malignancies (HMs). The overall survival and cure rates of patients with HMs have improved dramatically. The treatment affects fertility and bone density. Fifty‐two premenopausal women, from Stockholm region, were included in the study between 1998 and 2002, followed until 2011. The diagnoses were acute lymphoblastic leukaemia (n = 6), acute myeloid leukaemia (n = 10), chronic lymphocytic leukaemia (n = 1), chronic myeloid leukaemia (n = 12), Hodgkin lymphoma (n = 12) and non‐Hodgkin lymphoma (n = 11). Before treatment, women without children (43/52), when possible, were offered fertility preservation options. The mean age at diagnosis was 27, at final evaluation 39 yr. Thirty‐seven patients received HSCT; 26 allogeneic, 11 autologous. Before allogeneic HSCT, nineteen patients had myeloablative conditioning; seven had reduced‐intensity conditioning. Eleven patients got total body irradiation. Eight patients were transplanted with grafts from an HLA‐identical sibling donor, while 18 had unrelated donors. All women were in a menopausal state post‐therapy. Hormone replacement therapy (HRT) was given, and bone mineral density (BMD) was measured every other year. The serum levels of parathyroid hormone (PTH), free and bound calcium was within normal range. BMD measurements showed a slight increase over time in the spine with a mean of 0.015 g/cm2/yr. Four spontaneous pregnancies resulted in two babies and two discontinued pregnancies; two pregnancies were achieved with oocyte donation and surrogacy and one woman adopted a child. HRT sustains BMD in long‐term survivors from HMs. This study highlights the importance of HRT and fertility issues in this patient group.

The effect of physical training on bone mineral density in women with endometriosis treated with GnRH analogs : a pilot study

Background.  The effect of physical training on bone mineral density (BMD) in women with endometriosis treated with gonadotropin‐releasing hormone (GnRH) analogs was studied.