Juliana Dosy

Bone Mineral Density and Metabolism at an Early Stage of Menopause When Estrogen and Calcium Supplement Are Not Used and without the Interference of Major Confounding Variables

Objectives: To measure bone mineral density (BMD) and to screen for early biochemical abnormalities in bone mineral metabolism in the first five years of natural menopause when estrogen and calcium supplement are not used and in the absence of major confounding variables. Setting: Two homogeneous and comparable groups (n = 30) of healthy pre- and postmenopausal Caucasian women living in a northern region (latitude 46° N) were recruited during the mid-Spring/Summer season in a cross-sectional design. Methods: Volumetric apparent BMAD (g/cm3) was calculated from areal BMD (g/cm2) which was evaluated by dual energy X-ray absorptiometry (Lunar®) at both axial and peripheric (femur) sites using two sets of reference values (WHO criterion expressed as T-score and absolute values of areal density) in combination to bone specific biochemical measurements. Results: BMD and BM(A)D were significantly lower in postmenopausal women for all lumbar sites, but not for Ward’s triangle and any other femoral sites whereas free deoxypyridinoline (Dpd), urinary biochemical marker of bone resorption, was markedly (p < 0.0001) greater. Their serum calcium and phosphate were significantly higher without a difference in 1,25(OH)2D3 and PTH. The prevalence of osteopenia in pre- and postmenopausal women was about 2-fold lower in both groups (26.6 and 46.9%, respectively) when lumbar (L) spine and femur neck were combined and using the criteria based on reference values of areal density instead of T-scores. Conclusions: The present study showed that the negative effects of estrogen deficiency on BMD and bone metabolism in early menopause occurred independently of the effect of major calcitropic hormones. Bone loss affects a non negligible proportion of premenopausal women. The prevalence of osteopenia in pre- and postmenopausal women varied according to the criterion used and anatomic site.

Is Serum Ferritin an Additional Cardiovascular Risk Factor for All Postmenopausal Women

Background: Most of the studies on cardiovascular disease (CVD) risk factors in menopause have focused on serum lipid(lipoprotein) abnormalities and were conducted in populations which were not well controlled for several important influential factors. Methods: Two homogenous groups of 30 apparently healthy Caucasian premenopausal women and 3–5 years postmenopausal women who were nonobese, nonsmoking and not using estrogen were compared in a well-controlled cross-sectional design. Fasting serum ferritin and plasma total homocysteine (tHcy) were evaluated concomitantly to classical serum lipid(lipoprotein) risk factors. Relationships between risk factors and the influence of other contributing variables such as diet and body weight were also examined. Results: Serum total cholesterol (p < 0.01), low-density lipoproteins (LDL; p < 0.05) and triglycerides (p < 0.05) of postmenopausal women were greater than that of their menstruating counterparts, even though they ate a CVD-preventive diet, had similar body weight and body fat distribution. Their serum ferritin was almost 3-fold greater (p < 0.0001) but was still within normal limits, except for the 38.5% of postmenopausal women who exhibited values above the 80 µg/l limit that has been associated with sharp increases in the rate of heart disease in either gender. Serum ferritin was low in one third of the postmenopausal group (as low as in the premenopausal control group, whose dietary iron intake was slightly below the nutritional recommendation). The mean plasma tHcy of the postmenopausal group was almost twice as elevated (p < 0.0001). Both ferritin and tHcy were found to be linked to serum cholesterol. The correlation between tHcy and triglycerides was also significant. Conclusion: Early menopause is not associated with blood iron overload and CVD risk factor in an important proportion of women.

Coexistence of osteoporosis and cardiovascular disease risk factors in apparently healthy, untreated postmenopausal women

This study aimed to determine whether apparently healthy, untreated postmenopausal women at risk of osteoporosis relative to nonmenopausal women are concomitantly at risk of cardiovascular disease (CVD) in terms of various aspects of lifestyle, personality, body shape and composition, and blood chemistry. Two homogeneous groups of 30 women having reached menopause for 3-5 years and 30 nonmenopausal controls, all non-estrogen users without apparent CVD risk factors, were compared in a cross-sectional design. Data related to physical activity, dietary intakes, personality type, anthropometry, and skinfold-thickness were collected. Plasma insulin-like growth factor (IGF-1) and serum lipids were measured and used as biochemical predictors of osteoporosis and CVD, respectively. Compared to nonmenopausal controls, postmenopausal women were at greater risk of bone loss given their lower plasma IGF-1, lower physical activity level, and even given their higher serum lipids, as recent literature suggests. Moreover, their dietary calcium intake fulfilled only 70% of the current recommendation, which may reduce protection against osteoporosis and CVD (particularly hypertension) as well. The two groups did not differ regarding energy intake, body weight and frame size, body mass index (BMI), waist circumference, and waist-hip ratio (WHR). However, postmenopausal subjects had more adipose tissue and differed in terms of lifestyle factors (lower dietary lipids and greater alcohol consumption). While neither group was at particular risk of CVD according to waist circumference, WHR, and serum triglycerides, postmenopausal women were at risk according to percent body adiposity and serum cholesterol. This study shows that several risk factors for osteoporosis and CVD can coexist in apparently healthy postmenopausal women after a few years of natural menopause. It emphasizes the need for a timely screening that would stress both heart and bone risk factors.

Enhancement of calcium/vitamin d supplement efficacy by administering concomitantly three key nutrients essential to bone collagen matrix for the treatment of osteopenia in middle-aged women: a one-year follow-up.

Two vitamins and proline (CB6Pro), three nutrients essential for bone collagen, were used in combination to a 1000 mg calcium/250 IU vitamin D (Ca/D) daily supplement to treat osteopenia as a preventive measure against osteoporosis later in life. Middle-aged women not using estrogen were screened for osteopenia using the WHO criteria and divided into three groups (n = 20 each): 1) placebo healthy controls with normal bone mineral density (BMD); 2) control Ca/D-treated osteopenic patients; and 3) Ca/D + CB6Pro-treated osteopenic patients. The three groups were comparable at baseline except for BMD. After one-year treatment, cortical diaphyseal BMD remained constant in each group, but trabecular bone loss persisted (at 5 lumbar sites) in osteopenic group 2. No further bone loss was detected in osteopenic group 3. A loss of 2% was evidenced in the placebo group at one lumbar site. Markers of bone formation (which increase in coupling to resorption) decreased significantly in both osteopenic groups. Although biomarkers of resorption did not change, hormone (PTH and 1,25(OH)2D3)-induced osteoclastic activity was significantly reduced. No decline in BMD occurred at any bone site in osteopenic group 3, highlighting the importance of improving the quality of bone matrix concomitantly to mineral replacement.

Acknowledgement to the 2004 Reviewer

Martinez, A., Pamplona, Spain Mokuda, O ., Ichihara-City, Japan Moser, U., Basel, Switzerland Neuhäuser-Berthold, M., Giessen, Germany Pallauf, J., Giessen, Germany Palou, A., Palma de Mallorca, Spain Pedersen, J., Oslo, Norway Pool-Zobel, B., Jena, Germany Porrini, M., Milan, Italy Rethy, L., Budapest, Hungary Rimbach, G.H., Reading, UK Rodriguez-Amaya, D.B., Campinos, Brazil Rust, P., Vienna, Austria Salem, N., Rockville, Md., USA Schümann, K., Munich, Germany Simopoulos, A.P., Washington, D.C., USA Singer, P., Bensheim-Auerbach, Germany Sirtori, C.R., Milan, Italy Sjöström, M., Huddinge, Sweden Somoza, V., Garching, Germany Stahl, W., Düsseldorf, Germany Trichopoulo, A., Athens, Greece Trichopoulos, D., Boston, Mass., USA Trippo, U., Bergholz-Rehbrücke, Germany Uauy, R., Santiago, Chile Urbanek, R., Vienna, Austria Villalpando, S., Cuernavaca, Mexico Von Rücker, A., Bonn, Germany Von Schacky, C., Munich, Germany Wahlqvist, M.L., Melbourne , Australia Wahrendorf, J., Heidelberg, Germany Watzl, B., Karlsruhe, Germany Wenk, C., Zürich, Switzerland Winisch, W., Vienna, Austria Wisker, E., Kiel, Germany Zunft, H.-J., Bergholz-Rehbrücke, Germany Adam, O., Munich, Germany Antal, M., Budapest, Hungary Arthington, J., Ona , Fla., USA Berg, A., Freiburg, Germany Bitsch, I., Giessen, Germany Boeing, H., Bergholz-Rehbrücke, Germany Böhm, V., Jena, Germany Classen, H., Hohenheim, Germany Clinton, S., Columbus, Ohio, USA Cunningham, C., Winston-Salem , N.C., USA De Blas, J.C., Madrid , Spain Dobos, D., Essen, Germany Fürst, P., Stuttgart, Germany Gadek-Wesierski, J., Vienna, Austria Genser, D., Vienna, Austria Götz, M., Vienna, Austria Grassmann, J., Munich, Germany Hagfors, L., Umea, Sweden Hauner, H., Munich, Germany Hautvast, J., Wageningen, The Netherlands Herrera, E., Madrid, Spain Joost, H.J., Bergholz-Rehbrücke, Germany Kafatos, A., Heraklion, Greece Kalapos, M., Budapest, Hungary Kar, A ., Deoghar, India Kato, Saiama, Japan Keller, U., Basel, Switzerland Knasmüller, S., Vienna, Austria Koletzko, B., Munich, Germany König, J., Vienna, Austria Krawinkel, M., Giessen, Germany Kudlácková, M., Bratislava, Slovak Republik Laplace, J.P., Paris, France Lemmens, R., Vienna, Austria Linseisen, J., Munich, Germany Magee, P., Belfast, UK Marangoni, F., Milan, Italy