Magdalena Durán

Skin collagen changes related to age and hormone replacement therapy

A total of 76 nulliparous women who had been hospitalized for minor operations, classified according to age group (by decade from 20s to 60s) and 118 postmenopausal women randomly allocated to one of four groups were studied. In all, 312 skin biopsies were taken from the lower abdomen at 0 and 12 months and the skin collagen changes noted. Collagen content decreased significantly with age beyond the 40s (P < 0.001) and after the menopause (P < 0.01). The decrease was preventable by the use of hormone replacement therapy. All the therapeutic regimens induced increases in skin collagen content, whereas in the control group a significant decrease was observed (P < 0.05).

The effect of hormone replacement therapy on bone mass in patients with ovarian failure due to bone marrow transplantation

BACKGROUND Long permanent remissions in malignant hematopoietic disorders can often be achieved by autologous bone marrow transplantation (ABMT) or by allogenic bone marrow transplantation (BMT). Previous studies have shown that such therapies may induce osteoporosis due to iatrogenic ovarian failure. The administration of hormone replacement therapy (HRT) in these women could prevent the adverse effects of long-term ovarian failure without remarkable side effects. The aim of this study was to evaluate how the bone mass is affected by HRT in patients undergoing ABMT or BMT adjusting the results for age, weight, and height. SUBJECTS AND METHODS Thirteen women with previous ABMT/BMT were treated with a standard dose (0.625 mg/day) of conjugated equine estrogen (CEE) or with 50 micrograms/day of 17-beta-estradiol in transdermal therapeutic systems (TTS) plus 5 mg/day of medroxyprogesterone acetate sequentially added to the last 12 days of estrogen therapy. Bone mass was measured prior to and 12 months following HRT. Blood samples were collected before therapy and during the 6th and 12th treatment months. RESULTS The mean time elapsed between bone transplantation and HRT initiation was 13.0 months (range 3-26 months). Before treatment nine patients were osteopenic and after HRT bone mass increased in all cases. Following ABMT/BMT, hepatic hyperenzymemia was detected in three patients. After 6 and 12 months of treatment no significant changes were observed in hepatic enzymes. CONCLUSION Although hepatic hyperenzymemia is commonly considered as a contraindication for HRT, our results suggest that HRT is safe for these patients and that such therapy should be initiated after transplantation in women to prevent adverse effects of long-term ovarian failure.

Biochemical markers of bone turnover after surgical menopause and hormone replacement therapy

The objective of this study was to evaluate the effect of surgical menopause and hormone replacement therapy (HRT) on the new biochemical markers of bone turnover. Fourteen women who had undergone surgical menopause and began HRT 3 months after surgery were recruited for a 1-year study. Results were compared with a control group of 31 healthy premenopausal women of similar age. Serum samples were obtained to determine total alkaline phosphatase, bone alkaline phosphatase, propeptides carboxy- and amino-terminal of type I procollagen (PICP, PINP), osteocalcin, tartrate-resistant acid phosphatase, and carboxy-terminal telopeptides of type I collagen (ICTP and serum CTX). Urine samples were analyzed for hydroxyproline, pyridinoline, deoxypyridinoline, alpha- and beta-carboxy-terminal telopeptides of type I collagen (alpha-CTX and beta-CTX), and amino-terminal telopeptide of type I collagen (NTX). Determinations were performed after 3 months of surgical menopause and after 3 and 9 months of HRT. All biochemical markers increased after menopause, and most of them normalized after 9 months of HRT. Serum PINP showed the highest proportion of increased values after surgery among bone formation markers (62%), as well as the highest mean percent increase (101%). Among bone resorption markers in postmenopausal women, urinary beta-CTX, alpha-CTX, NTX, and serum CTX showed the highest proportion of increased values (100%, 67%, 58%, 58%, respectively) as well as the greatest mean percent increase. They were also the markers with the most marked response to HRT. In conclusion, serum PINP is the most sensitive marker of bone formation, whereas beta-CTX is the most sensitive marker of bone resorption after surgical menopause. In addition, both markers showed the highest response after HRT.

Transvaginal sonography of the endometrium in postmenopausal women: Monitoring the effect of hormone replacement therapy

BACKGROUND It is well known that progestins given in sufficient dosage reduce the risk of endometrial cancer and endometrial hyperplasia. It is also not uncommon that patients receiving hormone replacement therapy (HRT) require endometrial biopsy in order to evaluate the effects of oestrogens and progestogens on endometrium. However, endometrial biopsy is often associated with pain and discomfort, and transvaginal sonography has been suggested as a new and painless method of monitoring the effects of HRT on the endometrium. METHODS Transvaginal ultrasonography was performed in a series of women on several regimens of HRT immediately prior to endometrial biopsy (Cornier cannula). We correlated the morphology and thickness of the endometrium as assessed by transvaginal ultrasonography with the endometrial histology. Patients were assigned into four groups. The first (n = 15) received 0.6 mg/day of conjugated equine oestrogen (CEE) cyclically and the second (n = 6) received 50 micrograms/day of transdermal oestradiol cyclically. All these groups also received 5 mg of medroxy-progesterone acetate (MPA) sequentially for the last 12 days of HRT, while the third therapy group (n = 7) received 0.625 mg/day of CEE and 5 mg/day of MPA uninterruptedly. The fourth group (n = 8) constituted a treatment-free control group. In total 36 biopsies were taken. Our initial results suggest that endometrial thickness under 4 mm measured by ultrasonography is not associated with endometrial abnormalities and that transvaginal ultrasonographic scanning of the endometrium may be a useful tool in determining which patients require endometrial histologic evaluation and perhaps in detecting those who need adjustment in the progestin dosage.

Effect of surgical menopause and Paget's disease of bone on the isomerization of type I collagen carboxyterminal telopeptide: evolution after antiresorptive therapy.

Abstract. The objective of this study was to analyze the effect of surgical menopause and Pagets disease of bone, as well as the influence of therapy, on the isomerization of the carboxyterminal telopeptide of type I collagen (CTX). Fourteen women who had undergone surgical menopause and had begun hormone replacement therapy (HRT) after surgery were recruited. Results for these women were compared with those of 29 patients with Pagets disease of bone treated with tiludronate (400 mg/day) for 3 months, and with those of a group of 21 healthy premenopausal women (control group I). In addition, 14 healthy individuals with an age range similar to that of the pagetic patients (control group II) were included in the study. Urine samples were analyzed for levels of nonisomerized and β-isomerized CTX (α-CTX and β-CTX). Biochemical determinations were performed 3 months after surgical menopause and after 3 and 9 months of HRT, and at baseline, and 1 and 6 months after tiludronate treatment in the pagetic patients. The average levels of α-CTX and β-CTX were higher in patients than in controls. In patients after surgical menopause, because of their greater increase of β-CTX, the α-CTX/β-CTX ratio was lower than that of control group I (0.881 ± 0.3 vs 1.515 ± 0.8; P < 0.05). In contrast, at baseline, pagetic patients showed marked increases in α-CTX levels, resulting in a higher α-CTX/β-CTX ratio than that of control group II (2.879 ± 1.3 vs 0.96 ± 0.25; P < 0.0001). The average percent decrease in both markers after therapy was similar in both conditions (−60% for α-CTX and −44% for β-CTX after 3 months of HRT in the surgical menopause group, vs −66% for α-CTX and −41% for β-CTX in the pagetic group, 1 month after finishing tiludronate therapy; P, NS), resulting in a significant decrease of the α-CTX/β-CTX ratio in pagetic patients (2.879 ± 1.3 vs 1.614 ± 0.8; P < 0.001). In conclusion, surgical menopause is associated with a decrease in the urinary α-CTX/β-CTX ratio because of the higher increase in the β-CTX level after menopause. Pagetic patients show an increase in this ratio, compared with the control value, and the ratio decreases after bisphosphonate treatment. The response to therapy was similar in both conditions, with a comparable decrease of both markers. These findings show how bone markers may contribute to the understanding of pathophysiologic mechanisms in bone diseases.

Posicionamiento de la Asociación Española para el Estudio de la Menopausia sobre el uso clínico de las isoflavonas en el climaterio

Resumen Objetivo Existe un interes creciente en los paises occidentales acerca de la utilidad de las isoflavonas de la soja para el tratamiento de los sintomas y enfermedades relacionadas con la menopausia y el envejecimiento, que se ha traducido en la aparicion de un importante numero de publicaciones, muchas de las cuales presentan resultados contradictorios. La Asociacion Espanola para el Estudio de la Menopausia (AEEM) ha evaluado el papel de las isoflavonas en la salud de la mujer menopausica, basandose en las mejores evidencias disponibles. Material y metodos Se reunio un panel de expertos, clinicos e investigadores en el campo de las isoflavonas. Los estudios seleccionados se obtuvieron mediante una busqueda electronica que incluyo buscadores de internet, Medline (1966- marzo de 2007) y el Registro de Ensayos Clinicos Controlados Cochrane. Resultados Las diferentes revisiones y metaanalisis sobre los efectos de las isoflavonas en la salud de la mujer son controvertidos. La diversidad de resultados puede deberse, entre otras causas, a la falta de uniformidad de los compuestos estudiados. En relacion con la dosis y el contenido en genisteina, se han demostrado efectos beneficiosos en el perfil lipidico, como antioxidantes, asi como una reduccion moderada de los sofocos. Algunos estudios sugieren un efecto positivo en la masa osea. Los datos disponibles en otros aspectos, como la mama, canceres dependientes de los estrogenos, funcion cognitiva y piel, entre otros, son escasos. Conclusiones En diversas situaciones, las isoflavonas pueden ser una alternativa terapeutica en el climaterio, si bien antes de poder proceder a la realizacion de recomendaciones generales acerca del consumo de preparados de isoflavonas, se necesitan ensayos clinicos especificos, de diseno adecuado, con preparados normalizados en cuanto al contenido en isoflavonas y sus tipos, y con suficiente numero de pacientes y tiempo de estudio.

Posicionamiento de la Asociación Española para el Estudio de la Menopausia sobre el uso clínico de la Cimicífuga racemosa en el climaterio

Objetivo: Dado el creciente interes en los paises occidentales acerca de la utilizacion de ciertas plantas para el tratamiento de los sintomas relacionados con la menopausia, la Asociacion Espanola para el Estudio de la Menopausia (AEEM) ha evaluado el papel de la Cimicifuga racemosa en el tratamiento de los sintomas climatericos sobre la base de las mejores evidencias disponibles. Material y metodos. Se reunio un panel de expertos, clinicos e investigadores, en el campo de la fitoterapia. Los estudios seleccionados se obtuvieron mediante una busqueda electronica que incluyo buscadores de Internet, MEDLINE (1985-mayo 2008) y el Registro de Ensayos Clinicos Controlados Cochrane. Resultados: La mayoria de los estudios publicados en los ultimos anos estan realizados con el extracto isopropanolico de Cimicifuga racemosa. La dosis mas estudiada ha sido 40 mg/dia y ha demostrado obtener una reduccion moderada de las sofocaciones, sobre todo en las mujeres con sofocos mas intensos, y una mejoria del estado de animo. Utilizada a las dosis recomendadas, no hay riesgo relevante desde el punto de vista hepatico. Los datos disponibles sobre su efecto en la enfermedad cardiovascular, el hueso, la funcion cognitiva y la piel son muy escasos o inexistentes. Conclusiones: La Cimicifuga racemosa es un tratamiento eficaz en el alivio de los sintomas vasomotores, al menos en una poblacion adecuada de mujeres peri y posmenopausicas, si bien se precisan mejores ensayos clinicos con suficiente numero de pacientes incluidas y mayor duracion del estudio.