Rafael Sánchez Borrego

EMAS position statement: The ten point guide to the integral management of menopausal health

With increased longevity and more women becoming centenarians, management of the menopause and postreproductive health is of growing importance as it has the potential to help promote health over several decades. Women have individual needs and the approach needs to be personalised. The position statement provides a short integral guide for all those involved in menopausal health. It covers diagnosis, screening for diseases in later life, treatment and follow-up.

Recommendations on the management of fragility fracture risk in women younger than 70 years

The risk for fragility fracture represents a problem of enormous magnitude. It is estimated that only a small fraction of women with this risk take the benefit of preventive measures. The relationship between estrogen and bone mass is well known as they are the other factors related to the risk for fracture. There are precise diagnostic methods, including a tool to diagnose the risk for fracture. Yet there continues to be an under-diagnosis, with the unrecoverable delay in instituting preventive measures. Women under the age of 70 years, being much more numerous than those older, and having risk factors, are a group in which it is essential to avoid that first fragility fracture. Today it is usual not to differentiate between the treatment and the prevention of osteoporosis since the common aim is to prevent fragility fractures. Included in this are women with osteoporosis or with low bone mass and increased risk for fracture, for whom risk factors play a primary role. There is clearly controversy over the type of treatment and its duration, especially given the possible adverse effects of long-term use. This justifies the concept of sequential treatment, even more so in women under the age of 70, since they presumably will need treatment for many years. Bone metabolism is age-dependent. In postmenopausal women under 70 years of age, the increase in bone resorption is clearly predominant, related to a sharp drop in estrogens. Thus a logical treatment is the prevention of fragility fractures by hormone replacement therapy (HRT) and, in asymptomatic women, selective estradiol receptor modulators (SERMs). Afterwards, there is a period of greater resorption, albeit less intense but continuous, when one could utilise anti-resorptive treatments such as bisphosphonates or denosumab or a dual agent like strontium ranelate. Bone formation treatment, such as parathyroid hormone (PTH), in women under 70 years will be uncommon. That is because it should be used in cases where the formation is greatly diminished and there is a high risk for fracture, something found in much older women.

Frequency of FRAX risk factors in osteopenic postmenopausal women with and without history of fragility fracture

ObjectiveFractures associated with bone fragility represent a major public health concern. Although the risk of bone fracture is higher among patients with osteoporosis, the number of fractures is usually higher among patients with osteopenia due to its higher prevalence. MethodsThis is an observational case series study that compares the frequencies of nonskeletal risk factors for osteoporotic fractures in osteopenic postmenopausal women with previous clinical fragility fractures (FFs) and osteopenic postmenopausal women without previous FF. Risk factors included in the FRAX algorithm and other selected risk factors, including asymptomatic vertebral fractures, were evaluated. ResultsA total of 735 (50.3% with prior FF and 49.7% without prior FF) postmenopausal women were evaluated (median age, 60 y; mean bone mineral density [BMD] femoral neck T score of −1.67). The frequency of the following risk factors was significantly higher among women with FF—FRAX algorithm: age, use of corticosteroids, and BMD femoral neck T score; other factors: Hispanic ethnicity, falls during the last year, and BMD lumbar T score. In addition, the frequency of previously undetected asymptomatic vertebral fractures was four times higher among women with a history of FF. ConclusionsThe results of the present study support the need to assess the presence of asymptomatic vertebral fractures and BMD T scores in osteopenic postmenopausal women. The risk evaluation of this subpopulation can be accomplished by using some of the risk factors included in the FRAX algorithm combined with other conventional risk factors.

Structural validity of a 16-item abridged version of the Cervantes Health-Related Quality of Life scale for menopause: the Cervantes Short-Form Scale

ObjectiveThe Cervantes Scale is a specific health-related quality of life questionnaire that was originally developed in Spanish to be used in Spain for women through and beyond menopause. It contains 31 items and is time-consuming. The aim of this study was to produce an abridged version with the same dimensional structure and with similar psychometric properties. MethodsA representative sample of 516 postmenopausal women (mean [SD] age, 57 [4.31] y) seen in outpatient gynecology clinics and extracted from an observational cross-sectional study was used. Item analysis, internal consistency reliability, item-total and item-dimension correlations, and item correlation with the 12-item Medical Outcomes Study Short Form Health Survey Version 2.0 were studied. Dimensional and full-model confirmatory factor analyses were used to check structure stability. A threefold cross-validation method was used to obtain stable estimates by means of multigroup analysis. ResultsThe scale was reduced to a 16-item version, the Cervantes Short-Form Scale, containing four main dimensions (Menopause and Health, Psychological, Sexuality, and Couple Relations), with the first dimension composed of three subdimensions (Vasomotor Symptoms, Health, and Aging). Goodness-of-fit statistics were better than those of the extended version (&khgr;2/df = 2.493; adjusted goodness-of-fit index, 0.802; parsimony comparative fit index, 0.749; root mean standard error of approximation, 0.054). Internal consistency was good (Cronbach’s &agr; = 0.880). Correlations between the extended and the reduced dimensions were high and significant in all cases (P < 0.001; r values ranged from 0.90 for Sexuality to 0.969 for Vasomotor Symptoms). ConclusionsThe Cervantes Scale can be reduced to a 16-item abridged version (Cervantes Short-Form Scale) that maintains the original dimensional structure and psychometric properties. At 51% of the original length, this version can be administered faster, making it especially suitable for routine medical practice.

Características epidemiológicas de una población de mujeres posmenopáusicas con osteopenia y osteoporosis: importancia de la dieta mediterránea

Resumen Objetivos Conocer la distribucion de los factores de riesgo asociados con la osteoporosis posmenopausica en la poblacion espanola. Pacientes y metodos Estudio observacional multicentrico de 1.779 mujeres posmenopausicas. En funcion del diagnostico densitometrico, se dividieron en 3 grupos: a) 450 mujeres con osteoporosis; b) 766 con osteopenia, y c) grupo control formado por 479 mujeres con valores de densidad mineral osea normal. Resultados Los factores de riesgo conocidos de osteoporosis se presentan en nuestras pacientes con similar distribucion que en otros estudios. Ademas, se observa un efecto protector de la dieta basada en alimentos vegetales, junto al consumo moderado de alcohol, pescado y productos lacteos. Conclusion Se confirmo la importancia de los factores de riesgo conocidos de osteoporosis. Ademas, en nuestra poblacion se identifico el papel protector de la ingesta abundante de los alimentos que se incluyen en la llamada dieta mediterranea.

Estudio de eficacia y tolerabilidad del anillo vaginal (NuvaRing®) en anticoncepción (ETN@)

Resumen Objetivo Valorar la tolerabilidad del anillo vaginal anticonceptivo (AVA) en una muestra representativa de la poblacion femenina espanola que utiliza anticoncepcion hormonal. Sujetos y metodos Estudio observacional, prospectivo, multicentrico realizado en consultas de ginecologia y planificacion familiar, tanto publicas como privadas, sobre una muestra de 896 mujeres que solicitaron anticoncepcion hormonal durante el primer semestre de 2003, eligieron el AVA y fueron seguidas durante 6 ciclos. Para el analisis de los datos se utilizo el paquete estadistico SPSS mediante el calculo de la t de Student para el analisis comparativo de los datos cuantitativos y de la χ 2 de Pearson para las variables cualitativas. Resultados Tras 6 ciclos de uso, el 72% de las mujeres continua utilizando el AVA. Solo el 5% de las mujeres presentaba sangrado intermenstrual a los 6 ciclos y el 85,5% considero el AVA como el mejor metodo anticonceptivo, tras su uso. Conclusiones El AVA es bien tolerado por las mujeres debido a la escasa incidencia de sangrado intermenstrual y al alto grado de satisfaccion que genera en sus usuarias.

Levonorgestrel intrauterine device and preservation of fertility in endometrial cancer grade I

Citation: Antonijuan JR, Escribano G, Domínguez AMA, Borrego RS, Fabregas JP. Levonorgestrel Intrauterine Device and Preservation of Fertility in Endometrial Cancer Grade I: Case Report and Literature Review. Ann Clin Case Rep. 2017; 2: 1440. ISSN: 2474-1655 Copyright

A multigenic combination of estrogen related genes are associated with the duration of fertility period in the Spanish population

Objective: The duration of the fertile period (FP) can be considered a complex parameter that depends on the interaction of multiple factors. In the present study, the role of interaction between genetic variants within estrogen synthesis and signaling pathways in the FP in Spanish women is studied. Material and methods: Nine single nucleotide polymorphisms (SNPs) located at different candidate genes related to the estrogen signaling pathway were analyzed in 1980 Spanish postmenopausal women. Results: Independently, none of the nine markers were significantly associated with age at menopause. In contrast, survival analysis techniques suggest several epistatic interactions including these markers in relation to age at menopause, especially between ESR2, NRIP1 and BMP15: women who showed the three markers ESR2 (AA), BMP15 (rs3897937) (TC) and NRIP1 (AA), the FP was shorter than the control group of women without any of these markers (32.36 ± 1.49 versus 34.94 ± 0.32 years; p = 0.026). The digenic BMP15 (rs3897937) (TC) and NRIP1 (AA) combination were also associated with a decreased duration of the FP (33.32 ± 0.96 years, p = 0.031). Conclusions: The results suggest that interactions of estrogen-related alleles may contribute to variance in FP in Spanish women.