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243 Varas-Lorenzo C, Garcia-Rodriquez LA, Perez- Gutthann S, Duque-Oliart A. Hormone replacement therapy and the incidence of acute myocardial infarction. A population-based nested case-control study. Circulation 2000;101(22):2572–8. 244 Grady D, Wenger NK, Herrington D, et al. Postmenopausal hormone therapy increases risk for venous thromboembolic disease. The Heart and Estrogen/progestin Replacement Study. Ann Intern Med 2000;132(9):689–96. 245 Lowe G, Woodward M, Vessey M, Rumley A, Gough P, Daly E. Thrombotic variables and risk of idiopathic venous thromboembolism in women aged 45–64 years. Relationships to hormone replacement therapy. Thromb Haemost 2000;83(4):530–5. 246 Grady D, Sawaya G. Postmenopausal hormone therapy increases risk of deep vein thrombosis and pulmonary embolism (review). Am J Med 1998;105(1):41–3. 247 Psaty BM, Smith NL, Lemaitre RN, et al. Hormone replacement therapy, prothrombotic mutations, and the risk of incident nonfatal myocardial infarction in postmenopausal women. JAMA 2001;285(7):906–13. 248 Troisi RJ, Speizer FE, Willett WC, Trichopoulos D, Rosner B. Menopause, postmenopausal estrogen preparations, and the risk of adult-onset asthma. A prospective cohort study. Am J Respir Crit Care Med 1995;152(4 Pt 1):1183–8. 180 249 Lieberman D, Kopernik G, Porath A, Lazer S, Heimer D. Sub-clinical worsening of bronchial asthma during estrogen replacement therapy in asthmatic post-menopausal women. Maturitas 1995;21(2):153–7. 250 Puolijoki H, Liippo K, Herrala J, Salmi J, Tala E. Inhaled beclomethasone decreases serum osteocalcin in postmenopausal asthmatic women. Bone 1992;13(4):285–8. 251 Baldi S, Papotti M, Valente ML, Rapellino M, Scappaticci E, Corrin B. Pulmonary lymphangioleiomyomatosis in postmenopausal women: report of two cases and review of the literature. Eur Respir J 1994;7(5):1013–6. 252 Lieberman J, Tachiki KH. Effect of menses, estrogens and hemolysis on a serum-lectin-like factor in cystic fibrosis. Chest 1989;95(1):111–6. 253 Guilleminault C, Quera-Salva MA, Partinen M, Jamieson A. Women and the obstructive sleep apnea syndrome. Chest 1988;93(1):104–9.
CHAPTER 9: OSTEOPOROSIS AND ORAL BONE LOSS IN AGING WOMEN: RISKS AND THERAPY Robert Lindsay, M.D. Ph.D.;* Bruce Ettinger, M.D.; † Joan A. McGowan, M.N.S., Ph.D.; ‡ Maryann Redford, D.D.S., M.P.H.; § Elizabeth Barrett-Connor, M.D.** KEY POINTS a 1. Osteoporosis affects a large proportion of the population of elderly women throughout the world. 2. The loss of estrogen at menopause contributes significantly to skeletal bone loss, although the mechanism is not completely understood. 3. Although there has been major progress in methods for assessing risk for osteoporotic fractures, identifying individuals at greatest need of antiosteoporosis treatment remains an unmet need. 4. Low bone mass at menopause can be due to insufficient bone acquisition during growth or bone loss during adulthood. Adequate nutrition—in particular, but not exclusively, from intake of calcium and vitamin D— and adequate physical activity are the first line of prevention against osteoporosis [C]. 5. ERT has been a mainstay in the prevention and treatment of osteoporosis for menopausal women in many countries. HRT has been shown to maintain bone density and favorably influence markers of bone resorption [A]; observational data and some, but not all, controlled clinical trials have demonstrated reduced fracture risk with estrogen or hormone treatment [B]. 6. SERMs are two recently developed classes of drugs that have been shown to stabilize bone mass and prevent fracture in postmenopausal women [A]. The long-term effects of these agents are not known. * From the Department of Medicine, Columbia University, College of Physicians Surgeons, and Director, Clinical Research Unit, Helen Hayes Hospital, New York, NY, U.S.A. † From the Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA, U.S.A. ‡ From the Musculoskeletal Diseases Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD, U.S.A. § From the Clinical Trials and Epidemiologic Studies Program, National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD, U.S.A. ** From the Division of Epidemiology, Department of Family and Preventive Medicine, UCSD School of Medicine, La Jolla, CA, U.S.A. Osteoporosis affects a large proportion of the population of elderly women throughout the world. a Evidence categories are given in square brackets. A = randomized controlled trials (rich body of data); B = randomized controlled trials (limited data); C = nonrandomized trials and observational epidemiologic studies; D = Panel expert judgement. (See also table 1–1.) 181
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National Heart, Lung, and Blood Ins
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CHAIRS AND EDITORS Chair and Editor
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Anne McTiernan, M.D., Ph.D. Associa
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Lenore Manderson, Ph.D. Director an
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Michael Mendelsohn, M.D. Director,
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TABLE OF CONTENTS Preface XIII 1 Ex
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PREFACE Women’s health and menopa
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CHAPTER 1: EXECUTIVE SUMMARY Nanett
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TABLE 1-1 Evidence Categories Evide
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TABLE 1-2 (continued) Possible Bene
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symptom measures, cultural factors,
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5. PHYSIOLOGICAL ROLE OF ESTROGEN A
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The atherogenic risk profile of old
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• Hormone replacement therapy: Fi
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tion of the remaining ridge in area
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9.3.1 Interventions • In many cas
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Parkinson’s disease, no overall p
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TABLE 1-3 (continued) Sexuality •
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CHAPTER 2: THE MENOPAUSE AND AGING
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oped and are less prepared to addre
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FIGURE 2-4 Diabetes Mellitus. Estim
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Sarcopenia, defined as reduced musc
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Perimenopause WHO The term “perim
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decrease about 2 years before the F
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4.3 Menstrually Defined Menopausal
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to be under stress and to hold part
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21 Brincat MP. Hormone replacement
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62 Orentreich N, Brind JL, Rizer RL
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CHAPTER 3: SYMPTOMS AND THE MENOPAU
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women who may have reached natural
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numb-tingling feelings, headaches,
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(47 percent), problems sleeping (39
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FIGURE 3-2 Proportion of Women Both
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tomized hypogonadotropic women expe
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5.1 Exercise It has been suggested
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to consume 20-150 mg/day of isoflav
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REFERENCES 1 Stewart AL, Hays RD, W
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48 Avis NE, Crawford SL, McKinlay S
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92 Albertazzi P, Pansini F, Bonacco
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Hällström wrote that the psycholo
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countries. Perhaps, as the authors
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Beyene used a systematic ethnograph
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ange of variables, such as genetic
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REFERENCES 1 Gannon L, Ekstrom B. A
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47 George T. Women in a south India
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9. Estrogen and inhibins produced b
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HRT) display tissue-selective estro
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a partial agonist. In contrast, wit
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3. UROGENITAL TRACT ERα and ERβ a
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4. BONE: DEVELOPMENT AND HOMEOSTASI
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in response to estrogen. 106,105 In
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lation of sleep, motor behavior, an
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7. HORMONE REPLACEMENT THERAPY: TRA
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REFERENCES 1 Jensen EV, Jacobsen HI
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40 Power RF, Mani SK, Codina J, Con
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83 Oursler MJ, Pederson L, Fitzpatr
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125 Gabrielsson BG, Carmignac DF, F
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169 Renier MA, Vereecken A, Buytaer
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FIGURE 6-1 Structural features of E
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ound, the conformation of the recep
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with extremely potent estrogenic ac
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Its potency as an antiestrogen was
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The observation that the degree of
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findings were remarkable because a
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Recently, the use of phage display
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20 Crawley G. Non steroidal estroge
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65 Qu Q, Zheng H, Dahllund J, et al
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in their survey of postmenopausal w
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where over half the world’s popul
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The Danish study of Koster and Gard
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Many studies of sexual interest in
Page 146 and 147: 7. ASSESSING SEXUAL ACTIVITY Clinic
Page 148 and 149: None of these studies evaluated the
Page 150 and 151: estrogen-androgen group during the
Page 152 and 153: REFERENCES 1 Sarrel PM, Whitehead M
Page 154 and 155: 52 Utian WH. The true clinical feat
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Page 158 and 159: outes of administration and differe
Page 160 and 161: FIGURE 8-2 Change in Age-Adjusted D
Page 162 and 163: fied as overweight or obese. 32 The
Page 164 and 165: TABLE 8-1 148 Guide to Risk Reducti
Page 166 and 167: TABLE 8-1 (continued) 150 Recommend
Page 168 and 169: TABLE 8-1 (continued) 152 Recommend
Page 170 and 171: Interesting differences in atherosc
Page 172 and 173: similar effects in both patients wi
Page 174 and 175: a lowering of triglycerides, 140 an
Page 176 and 177: may account for a substantial propo
Page 178 and 179: associated with an independent prot
Page 180 and 181: eases preoperatively. Quality of li
Page 182 and 183: excess risk of 6-18 per 10,000 per
Page 184 and 185: REFERENCES 1 NHLBI Morbidity and Mo
Page 186 and 187: 36 Samaras K, Hayward CS, Sullivan
Page 188 and 189: 79 Collins P, Rosano GM, Jiang C, L
Page 190 and 191: 121 Mäkelä S, Savolainen H, Aavik
Page 192 and 193: 162 Clarke S, Kelleher H, Lloyd-Jon
Page 194 and 195: 201 Rahimtoola SH, Bennett AJ, Grun
Page 198 and 199: 7. A connection between menopausal
Page 200 and 201: 3. PATHOGENESIS OF FRACTURE Fractur
Page 202 and 203: Diagnosis of osteoporosis according
Page 204 and 205: density and has a favorable effect
Page 206 and 207: How should this information be inco
Page 208 and 209: emergence of proved treatment alter
Page 210 and 211: Data on the relation between skelet
Page 212 and 213: REFERENCES 1 Osteoporosis Preventio
Page 214 and 215: 42 Gluer CC. Quantitative ultrasoun
Page 216 and 217: 85 Ettinger B, Pressman A, Silver P
Page 218 and 219: 130 Jeffcoat MK, Lewis CE, Reddy M,
Page 220 and 221: 1. INTRODUCTION Perimenopausal wome
Page 222 and 223: for breast cancer are at increased
Page 224 and 225: findings on biopsy in women with an
Page 226 and 227: thra. Patients typically describe l
Page 228 and 229: Biofeedback: Used in conjunction wi
Page 230 and 231: There has been one systematic revie
Page 232 and 233: ence in pelvic organ prolapse. The
Page 234 and 235: 21 Ferenczy A. Endometrial carcinom
Page 236 and 237: 65 Wyman JF, Fantl JA, McClish DK,
Page 238 and 239: 222
Page 240 and 241: 1. INTRODUCTION Worldwide, breast c
Page 242 and 243: difficult to compare because of com
Page 244 and 245: Although HRT has been related to an
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cyclic use and 2.9 (95 percent CI 2
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TABLE 11-3 Selected Studies on Horm
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TABLE 11-3 (continued) Thus, a stro
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TABLE 11-4 236 Cohort Studies on Ho
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TABLE 11-5 238 Case-Control Studies
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TABLE 11-5 (continued) 240 Adjustme
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When the same women in NSABP were r
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REFERENCES 1 Pisani P, Parkin DM, B
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47 Day NE. Epidemiology: the role o
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93 Rodriguez C, Patel AV, Calle EE,
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139 Parazzini F, La Vecchia C, Negr
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1. INTRODUCTION Menopause is associ
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inverse relation with nonverbal mem
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ease decreased significantly with i
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of households selected to be repres
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standard antipsychotic drugs increa
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5. FUTURE NEEDS • Explore the pos
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19 Berman KF, Schmidt PJ, Rubinow D
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64 Lerner A, Koss E, Debanne S, Row
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114 Smith R, Studd JW. A pilot stud
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162 Klein BE. Lens opacities in wom
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patients with strong personal convi
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Therefore, convincing evidence of t
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3.1.1 Risk Factors Many factors are
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278 lower dosages of estrogen will
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• Diabetes: Women with diabetes b
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Lipids and lipoproteins • LDL cho
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284 persists but is less steep in w
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5.2.3 Pharmacotherapy Breast Cancer
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• There is no clinical trial evid
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Sirtori CR, Pazzucconi F, Colombo L
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Hansson L, Zanchetti A, Carruthers
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Dementia and Mental Health Forette
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CRP C-reactive protein CT computed
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PTCA percutaneous transluminal coro
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U.S. DEPARTMENT OF HEALTH AND HUMAN
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