Sexual Activity After Bariatric Surgery: A Prospective Monocentric Study Using the PISQ-IR Questionnaire

IntroductionObesity can lead to pelvic floor disorders, interfering with women’s sexual life; Prolapse/Incontinence Sexual Questionnaire-International Urogynecology Association–Revised (PISQ-IR) is a new instrument to measure sexual life in women with pelvic floor disorders.AimsTo assess the utility of using PISQ-IR in morbidly obese women undergoing bariatric surgery and to show the improvement of bariatric surgery on sexuality.MethodsThis prospective monocentric study included all women who underwent bariatric surgery from June 2016–May 2017. Sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) was performed by 1 surgeon, and data were collected by 1 researcher. Demographics, medical history, number of deliveries, and type of bariatric surgery (SG or RYGB) were collected at baseline. At the 1-year follow-up consultation, postoperative complications, percentage of total body weight loss (TWL) and percentage excess weight loss were assessed. Questionnaires were given at baseline and at 1-year follow-up.Main Outcome MeasuresPostoperative complications and total weight loss were measured at the 1-year follow-up. Sexual activity, using the PISQ-IR, and pelvic organ prolapse, urinary incontinence, and anal incontinence, using the urinary symptom profile and PFDI (Pelvic Floor Distress Inventory) 20, were compared before surgery and at 1-year follow-up.Results72 patients were included at baseline, 54 (75%) were considered for final analysis (30 RYGB and 24 SG), and 51 patients were considered for PISQ-IR. The mean preoperative body mass index was 41 ± 5.4 kg/m², and mean age was 43 ± 11.8 years. Both procedures induced an important weight loss (mean TWL of 33%) and had a similar percentage of TWL for each procedure: 31 (15–46) for SG vs 34 (9–51) for RYGB. 9 patients (17 [6%]) became sexually active 1 year after surgery. For the sexually inactive population after 1 year, there was no differences in the PISQ-IR in the follow-up. When body mass index loss was >13 kg/m², a higher percentage of the sexually active population improved their different scores, and there were significant results for both global quality of life and desire (P = .026 and .046). The other questionnaires showed a significant decrease in urinary incontinence symptoms (P < .001) associated with weight loss, whereas there was no difference in terms of pelvic organ prolapse or anal incontinence.ConclusionPISQ-IR is a useful instrument to measure sexual function regarding pelvic floor disorders. Bariatric surgery improves sexual activity in obese women 1 year after surgery.Treacy PJ, Mazoyer C, Falagario U, et al. Sexual Activity After Bariatric Surgery: A Prospective Monocentric Study Using the PISQ-IR Questionnaire. J Sex Med 2019;16:1930–1937.     

Relationship between body fat distribution and bone mineral density in premenopausal Japanese women

OBJECTIVE: To investigate the relationship between body fat distribution and bone mineral density (BMD). METHODS: Subjects were 282 premenopausal women (mean age +/- standard deviation [SD], 38.8 +/- 8.5 years; range, 20-51 years) with regular menstrual cycles. Baseline characteristics included age, age at menarche, height, weight, body mass index ([BMI], weight/height(2)), and parity. Anthropometric characteristics including the ratio of trunk fat mass to leg fat mass (trunk-leg fat ratio), percentage of body fat, and total body lean mass were measured by whole-body scanning with dual-energy x-ray absorptiometry. Lumbar spine BMD (L2-4) was also measured by dual-energy x-ray absorptiometry. Correlations of BMD to baseline and anthropometric characteristics were investigated using univariate and multivariate analysis. RESULTS: Although height, trunk-leg fat ratio, and total body lean mass were positively correlated with lumbar spine BMD (r =.18, P <.01; r =.17, P <.01; and r =.25, P <.001; respectively), age at menarche was inversely correlated with BMD (r = -.19, P <.01). On multivariable analysis, trunk-leg fat ratio, height, age at menarche, and total body lean mass were still independently correlated with lumbar spine BMD (P <. 05). However, total fat mass was not correlated with BMD. CONCLUSION: Upper body fat distribution rather than overall adiposity is associated with lumbar spine BMD in premenopausal women. Humoral factors associated with body fat mass appear to influence lumbar spine BMD.     

Aromatase inhibitor-induced bone mineral loss and its prevention by bisphosphonate administration in postmenopausal breast cancer patients

AIM: To investigate aromatase inhibitor-induced bone mineral loss and its prevention by bisphosphonate administration in postmenopausal breast cancer patients. METHODS: Subjects were 17 postmenopausal breast cancer patients (mean age, 63.3 +/- 9.9 years) receiving non-steroidal aromatase inhibitor (AI; anastrozole, 1 mg daily) only and 10 such patients (mean age, 65.0 +/- 5.1 years) receiving AI + bisphosphonate (risedronate sodium, 2.5 mg daily) for 6 months. All of the subjects had undergone surgical resection and had positive estrogen receptor tumor status. Age, age at menopause, years since menopause, height, weight, and body mass index (Wt/Ht(2)) were recorded. Lumbar spine (L2-4) bone mineral density (BMD), T-, and Z-scores were assessed on dual-energy X-ray absorptiometry before and after therapy. RESULTS: In the AI-only group BMD, T-, and Z-scores significantly decreased from the baseline during the 6-month therapy period (P < 0.05). Mean decreases in L2-4 BMD and Z-score were 2.5% and 3.0%, respectively. In the AI + bisphosphonate group, however, BMD, T-, and Z-scores significantly increased from the baseline values (P < 0.01). Mean increases in L2-4 BMD and Z-score were 4.5% and 3.3%, respectively. CONCLUSION: AI carries a potential risk of bone mineral loss despite the short therapy duration. Bisphosphonate has a preventive effect on this loss.     

The influence of other than prolactin hormones on bone mineral density in women with hyperprolactinaemia of various origins

Objective.?Hyperprolactinaemia may lead to bone loss, both due to hypogonadism and other hormonal disturbances. Aim of the case–control study was the analysis of influences of hormonal profiles associated with hyperprolactinaemia on the bone mineral density (BMD) in women with hyperprolactinaemia of various origin.

Material and methods.?The subjects were 32 patients with prolactinoma, 43 ones with functional hyperprolactinaemia and 29 healthy controls. All of them were studied for BMD (lumbar spine, proximal femur, forearm, total body) by dual-energy X-ray absorptiometry and their correlations with hormones levels (prolactin, oestradiol, luteinising hormone, follicle stimulating hormone, sex hormone binding globulin (SHBG), testosterone, dehydroepiandrosterone sulphate (DHEA-S), insulin-like growth factor-1 and intact parathyroid hormone) using Spearman correlation analysis and multiple regression analysis model.

Results.?Correlation analysis revealed the anabolic influence of PTH on lumbar spine in women with prolactinoma, and on ultradistal radius in functional hyperprolactinaemia. In multiple regression analysis, oestradiol had greatest influence on lumbar spine and total body BMD. Moreover, positive influence of testosterone, SHBG on spine BMD, and of oestradiol, testosterone, SHBG and DHEA-S on total body BMD were observed in patients with prolactinoma.

Conclusion.?Hormonal disturbances associated with hyperprolactinaemia influence BMD more in patients with prolactinoma than in ones with functional hyperprolactinaemia.     

Relation of estrogen receptor expression in endometrial cancer specimens to bone mineral density

BACKGROUND: To investigate the relation of estrogen and progesterone receptor (ER and PR) expression in endometrial cancer specimens to bone mineral density (BMD). MATERIALS AND METHODS: Subjects were 48 postmenopausal women with endometrial cancer treated with hysterectomy. Baseline characteristics included age, years since menopause (YSM), height, weight, and body mass index (BMI). Lumbar spine BMD (L2-4), the ratio of trunk fat to leg fat mass (trunk-leg fat ratio), body fat mass, and the percentage of body fat were measured by dual-energy x-ray absorptiometry (DEXA). ER and PR expression in endometrial cancer specimens were determined immunohistochemically. RESULTS: Of 48 women, 32 (66.7%) were ER/PR-positive, nine (18.8%) were ER/PR-negative, three (6.3%) were ER-positive/PR-negative, and four (8.3%) were ER-negative/PR-positive. Lumbar spine BMD and trunk-leg fat ratio were significantly higher in women with ER-positive than in those with ER-negative (p<0.05), but other variables did not differ between the two groups. BMD and baseline- and anthropometric characteristics did not differ between the two groups divided by the presence or absence of PR expression. CONCLUSIONS: ER expression in endometrial cancer specimens is associated with higher lumbar spine BMD.     

Early Effect of Bariatric Surgery on Urogenital Function in Morbidly Obese Men

IntroductionObesity is an independent risk factor for erectile dysfunction (ED) and lower urinary tract symptoms (LUTS). Bariatric surgery has been shown to improve erectile function and urinary symptoms in medium- to long-term studies (3- to 12-month postoperative follow-up).AimTo investigate the early effect (1 month postoperatively) of bariatric surgery on ED and LUTS, which has not previously been investigated.MethodsMorbidly obese men (body mass index > 35 kg/m²) undergoing bariatric surgery were asked to complete the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) questionnaires before surgery and 1, 3, and 6 months after surgery.Main Outcome MeasureThe influence of bariatric surgery on urogenital function, body mass index, fasting blood glucose, and glycated hemoglobin were analyzed using parametric and non-parametric tests for paired samples.ResultsOf 30 patients who completed the study, 18 reported ED (IIEF score < 25) and 14 reported moderate or severe LUTS (IPSS ≥ 8) before the operation. Twelve patients had ED and moderate or severe LUTS. IIEF score, IPSS, body mass index, percentage of weight loss, fasting blood glucose, and glycated hemoglobin showed significant and rapid improvement after bariatric surgery starting at the 1-month postoperative time point and improvement continued throughout the study in all patients with ED or moderate to severe LUTS.ConclusionThis is the first study showing improvement in erectile and urinary function within 1 month after bariatric surgery, an effect that was parallel to glycemic improvement and weight loss.     

A systematic review and meta-analysis of randomized placebo-controlled trials of DHEA supplementation of bone mineral density in healthy adults

Abstract

To find out if DHEA replacement improves bone mineral density (BMD) in healthy older adults. We systematically searched Medline via PubMed, Embase, and the Cochrane Library Center Register to identify randomized controlled trials up to October 2018. Effect estimates were performed in random effect models. Bone mineral density of hip and trochanter, total body, lumbar spine, and femoral neck were conducted. Hip BMD increased significantly above placebo group in women who took DHEA supplementation (SMD –0.5[–0.95, –0.04], p?=?.03). The SMD of trochanter BMD of women in placebo group than DHEA group was –0.55 [–1.10, 0.00], p?=?.05. Insulin-like growth factor 1 (IGF-1) did not change in men compared to placebo group also (–0.56 [–1.22, 0.10], p?=?.09). In women, IGF-1 significantly improved in DHEA supplementation group than placebo group (–2.61 [–4.85, –0.38], p?=?.02). In summary, the results of this meta-analysis suggest that DHEA replacement therapy can partially increase BMD of hip and trochanter in women. Similar results were not observed in men. More trials may be necessary to allow for a positive and clinically significant effect of DHEA on BMD.     

Neonatal outcomes in pregnancies after bariatric surgery: a retrospective multi-centric cohort study in three French referral centers

Objective: To analyze short-term neonatal outcomes in pregnancies after bariatric surgery according to procedure, to the body mass index (BMI) at the beginning of the pregnancy and to the interval from surgery to conception, using a retrospective multi-centric cohort study in three French tertiary perinatal care and bariatric centers. Methods: 94 neonates in 79 women were included. Frequencies of adverse neonatal events by procedure, laparoscopic adjustable gastric banding (LAGB, n = 63) or Roux-en-Y gastric bypass (RYGB, n = 31), BMI class (72 women with BMI ≥ 30?kg/m²) and interval between surgery and conception (43 deliveries of patients who conceived during the first postoperative year) were compared with χ² tests. For parametric continuous data, t-tests or analysis of variance were used; non-parametric distributions were compared with the Wilcoxon or Kruskal–Wallis tests. Results: Significantly lower mean birth weight (2993?g vs. 3253?g; p = 0.02) was observed after RYGB and the mean Z-score for birth weight was significantly closer to 0 in neonates of the LAGB group than in those of the RYGB group. However, no significant differences were noticed regarding small-for-gestational age (32.3% vs. 17.1%; p = 0.06), umbilical arterial blood pH < 7.0 (9.7% vs. 0%; p = 0.11), low Apgar scores, perinatal mortality, and NICU admission. Neonatal outcomes according to the interval from surgery to conception or to the BMI at the beginning of the pregnancy were not significantly different. Conclusions: The short-term neonatal outcomes are basically comparable in pregnancies after RYGB than after LAGB.     

Low bone mass in urban Indian women above 40 years of age: prevalence and risk factors

Objective.?To assess the prevalence and the relative importance of risk factors for low bone mass in Indian pre- and post-menopausal women.

Methods.?Data were collected on anthropometry and lifestyle factors in apparently healthy 80 pre- and 92 post-menopausal (40–75 years) women. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. Fasting blood samples were analysed for Parathyroid hormone, vitamin D, calcium and zinc.

Results.?BMD at all three sites was significantly lower in post-menopausal than the pre-menopausal women (p?<?0.001). Prevalence of osteoporosis was highest at the lumbar spine (25.8%) in post-menopausal women, while prevalence of osteopenia was high in pre-menopausal women (44.3%). Vitamin D deficiency was seen in 54.5% pre and 41.8% post-menopausal women and significant correlation of serum 25(OH)D levels (r?=?0.16) was obtained only for total hip Z-score (p?<?0.05). Correlation between sun index and lumbar spine BMD was marginally significant (r?=?0.14, p?=?0.07). Generalised linear models revealed that after adjusting for age, weight and height, percent decrease of 2.1–4.5% in BMD may be attributed to menopause.

Conclusion.?Age, weight, height, menopause, low intakes of calcium and low 25(OH)D along with poor sunlight exposure are the major factors contributing to bone loss in Indian women above 40 years of age.     

Association between P1NP and bone strength in postmenopausal women treated with teriparatide

ObjectiveTo evaluate the association between P1NP and bone strength in postmenopausal women treated with teriparatide.Materials and MethodsThis prospective study enrolled 248 postmenopausal women with severe osteoporosis treated with teriparatide. Procollagen type 1 N-terminal propeptide (P1NP) were assessed at baseline, 3, 6, and 12 months. Lumbar spine (LS), femoral neck (FN), and total hip (TH) bone mineral density (BMD) and LS trabecular bone score (TBS) were measured by Dual-energy x-ray absorptiometry at baseline and 12 months.ResultsWith teriparatide use, P1NP levels increase and peaked at 6 months. Significant increase in LS and hip BMD and LS TBS were also noted. The percentage change or absolute change >10 μg/L in PINP at 3 months was only related to changes in LS BMD at 12 months. With a median baseline P1NP level was 65.5 ng/mL, we found no correlation between P1NP and LS and hip BMD nor LS TBS. There was no association between LS TBS and axial BMD. After treatment, there was also no significance between the changes in TBS and axial BMD. Over the study period, 83.9% of the 248 participants were persistent with teriparatide at 3 months, 77.8% at 6 months, and 67.3% women at 12 months.ConclusionP1NP levels may provide a signal of osteoporosis risk but is not related to bone strength. Early changes in P1NP may offer information regarding subsequent BMD response so standardized monitoring of P1NP levels at baseline and at 3 months should be considered during osteoporosis therapy. As an additional benefit, serum level monitoring during treatment may also improve medication persistence.     

Comparison of the effects of raloxifene and low-dose hormone replacement therapy on bone mineral density and bone turnover in the treatment of postmenopausal osteoporosis

Objective. The aim of the present study was to compare the effects of raloxifene and low-dose hormone replacement therapy (HRT) on bone mineral density (BMD) and bone turnover markers in the treatment of postmenopausal osteoporosis.

Methods. Forty-two postmenopausal osteoporotic women, who were randomized to receive raloxifene 60 mg or estradiol 1 mg/norethisterone acetate 0.5 mg daily for 1 year, were studied. All women received calcium 600 mg/day and vitamin D 400 IU/day. BMD and markers of bone turnover were measured at baseline and at 12 months.

Results. After 12 months of treatment, there were statistically significant increases in BMD in both groups at all sites (all p < 0.05). For the lumbar spine, the increase in BMD was 2.3% for raloxifene compared with 5.8% for low-dose HRT and corresponding values for total body BMD were 2.9% for raloxifene and 4.6% for low-dose HRT; the increases being significantly greater in the low-dose HRT group (p < 0.001 and p = 0.02, respectively). Although the increase in BMD at the hip was significant for both raloxifene (2.1%) and low-dose HRT (3.2%) compared with baseline, the difference between the two regimens did not reach statistical significance. The decrease in serum C-terminal telopeptide fragment of type I collagen and serum osteocalcin levels for the low-dose HRT group (?53% and ?47%, respectively) was significantly greater than for the raloxifene group (?23% and ?27%, respectively; both p < 0.01).

Conclusions. In postmenopausal women with osteoporosis, low-dose HRT produced significantly greater increases in BMD of the lumbar spine and total body and greater decreases in bone turnover than raloxifene at 12 months.     

A comparison of bone mineral density in normal weight and obese adolescents with polycystic ovary syndrome

Study ObjectiveTo evaluate whether there are any differences in bone mineral density (BMD) between normal weight and obese adolescents suffering from polycystic ovary syndrome (PCOS) with oligo/amenorrhea.DesignProspective cohort study.SettingAdolescent gynecology clinic in a general service hospital.ParticipantsSubjects consisted of adolescents between 16 to 18 years of age presenting with oligo/ amenorrhea with ultrasound morphology of polycystic ovaries ± evidence of hyperandrogenism over 24 months. Controls consisted of consecutive eumenorrheic patients within the same age group.InterventionsAll underwent full hormonal profile assessment, and dual energy X-ray absorptiometry and peripheral quantitative computed tomography scans.Main Outcome MeasuresAreal and volumetric BMD parameters.ResultsOf 37 adolescents with PCOS, 12 (32%) were obese with BMI ≥25, of which 9/12 (75%) were hyperandrogenic. The control group consisted of 40 normal weight eumenorrheic girls. The PCOS group overall had lower lumbar spine BMD values as compared to the controls (0.91 vs 0.97 g/ cm², P = 0.033). The normal weight PCOS group had lower BMD at the spine (0.90 vs 0.97 g/ cm², P = 0.027), trochanter (0.66 vs 0.71 g/ cm², P = 0.039) as well as volumetric distal tibial core sites (268 vs 296 mg/ cm³) as compared to eumenorrheic controls, but there were no significant BMD differences between the obese PCOS group and the eumenorrheic controls.ConclusionsNormal weight PCOS adolescents with oligo/amenorrhea have marginally lower BMD values than controls, but obese PCOS adolescents have BMD values compatible with eumenorrheic adolescents.     

The debated role of bariatric surgery in improving in-vitro fertilization outcomes in morbidly-obese infertile women-a case report and brief overview

ObjectiveObesity has a negative impact on in-vitro fertilization (IVF) outcomes, and obese women who plan IVF treatments are often encouraged to pursue weight reduction. Bariatric surgery is an effective strategy for the treatment of morbidly obese women. The current case report is to investigate the impact of bariatric surgery on IVF outcome in a morbidly obese woman with subfertility.Case reportA 37-year-old, morbidly obese woman with subfertility was indicated for IVF treatment. Due to her high body mass index (47.9 kg/m²), she was advised to lose weight; initial failure at conservative measures of weight loss prompted her to undergo bariatric surgery, combined with post-operative lifestyle change, prior to receiving IVF treatment. The woman successfully conceived at the second cycle and delivered twins by cesarean section smoothly at 36 + 3/7 weeks of gestation. Both twins have normal development up to two years of age.ConclusionsWeight reduction mediated by bariatric surgery in subfertile and morbidly obese women can be considered before IVF treatment.     

Difference in the relative contribution of lean and fat mass components to bone mineral density with generation

AIM: To investigate whether the relative contribution of body composition (lean and fat mass component) to bone mineral density (BMD) differs depending on generation or menopause. METHODS: Subjects were 302 premenopausal women aged 30-49 years old and 197 postmenopausal women aged 50-69 years old. They were classified into four subgroups with 10-year increments. Age, height, weight and years since menopause (YSM) were recorded. Lumbar spine (L2-4), total body BMD, body fat mass, lean body mass (LBM), and the percentage of body fat (%fat) were measured using dual-energy X-ray absorptiometry. The correlation of body composition with BMD was investigated. RESULTS: The mean age at menopause was 50.2 +/- 4.1 years old. On Pearson's correlation test, LBM was positively correlated with BMD of the two sites in all groups. In a group aged 60-69 years, both the %fat and body fat mass were correlated with BMD. On multiple regression analysis, LBM was the principal BMD determinant in women aged less than 60 years, while body fat mass and percentage fat were the principal BMD determinants in women aged 60-69 years. Mean %fat in the group aged 60-69 years was 35.5 +/- 7.3%, which was significantly higher than that in the group aged 50-59 years (33.0 +/- 6.7%, P < 0.05). CONCLUSION: Although LBM still influences BMD up to 10 years after menopause, the body fat mass initially influences BMD after 60 years of age. These difference may be attributable to certain aging-related factor(s).     

Inadequate Vitamin D Status in Adolescents with Substantial Bone Mineral Density Loss During the Use of Depot Medroxyprogesterone Acetate Injectable Contraceptive: A Pilot Study

Study ObjectiveTo examine vitamin D and parathormone (PTH) levels in adolescents who experienced substantial bone mineral density (BMD) loss during depot medroxyprogesterone acetate (DMPA) use.DesignA non-randomized, multi-center study, during which DMPA was administered every 12 weeks and evaluation of lumbar spine and hip BMD by dual-energy X-ray absorptiometry (DXA) was conducted every 6 months. A blood sample for vitamin D and PTH measurements was obtained from adolescents who experienced >5% BMD loss. Vitamin D deficiency was defined as 25-hydroxyvitamin D (25OHD) level of <20ng/mL, insufficiency as 25OHD level of 20-30ng/mL, and sufficiency as 25OHD level of >30ng/mL.ResultsEvaluation of vitamin D and PTH was carried out in 15 participants who experienced BMD loss of ≥5% during DMPA use. At initiation of DMPA, participants had mean (+SE) age 17+1years, gynecologic age 61+4 months, and body mass index 24+1.5kg/m2. Racial/ethnic distribution was: Caucasian–7 girls, Hispanic–4 girls, African-American–3 girls, and other–1 girl. Six participants had BMD loss of >5% after 2 DMPA injections, five after 3 injections, one after 5 injections, one after 8 injections, one after 10 injections, and one after 13 injections. Only one girl (7%) had sufficient vitamin D. The other participants had vitamin D insufficiency (50%) or deficiency (43%). Participants' mean (+SE) PTH was 22+4pg/mL (reference range 7-53pg/mL), and mean (+SE) 1,25-dihydroxyvitamin D was 56+5pg/mL (reference range 22-67pg/mL).ConclusionsInadequate vitamin D status was evident among the majority of female adolescents who experienced a substantial BMD loss while using DMPA.     

A prospective, controlled study of the effects of hormonal contraception on bone mineral density

OBJECTIVE: To compare the effect of depot medroxyprogesterone acetate (DMPA) and two types of oral contraceptives (OC) on bone mineral density (BMD) among women 18-33 years of age with those not using hormonal contraception. METHODS: Data from 155 women were analyzed. Depot medroxyprogesterone acetate was administered to 33 women; 63 women who chose oral contraception were randomly assigned to receive either a norethindrone-containing pill (n = 28) or a desogestrel-containing pill (n = 35). Fifty-nine women who did not use hormonal contraception served as controls. Lumbar spine BMD was determined using dual-energy x-ray absorptiometry at baseline and after 12 months of contraceptive use. We analyzed method-related percent change in BMD while controlling for body mass index, calcium intake, exercise, and smoking. We had approximately 90% power to detect a 2.5% difference between any two groups. RESULTS: Users of DMPA experienced a mean BMD loss of 2.74% over 12 months compared with controls who sustained a 0.37% loss (P = .01). Users of OCs generally demonstrated a gain (2.33% for norethindrone-containing pills, 0.33% for desogestrel-containing pills), which was different from controls among users of norethindrone-containing pills (P = .01), but not among users of desogestrel-containing pills (P = .99). Observed changes in BMD among DMPA users differed from women who used either type of pill (P < .002). CONCLUSION: Depot medroxyprogesterone acetate has an adverse effect on BMD, in comparison with OCs or nonhormonal methods, when used for 12 months. Results must be interpreted cautiously until it is determined whether these effects endure or are reversible.     

Evaluation of body composition in POF and its association with bone mineral density and sex steroid levels

Abstract

The study aims to investigate the body composition and bone mineral density (BMD) characteristics and discuss the relationships among body composition, BMD and sex steroid level in POF. A total of 240 POF patients, 240 normal women, and peri/postmenopausal women (Peri-M/Post-M) (260 patients in each group) were included. Compared to the control group, POF patients? strength of left/right lower limb (SLL/SRL), muscle distributing coefficient of lower limbs (MD) decreased however, waist circumference (WC) and hip circumference (HC) increased. The weight, WC, HC, whole body fat percentage (BF%), average fat distribution (FD), MD of POF patients were lower than those among Peri-M and Post-M and BMD were lower than the Peri-M, yet still higher than Post-M. Moreover, BMD were significantly positively correlated with BF%, FD, SLL, MD and estradiol (E2). The factors associated with L2–L4 BMD were E2, SRL, FD and age. For the FN BMD, the factors were FD, E2 and SLL. Therefore, we conclude that maintenance of appropriate weight, physical exercise and hormone replacement treatment (HRT) may have positive effects on increasing BMD, improving muscle mass and muscle strength, preventing osteoporosis.     

Effects of Hormone Replacement Therapy on Low Bone Mineral Density in Adolescents and Young Women with Hypogonadism: Comparison of Oral and Transdermal 17 Beta-Estradiol Administration

Study ObjectiveTo evaluate the effects of physiological dose 17 beta-estradiol (E₂) replacement on low bone mineral density (BMD) and compare the results of oral and transdermal (TD) E₂ administration in adolescents and young women with hypogonadismDesign, Setting, and ParticipantsWe retrospectively reviewed the medical records of patients aged 15 to 24 years who were diagnosed with hypogonadism, who had begun receiving oral or TD E₂ replacement, and whose initial dual-energy X-ray absorptiometry scan detected a lumbar spine BMD Z-score of -1 or lower between 2014 and 2018. The patients were divided into 2 groups according to the E₂ route of administration as those who received 2 mg orally (Group 1) and 0.1 mg TD (Group 2).InterventionsNoneMain Outcome MeasureBMD scans of the patients at baseline and repeated within 2 years after E₂ replacementResultsIn total, 43 patients who met the inclusion criteria were included in the study. Two groups did not differ for BMD scores at baseline. A significant improvement in BMD was observed with physiological dose E₂ replacement in both groups. Mean BMD Z-score increased by +0.7 (95% CI, 0.47-0.93) in response to TD E₂ administration, compared with +0.41 (95% CI, 0.25-0.58) during oral E₂ replacement (P = .037).ConclusionWe conclude that physiological dose E₂ replacement, even within a short period of 2 years, has a significant beneficial effect on bone mass acquisition on the lumbar spine. Our study also demonstrates the possible superiority of TD E2 replacement over the oral route in increasing lumbar spine BMD.     

Comparison of bone mineral density and its variables between premenopausal and postmenopausal women

Objectives

To compare the bone mineral density (BMD) and its variables in premenopausal and postmenopausal women.

Methods

In this cross sectional study, 62 premenopausal and 62 postmenopausal apparently healthy women were evaluated by a questionnaire. The dietary intake of calcium was evaluated by 24 hours recall method and using table for proximate principle of common Indian food by Indian Council of Medical Research (ICMR). BMD at lumbar spine, femoral neck and Ward’s triangle were measured by dual energy X-ray absorptiometry (DXA). A correlation between BMD and various variables were calculated for each of the two groups.

Results

The mean age of premenopausal and postmenopausal women was 32.46±7.8 and 51.74±7.1 years respectively. The body mass index (BMI), height and weight were comparable in both the groups. The daily intake of calcium was significantly higher in premenopausal women (p<0.01). Approximately, 17% of the postmenopausal women and 9.6% of the premenopausal women were having osteoporosis; 28.56% of the postmenopausal women and 43.54% of the premenopausal women were having osteopenia at the lumbar spine. The BMD at lumber spine was found to be statistically significantly higher in premenopausal women than that in postmenopausal women (p=0.03). BMD at lumbar spine, femoral neck and Ward’s triangle were positively correlated with height, weight, BMI in premenopausal as well in postmenopausal women.

Conclusion

A significant number of women had osteopenia during premenopausal period and osteoporosis in postmenopausal phase. By increasing awareness towards bone health in second and third decade, morbidity of osteoporosis can be reduced.     

The effects of short-term hormone replacement therapy on long-term bone mineral density.

INTRODUCTION: Short-term hormone replacement therapy (HRT) relieves menopausal symptoms and increases bone mineral density (BMD), but bone loss reoccurs upon discontinuation. This study assesses whether short-term HRT provides long-term BMD benefits. METHOD: This was a prospective study of women aged 50-54 years followed up for 9 years. Women were categorized into three groups according to the treatment they received: No-HRT (n = 340), Short-term HRT (2-4 years, n = 60), and Long-term HRT (9 years, n = 187). RESULTS: BMD increased significantly at the hip (2.4%, p < 0.001) and spine (8.0%, p < 0.001) over 9 years in the Long-term HRT group. Women without treatment lost BMD at the hip (-4.2%, p < 0.001) and spine (-3.5%, p < 0.001). Women in the Short-term HRT group had no significant loss of BMD at the hip (-1.6%, p = 0.08) or spine (-1.4%, p = 0.18) over 9 years. BMD in the Short-term HRT group was significantly higher at 9 years than in the No-HRT group at both spine (difference 0.023 g/cm(2), p = 0.048) and hip (difference 0.016 g/cm(2), p = 0.042). CONCLUSION: After 9 years, women who had taken short-term HRT had no significant loss of BMD and were better off in terms of BMD than those left untreated. Short-term HRT in the early postmenopausal period provides long-term BMD benefits.