Oestrogen and progesterone receptor status in bone biopsy specimens from patients with breast cancer

Health effects of breast feeding for mothers: a critical review

Lactation results in a number of physiological adaptations which exert direct effects on maternal health, some of which may confer both short and long term advantages for breast feeding mothers. Breast feeding in the early postpartum period promotes a more rapid return of the uterus to its prepregnant state through the actions of oxytocin. Breast feeding may also lead to a more rapid return to prepregnancy weight. Among studies that had good data on duration and intensity of lactation, the majority show a significant association between lactation and weight loss. However, there is no evidence that lactation prevents obesity. Lactation also affects glucose and lipid metabolism. The long term effects of these adaptations are unknown but may have implications for preventing subsequent development of diabetes and heart disease. Lactation delays the return of ovulation and significantly reduces fertility during the period of lactational amenorrhoea. This process is linked with feeding patterns and may therefore be affected by practices such as scheduled feedings and the timing of introduction of complementary foods. While the evidence from epidemiologic studies is mixed, several large studies have shown that extended lactation is associated with reduced risk of premenopausal breast, ovarian and endometrial cancers. Although bone mineralization declines during lactation, repletion takes place after weaning. As a result, breast feeding does not appear to cause long term depletion of bone nor does it increase risk of osteoporosis. Many of the physiological effects of lactation are dependent on the stimulation of the hypothalamic-pituitary axis and milk removal and thus may vary with infant feeding practices. Well controlled studies are needed that include detailed information regarding infant feeding practices in addition to the total duration of any breast feeding. Future feeding recommendations should reflect careful consideration of how such practices affect both infant and maternal health.

Age-related changes in human oestrogen receptor alpha function and levels in osteoblasts

Oestrogen receptors (ERs) are present in human osteoblasts and mediate anti-resorptive effects on bone. Human osteoblast-like cells derived from different aged healthy female donors not on hormone replacement therapy were utilized under well-defined conditions in vitro to investigate ER function and levels. Treatment with 0.1 nM oestradiol-17beta of cell strains derived from eight young women (less than 50 years of age) increased hydroxyproline levels significantly [an average (2.2+/-0.1 S.E.M.)-fold increase], whereas cells derived from nine older women (more than 50 years of age) were not significantly affected. Similarly, cell strains, derived from younger women, transfected with a consensus oestrogen-responsive element linked to chloramphenicol acetyltransferase exhibited a greater response to oestrogen than strains derived from older women. When basal ERalpha levels were measured by enzyme immunoassay and normalized on a per cell basis, osteoblast-like strains derived from younger women (n=24) had a mean value of 2.54+/-0.16 fmol of ERalpha per 10(6) cells. In contrast, strains derived from older women (n=20) had a mean value of 5.44+/-0.48 fmol of ERalpha per 10(6) cells. An age-related increase in ERalpha number was also observed in human skin-derived fibroblasts and directly in dermal biopsies from women not on hormone replacement therapy. The results demonstrate ligand concentration-dependent ERalpha induction and indicate a loss of receptor regulation and diminution of ligand-receptor signal transduction with increasing donor age.

Estrogen receptor status of breast cancer: a marker of different stages of tumor or different entities of the disease?

Breast cancer can be divided into two types according to the estrogen receptor (ER) level of the tumor: ER-positive and ER-negative. Two hypotheses have been raised about the relationship between ER-positive and ER-negative breast tumors. One hypothesis considers ER status as an indicator of a different stage of the disease. The other regards ER-positive and ER-negative tumors as different entities. For both etiological and biological studies of breast cancer it is important to know which hypothesis is correct. In this paper, we review evidence for and against each hypothesis and suggest issues to be addressed in future studies.

Progesterone antagonist RU 486 has bone-sparing effects in ovariectomized rats

We demonstrated previously that progesterone prevents ovariectomy-induced bone loss. RU 486 is a synthetic steroid with antiprogesterone activities in reproductive tissue. We used 12-week-old rats to evaluate effects of RU 486 in sham-operated rats and to compare medroxyprogesterone (MPA), RU 486, and medroxyprogesterone plus RU 486 combined treatment in ovariectomized rats. Ovariectomized rats were treated with MPA (60 mg/kg intramuscularly), RU 486 (10 mg/kg/day subcutaneously every 4 days), both, or vehicle. Sham-operated rats were treated with similar doses of RU 486 or vehicle. After 4 weeks of treatment the rats were sacrificed and bone histomorphometry was performed on proximal tibial metaphysis. Trabecular bone volume was lower (33.9 +/- 1.5% vs. 46.3 +/- 1.4%) and bone turnover was higher in ovariectomized than in sham-operated rats. The fraction of trabecular bone in OVX rats treated with MPA, RU 486, or both were 41.6 +/- 2.5%, 44.8 +/- 2.8%, and 38.4 +/- 1.4%, respectively. Medroxyprogesterone treatment tended to preserve bone mass by inhibiting the increased resorption indices while maintaining higher formation rates seen in ovariectomized rats. The effects of RU 486 were similar to those of medroxyprogesterone, suggesting an agonist-like effect. Medroxyprogesterone effects were attenuated when it was combined with RU 486, suggesting that RU 486 acted as a partial antagonist in the presence of exogenous progesterone. Bone parameters were less affected in sham-operated RU 486-treated rats, and there was no significant change in bone volume (43.2 +/- 1.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Premenopausal bone loss and depot medroxyprogesterone acetate administration

A 39-year-old woman on depot medroxyprogesterone acetate for 17 years developed multiple fractures after falling from a stationary horse. Densitometry revealed significant osteopenia. Although the reported patient was a thin, Caucasian woman, she did not have any other significant risk factors for osteoporosis except for a possible state of partial estrogen deficiency induced by the use of depot medroxyprogesterone acetate. Studies have shown that the estradiol levels of premenopausal women who have received this hormonal contraceptive for more than 1 year never reach those seen in the mid-cycle or luteal phase of the normal menstrual cycle. The estradiol levels are comparable only with those found in the early follicular phase. Therefore, women who use depot medroxyprogesterone acetate are in a state of partial estrogen deficiency, which may be associated with increased bone loss.

Ultrastructural localization of endogenous hormones and receptors in bone tissue: an immunocytological approach in frozen samples

In addition to their well-known mechanical role, bones are essential for the regulation of calcium phosphate metabolism. Most of the peptide and steroid hormones acting on bone tissue exert their cellular effects directly on bone cells after binding to cell receptors. A combined method using immunocytology on ultrathin frozen sections has been applied to bone tissue and made possible the ultrastructural localization of endogenous hormones and hormone receptors. There is immunocytological evidence, at the osteoblast level, for: (1) the presence of calcitonin, parathyroid hormone, growth hormone, 1,25 dihydroxyvitamin D3, aldosterone, corticosterone and progesterone; (2) the existence of 1,25 dihydroxyvitamin D3 and progesterone receptors; (3) the absence of estradiol and receptors, testosterone and gonadoliberin. Ultimate goals of future studies are to extend the ultrastructural localization of hormones at the osteoclast level, to assess the distribution of adhesive proteins and of their receptors in bone cells and matrix, and to use well-calcified human bone samples in order to evaluate better the role of therapeutic agents.