The importance of preventive health care in post-menopausal women

Association of serum 25-hydroxyvitamin D levels with all-cause and cause-specific mortality among postmenopausal females: results from NHANES

BACKGROUND

Vitamin D deficiency is common among the population, but its relationship with mortality of postmenopausal females is unclear. The aim of this study is to explore the association between serum 25-Hydroxyvitamin D (25(OH)D) and all-cause and cause-specific mortality among postmenopausal women in the United States.

METHODS

6812 participants of postmenopausal females from the National Health and Nutrition Examination Survey (2001-2018) were included in this study. The mortality status of the follow-up was ascertained by linkage to National Death Index (NDI) records through 31 December 2019. We used cox proportional hazards models to estimate the association of serum 25(OH)D concentrations and mortality of postmenopausal females.

RESULTS

The mean level of serum 25(OH)D was 72.57 ± 29.93 nmol/L, and 65.34% had insufficient vitamin D. In postmenopausal females, low serum 25(OH)D concentrations were significantly associated with higher levels of glycohemoglobin, glucose, and lower levels of HDL. During follow-up, 1448 all-cause deaths occurred, including 393 cardiovascular disease (CVD)-related deaths and 263 cancer deaths. After multivariate adjustment, higher serum 25(OH)D levels were significantly related with lower all-cause and CVD mortality. In addition, serum 25(OH)D presented a L-shaped relationship with all-cause mortality, while appeared a U-shaped with CVD mortality, and the cut-off value is 73.89 nmol/L and 46.75 nmol/L respectively.

CONCLUSIONS

Low serum 25(OH)D levels are associated with the higher risk of all-cause and CVD mortality in postmenopausal females. These findings provide new ideas and targets for the health management of postmenopausal women.

Menopausal experiences of women of Chinese ethnicity: A meta-ethnography

OBJECTIVE

Menopause and the changes it brings to a woman's life necessitate a comprehensive approach to face and experience the transition. This paper aims at synthesizing results from qualitative studies of menopausal experiences among Chinese and other women of similar ethnicity and culture.

DESIGN AND METHOD

A comprehensive search strategy of multiple databases along with bibliographic hand searches was employed to identify qualitative studies published in English peer-reviewed journals between 2008 and 2022 focused on the menopausal experiences (peri and post-menopause) of Chinese and other women of similar ethnic backgrounds. Twelve studies met the inclusion criteria. The final sample consisted of 238 women aged between 40 to 60 years who had experienced menopausal symptoms. This qualitative systematic literature review adopted Noblit and Hare's seven-stage theoretical meta-ethnographic approach to construct an inductive and interpretive form of synthesis and subsequent analysis.

SYNTHESES OF FINDINGS

The synthesis of primary data identified four key concepts that entitle women's menopausal experiences: being menopausal, ramifications on well-being, family and social support around menopause, and healthcare throughout menopause. The subsequent second-order interpretation revealed that women accepted the inevitability of the natural aging process in the decline of sexual drive, reinvented relationships with partners, and expressed the significance of a supportive environment in order to successfully navigate the transition. Third-order interpretations sought to establish a link between physiological complications, loss of femininity, patriarchal-dominated societal norms, and a support system that spans the entire menopause experience. Healthcare's contribution has also been deemed to be insufficient due to a lack of information and empathy from health experts. Negligence or reluctance to seek healthcare and skepticism toward hormone replacement therapy (HRT) had also been a source of concern, as they have had the potential to exacerbate medical difficulties and emotional turmoil.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

A comprehensive approach that considers women's physiological and psychological well-being and major attempts to change cultural beliefs and norms about women's sexual health may be effective in aiding menopausal women during their transition. Additionally, appropriate guidelines and management should be in place to enable women to address menopause difficulties effectively with the assistance of healthcare experts and the support of their families and community.

Prevalence and associated socioeconomic factors of multimorbidity in 10 regions of China: an analysis of 0.5 million adults

BACKGROUND

The epidemiology of multiple chronic conditions in China is poorly understood. We investigated the prevalence of multimorbidity among the middle-aged and elderly population in China and analyzed its demographic and socioeconomic correlates.

METHODS

Data were obtained from the baseline of the China Kadoorie Biobank Study, which recruited over 0.5 million participants between 2004 and 2008. We calculated the prevalence by the characteristics of multimorbidity. The demographic and socioeconomic correlates were analyzed using a multivariable logistic regression model.

RESULTS

15.9% of the participants were multimorbid. Although the prevalence of multimorbidity increased with age, the absolute number of people with multimorbidity was much higher among middle-aged adults (30-60 years, n = 42 041) than the elderly group (>60 years, n = 38 834). The odd of multimorbidity was higher in males (aOR =1.09, 95% CI: 1.07-1.11) and among those who were unemployed (aOR = 1.58, 95% CI: 1.55-1.62). Those who received the highest level of education were most likely to be multimorbid compared with those with no education (aOR = 1.14, 95% CI: 1.09-1.19). Such an association was similar when treating multimorbidity as multinomial variable.

CONCLUSIONS

Multimorbidity is a public health concern, with higher prevalence among the elderly, males and those who belong to a lower socioeconomic stratum. Actions are needed to curb multimorbidity epidemic in China.

Chronic non-communicable disease risk calculators - An overview, part I

This review identifies the different risk assessment tools that stratify the individual's risk of four of the eight leading causes of death in women: breast cancer, lung cancer, colorectal cancer and osteoporosis. It will be followed by the publication of a second paper that summarizes the risk assessment tools for the other four leading causes of death (myocardial infarction, stroke, diabetes mellitus type 2 and dementia). The different tools were compared by their use of different variables and validation criteria. To corroborate the validation process, validation study papers were considered for each risk assessment tool. Four tables, one for each illness, were designed. The tables provide an outline for each risk assessment tool, which includes its inventor/company, required variables, advantages, disadvantages and validity. These tables simplify the comparison of the different tools and enable the identification of the most suitable one for each patient.

Psychometric properties of the Chinese version of the Menopause-Specific Quality-of-Life questionnaire

Objective:

The Menopause-Specific Quality-of-Life (MENQOL) questionnaire was developed as a specific tool to measure the health-related quality-of-life of postmenopausal women. Thus far, the Chinese version questionnaire has not been subjected to psychometric assessment with a large sample. This study aims to evaluate the validity and reliability of the Chinese version of the MENQOL specific to postmenopausal women in China.

Methods:

A total of 1,137 menopausal symptomatic and 491 menopausal asymptomatic women from eight cities in China were recruited using a convenience sampling method. Psychometric properties were evaluated by descriptive statistics, validity, and reliability. Reliability was assessed for each subscale of the MENQOL through internal consistency reliability with Cronbach's α and intersubscale correlations. Item-domain correlations, principal components analysis (PCA), and confirmatory factor analysis were performed to determine construct validity. t tests were used to compare the differences between the menopausal symptomatic and asymptomatic women and to evaluate the discriminate validity. Pearson correlation coefficients were calculated between MENQOL scores and the Kupperman index to assess criterion-related validity.

Results:

The most common symptoms in Chinese menopausal symptomatic women were “experiencing poor memory” (94.4%), “feeling tired or worn out” (93.8%), “aching in muscle and joints” (89.4%), “low backache” (86.9%), “decrease in physical strength” (86.6%), “aches in back of neck or head” (86.2%), “difficulty sleeping” (83.6%), “accomplishing less than I used to” (83.4%), “feeling a lack of energy” (83.3%), “change in your sexual desire” (81%), and “hot flash” (80.7%) among others. The symptoms of “increased facial hair” were rarely seen (9.9%). The vasomotor domain, as well as psychosocial, physical, and sexual domains showed high reliability (Cronbach's α 0.84, 0.87, 0.89, and 0.86, respectively). Item-domain correlation analysis showed that all items correlated more strongly with their own domains than with other domains. In the PCA, after deleting the “increased facial hair” item, items in the vasomotor, sexual, and psychosocial subscales loaded on their respective domains by and large, and items in the physical subscale divided into two factors. The PCA revealed a latent structure of the Chinese version of MENQOL nearly identical to the original MENQOL domains. The confirmatory factor analysis demonstrated that the questionnaire fits well with a four-domain model. The MENQOL can discriminate between menopausal symptomatic women with asymptomatic women as it showed good discriminate validity. Criterion-related validity was confirmed by a significant correlation between MENQOL scores and the Kupperman index.

Conclusions:

This study showed that Chinese version of MENQOL has good psychometric properties and would be suitable to measure the health-related quality-of-life of Chinese menopausal women except for item 21 (increased facial hair).

Age of despair or age of hope? Palestinian women's perspectives on midlife health

There is limited evidence about women's experiences of the midlife, beyond a narrow - frequently biomedical - focus on the menopause. The broader (physical, social, cultural, political) dimensions of women's midlife health are poorly understood, particularly in low and middle-income countries. Our study seeks to understand how women in the West Bank (occupied Palestinian territories) conceptualise, experience and manage their health in the midlife. We generated qualitative evidence using in-depth life history interviews in 2015 with women (n = 35) living in the West Bank, analysed thematically. Women's understandings of good health draw on indigenous and biomedical knowledge and include a calm psychological state, ease of movement, as well as physical appearance and complexion. Exposure to political violence was understood as impacting mental and physical well-being. Most women articulated a positive view about midlife and ageing as a natural process. A range of terms and expressions were suggested by women experiencing this transition, internalised differently according to marital and motherhood status. For many women, the menopause was merely one - often relatively unimportant - aspect of changes associated with ageing. In dealing with midlife health issues women used multiple strategies, or health pluralism, sequentially or simultaneously; drawing on multiple sets of accrued resources. For never-married or childless women, formal healthcare services represented a site of social exclusion. Our evidence highlights the importance of considering the broader dimensions related to midlife health for understanding women's health maintaining and care-seeking behaviours as they age.

The Effect of Husbands' Education Regarding Menopausal Health on Marital Satisfaction of Their Wives

Objectives

Marital satisfaction has an important effect on people's mental health. Due to the increasing average age and life expectancy of Iranian women, obtaining knowledge about sexual aspects of post-menopause women for partners can improve their health and quality of life. This study aimed to determine the effect of education for the husbands regarding menopause on marital satisfaction of their wives.

Methods

This randomized controlled trial was conducted on 100 women aged 45 to 55 years old and their husbands in Yazd in 2014. Subjects were randomly assigned to intervention group (50 couples) and control group (50 couples). The data gathering tools included two questionnaires, the first one contained questions about demographic information of women and men, and the other one was used to assess knowledge and practice in men about menopause and Enrich marital satisfaction. The second questionnaire was applied twice; before intervention and two months after that. In the intervention group an educational program in the form of three 60-minute sessions were conducted using speech, but the control group received no training. Analysis was performed through the statistical SPSS software, paired t-test, t-test and chi-square.

Results

In the intervention group, two months after the educational program the knowledge of menopausal health and women's marital satisfaction scores increased significantly (P<0.001). But there was no significant difference in control group.

Conclusions

Training menopausal health to husbands can increase women's marital satisfaction in the period of menopausal transition. Therefore, designing and implementing educational programs for husbands is recommended.

Disability-adjusted-life-years losses in postmenopausal women with osteoporosis: a burden of illness study

BACKGROUND

To estimate the disability-adjusted life years (DALY) in a nationwide representative sample of postmenopausal women with osteoporosis. The effects of drug-based therapy and risk factors for osteoporotic bone fractures on DALY losses were also explored.

METHODS

DALY were estimated based on participant's clinical characteristics and Health-Related Quality-of-Life (HRQoL) data obtained from a cross-sectional, epidemiological one-visit study (the GINERISK study). The study enrolled postmenopausal women (at least 12-months after their last menstrual period) with osteoporosis, above 18-years old, who attended Spanish outpatient Gynaecology clinics. HRQoL was assessed using the generic SF-12v2 questionnaire, which was used to derive disutility values. Mortality rates were extracted from the Spanish national statistics database. Factors explored to be associated with DALY losses were examined using ANOVA, ANCOVA and MANCOVA models.

RESULTS

DALY could be computed in 2,782 (67%) out of 4,157 postmenopausal women, with a mean (95% CI) age of 61.0 (60.7-61.2) years. Overall individual undiscounted DALY per woman were 6.1 (5.9-6.2), resulting to be significantly higher in women with severe osteoporosis with prior bone fracture; 7.8 (7.2-8.4) compared to osteoporotic women [5.8 (5.6-6.0)] or postmenopausal women with a BMD > -2.5 T-score that received a drug-based therapy [6.2 (5.8-6.5)]; F = 27.0 (P < 0.01). Models explaining the variation in the levels of health based on the use of a selective estrogen receptor modulator (SERM) or possession of risk factors for osteoporotic BF were found (P < 0.05).

CONCLUSIONS

DALY losses were considerable amongst postmenopausal women with osteoporosis. Not having a prior bone fracture, being older, using a SERM and having less osteoporotic risk factors were all linked to less DALY losses.

Cross cultural adaptation of the menopause specific questionnaire into the persian language

Background:

The menopause-specific quality-of-life (MENQOL) was developed as a specific tool to measure the health-related quality-of-life in menopausal women. Recently, it has been translated into about 15 languages.

Aim:

This study was performed to develop the Persian version of the MENQOL questionnaire from the original English language version.

Subjects and Methods:

This was a cross-sectional study that evaluated 300 menopausal women attending five primary health-care centers in Shiraz. The “forward-backward” procedure was applied to translate the questionnaire from English to Persian by two independent translators and then back translated into English and was checked to ensure the correct translation. Then, participants were interviewed and the questionnaire filled out.

Results:

Over all Cronbach's alpha was 0.9 and in subscales of vasomotor, psychosocial, physical and sexual were 0.8, 0.7, 0.8 and 0.3, respectively. However, the major items were acceptable (Cronbach's alpha > 0.7), but internal consistency in sexual item was poor (Cronbach's alpha = 0.3). The result of internal consistency was acceptable in subgroups of age, disease, education, marital status and smoking habit.

Conclusions:

The Persian MENQOL questionnaire demonstrates good internal consistency in vasomotor, physical and psychosocial domains, but not sexual. Therefore we suggest that, the items: “Vaginal dryness during intercourse” and “weight gain” should be deleted in Persian version of the MENQOL. This questionnaire can be used in Persian language and Iranian culture in different subgroups of age, marital status and educational level as well as in individuals with hypertension and diabetes.

Factors associated with self-perception of health among Brazilian women 50 years or older: a population-based study

OBJECTIVE

The aim of this study was to evaluate factors associated with self-perception of health among women 50 years or older living in a Brazilian city.

METHODS

A cross-sectional, population-based study was conducted using self-reported data from a household survey carried out in a sample of 622 women 50 years or older. Sociodemographic and clinical factors associated with the women's perception of their own health (very good, good, fair, poor, or very poor) were assessed. χ2 test and Poison multiple logistic regression analysis were used to select the principal factors associated with a poorer perception of health at a significance level of 5%.

RESULTS

Multiple analyses showed that the probability of association of chronic diseases with a woman's perception of her health as fair, poor, or very poor increased by 97% when at least two morbidities were present, whereas for each point (kg/m2) increase in body mass index, the probability of association with her perceiving her health as poorer increased by 2% (95% CI, 1.01-1.04). The probability of association decreased by 50% if she had more than 8 years of schooling (95% CI, 0.36-0.70), by 29% if she had health insurance (95% CI, 0.59-0.86), and by 32% if she performed physical exercise weekly (95% CI, 0.54-0.86).

CONCLUSIONS

The presence of multimorbidities and a higher body mass index increases the probability of association with a woman's poorer perception of her own health, whereas having more than 8 years of schooling, having medical insurance, and performing physical exercise weekly decreases the probability of association with a poorer perception of health.

Aging, obesity, and multimorbidity in women 50 years or older: a population-based study

OBJECTIVE

This study aims to evaluate multimorbidity and its associated factors in Brazilian women aged 50 years or older.

METHODS

This is a cross-sectional, population-based study using self-reports. A total of 622 women aged 50 years or older were included. Multimorbidity was defined as two or more of the following morbidities: hypertension, osteoarthritis, cataracts, diabetes mellitus, osteoporosis, glaucoma, chronic bronchitis or asthma, urinary incontinence, cancer, myocardial infarction, stroke, and pulmonary emphysema. Sociodemographic, clinical, and behavioral factors were evaluated. Data were analyzed using χ test and Fisher's exact test, and Poisson multiple regression analysis was performed. Prevalence ratios and their 95% CIs were calculated.

RESULTS

In this sample, 15.8% of participants reported no morbidities, whereas 26% reported having one morbid condition and 58.2% reported multimorbidity. With respect to morbidities, 55.9% of women reported having hypertension, 33.8% reported having osteoarthritis, 24.5% reported having cataracts, 22.7% reported having diabetes, 21.3% reported having osteoporosis, 9.9% reported having glaucoma, 9.2% reported having bronchitis, 8.9% reported having urinary incontinence, and 6.8% reported having cancer, whereas 4.8% reported having had a myocardial infarction, 2.7% reported having had a stroke, and 1.8% reported having pulmonary emphysema. Multiple regression analysis showed that for each additional year of life, women increased their likelihood of multimorbidity by 3% (95% CI, 1.02-1.04). Furthermore, for each point increase (kg/m) in their body mass index, women also increased their likelihood of multimorbidity by 3% (95% CI, 1.02-1.04).

CONCLUSIONS

Multimorbidity is principally associated with aging and obesity.

Impact of osteoporosis and bone fracture on health-related quality of life in postmenopausal women

BACKGROUND

Osteoporosis is responsible for fragility fractures, which are associated with decreased physical and social function. The GINERISK study was a cross-sectional epidemiological study conducted in 4157 Spanish postmenopausal women initially diagnosed with osteoporosis according to WHO criteria within the last 2 years.

AIM

The aim of the study was to explore the impact of osteoporosis on health-related quality of life (HRQoL).

METHOD

Menopause-specific and generic HRQoL were assessed, respectively, with the specific Cervantes Scale and the generic SF-12v2 Health Survey. The impact of osteoporosis on HRQoL was ultimately evaluated in 3328 (80.1%) women who had measurements for both bone mineral densitometry (BMD) and HRQoL.

RESULTS

Menopause-specific or generic HRQoL, respectively, were worse in women with current osteoporosis and prior osteoporotic bone fracture (BF) in comparison with current osteoporosis without BF or whose T-score had increased above -2.5 on the BMD after receiving osteoporosis drug therapy. Impaired HRQoL was found both in Spanish postmenopausal female populations and the Spanish general female population. Women with osteoporosis with BF had physical and mental summary component scores in the 20th and 30th percentiles, respectively, of the Spanish general population. Higher risk for cardiovascular death was also associated with greater HRQoL impairment. The use of selective estrogen receptor modulators in women with a BMD T-score ≤ -2.5 was associated with lower impact of osteoporosis on HRQoL, particularly in the domains of physical health and sexuality.

CONCLUSION

The HRQoL analysis results in this study demonstrated a loss of quality of life in postmenopausal women with osteoporosis and confirmed that this loss is greater in women with prior osteoporotic fracture.

Development and validation of anthropometric equations to estimate appendicular muscle mass in elderly women

OBJECTIVE

This study aimed to examine the cross validity of two anthropometric equations commonly used and propose simple anthropometric equations to estimate appendicular muscle mass (AMM) in elderly women.

METHODS

Among 234 physically active and functionally independent elderly women, 101 (60 to 89 years) were selected through simple drawing to compose the study sample. The paired t test and the Pearson correlation coefficient were used to perform cross-validation and concordance was verified by intraclass correction coefficient (ICC) and by the Bland and Altman technique. To propose predictive models, multiple linear regression analysis, anthropometric measures of body mass (BM), height, girth, skinfolds, body mass index (BMI) were used, and muscle perimeters were included in the analysis as independent variables. Dual-Energy X-ray Absorptiometry (AMMDXA) was used as criterion measurement. The sample power calculations were carried out by Post Hoc Compute Achieved Power. Sample power values from 0.88 to 0.91 were observed.

RESULTS

When compared, the two equations tested differed significantly from the AMMDXA (p <0.001 and p = 0.001). Ten population / specific anthropometric equations were developed to estimate AMM, among them, three equations achieved all validation criteria used: AMM (E2) = 4.150 +0.251 [bodymass (BM)] - 0.411 [bodymass index (BMI)] + 0.011 [Right forearm perimeter (PANTd) 2]; AMM (E3) = 4.087 + 0.255 (BM) - 0.371 (BMI) + 0.011 (PANTd) 2 - 0.035 [thigh skinfold (DCCO)]; MMA (E6) = 2.855 + 0.298 (BM) + 0.019 (Age) - 0,082 [hip circumference (PQUAD)] + 0.400 (PANTd) - 0.332 (BMI). The equations estimated the criterion method (p = 0.056 p = 0.158), and explained from 0.69% to 0.74% of variations observed in AMMDXA with low standard errors of the estimate (1.36 to 1.55 kg) and high concordance (ICC between 0,90 and 0.91 and concordance limits from -2,93 to 2,33 kg).

CONCLUSION

The equations tested were not valid for use in physically active and functionally independent elderly women. The simple anthropometric equations developed in this study showed good practical applicability and high validity to estimate AMM in elderly women.

Multimorbidity and associated factors in Brazilian women aged 40 to 65 years: a population-based study

OBJECTIVE

The aim of this study was to evaluate the presence of multimorbidity and associated factors in Brazilian women aged 40 to 65 years with 11 or more years of school education.

METHODS

A secondary analysis of a cross-sectional population-based study was conducted using an anonymous self-report questionnaire completed by 377 women. The number of reported morbid conditions was evaluated (depression, hypertension, diabetes mellitus, urinary incontinence, and insomnia) and classified as none or one and two or more morbid conditions. The sociodemographic, behavioral, clinical, and reproductive factors associated with these conditions were also assessed. The χ test and multiple logistic regression analysis with stepwise selection criteria were used to select the major factors associated with morbid conditions, with a significance level set at 5%.

RESULTS

Insomnia was reported by 38.5%, depression by 31%, hypertension by 28.4%, urinary incontinence by 23.2%, and diabetes by 6.3% of the participants. In this sample, 28.9% did not report any morbid conditions, 31.8% reported one morbid condition, and 39.3% reported two or more morbid conditions. On logistic regression analysis, the increased likelihood of having two or more morbid conditions was associated with bad/fair self-perception of health (increased 5.1 times; 95% CI, 1.85-14.1), nonperformance of physical activity (increased by 2.7 times; 95% CI, 1.08-6.81), obesity (increased by 30.3 times; 95% CI, 3.17-250), postmenopause (increased by 4.4 times; 95% CI, 1.57-12.11), and nervousness (increased by 3.8 times; 95% CI, 1.45-9.8).

CONCLUSIONS

A worse self-perception of health, sedentariness, obesity, nervousness, and being postmenopausal were associated with multimorbidity.

Long-term effect of a dietary education program on postmenopausal cardiovascular risk and metabolic syndrome: the Brisighella Heart Study

OBJECTIVE

To evaluate whether a nutritional education intervention on a general population cohort is able to balance the metabolic effects of incident menopause in a large sample of perimenopausal women.

METHODS

We measured body mass index (BMI), blood pressure, plasma lipids, fasting plasma glucose, and prevalence of metabolic syndrome in two groups of perimenopausal nondiabetic women involved in the Brisighella Heart Study, a longitudinal epidemiological study, before (sample size 301) and after (sample size 262) a nutritional education program aimed at improving the cardiovascular disease (CVD) risk profile in a whole village population.

RESULTS

Before the interventional period, women undergoing menopause experienced a significant increase in BMI, systolic blood pressure, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (LDL-C), and triglycerides (all parameters exhibited p < 0.01). After the nutritional intervention, women undergoing menopause experienced a significant reduction only in triglyceride plasma level (p < 0.001). Metabolic syndrome prevalence was 73 in 301 and 99 in 301 (p = 0.018), respectively, before and after menopause in the preintervention group, and it was 66 in 262 and 68 in 262 (p = 0.871), respectively, in the postintervention group.

CONCLUSIONS

In our study, a nutritional education program aimed at improving the CVD risk profile of a whole village population is associated with the prevention of increase in systolic blood pressure, BMI, cholesterolemia, and metabolic syndrome prevalence linked to menopause.

Assessment of quality of life in menopausal periods: a population study in kashan, iran

BACKGROUND

Menopause is a physiological process in women's life. The aim of this study was to assess QOL and related factors among menopausal women in Kashan city in Iran.

METHODS

Seven hundred women aged 40-60 years were assessed using cluster sampling. Women with mental and physical problems or systemic diseases were excluded. Data were collected by standard questionnaire of quality of life in the menopause.

RESULTS

The mean menopausal age was 47.6±4.1 years. 55.6% of women had been postmenopausal for less than 5 years. The overall mean scores obtained for each domain was 2.82±1.64 for vasomotor, 2.71±1.2 for psychosocial, 2.46±0.99 for physical and 2.89±1.73 for sexual domains.

CONCLUSION

Age, working status, physical activity, educational level, duration of menopause, income satisfaction, marriage satisfaction and the number of children in those living with family had influence on quality of life in menopausal women.

A protective effect of Curcuma comosa Roxb. on bone loss in estrogen deficient mice

ETHNOPHARMACOLOGICAL RELEVANCE

Curcuma comosa Roxb. or Wan chak motluk is an indigenous medicinal herb and has traditionally been used among postmenopausal women for relief of unpleasant menopausal symptoms.

AIM OF THE STUDY

Estrogen deficiency is a causative factor in the development of osteoporosis in menopausal women. Phytoestrogens, non-steroidal plant-derived compounds which have an array of beneficial effects, are considered as an effective alternative compound in preventing bone loss caused by the deficiency of estrogen. The present study determined the potential effect of Curcuma comosa Roxb. (C. comosa) hexane extract containing phytoestrogens in protecting bone loss induced by ovariectomy in mice.

MATERIALS AND METHODS

Mature Swiss albino female mice were ovariectomized and treated with the C. comosa extract for 5 weeks. Bone calcium content, bone mass density, histology, and bone markers were evaluated.

RESULTS

The ovariectomized mice showed a marked decrease in total bone calcium content and bone mass density of lumbar vertebrae 5-6, femur and tibia bone in comparison with the intact control mice. Bone histology demonstrated the poor development of endochondral bone formation in ovariectomized mice which correlated with a decrease in plasma bone alkaline phosphatase activity. Treatment with C. comosa protected against the loss of total bone calcium content and bone mass density in both trabecular and cortical bones, similar to results observed with estrogen treatment. In addition, C. comosa treatment resulted in less increase in uterine weight compared to estrogen treatment.

CONCLUSION

Our results suggest that C. comosa prevents bone loss induced by estrogen deficiency. Therefore, C. comosa would be a potential alternative treatment for prevention of postmenopausal osteoporosis.

Similarities in acquired factors related to postmenopausal osteoporosis and sarcopenia

Postmenopausal population is at increased risk of musculoskeletal impairments. Sarcopenia and osteoporosis are associated with significant morbidity and social and health-care costs. These two conditions are uniquely linked with similarities in pathophysiology and diagnostic methods. Uniform diagnostic criteria for sarcopenia are still evolving. Postmenopausal sarcopenia and osteoporosis share many environmental risk- and preventive factors. Moreover, geriatric frailty syndrome may result from interaction of osteoporosis and sarcopenia and may lead to increased mortality. The present paper reviews the factors in evolution of postmenopausal sarcopenia and osteoporosis.

Fracture, bone mineral density, and the effects of calcitonin receptor gene in postmenopausal Koreans

SUMMARY

In a candidate gene association study, we found that the variations of calcitonin receptor (CALCR) gene were related to the risk of vertebral fracture and increased bone mineral density (BMD).

INTRODUCTION

Calcitonins through calcitonin receptors inhibit osteoclast-mediated bone resorption and modulate calcium ion excretion by the kidney and also prevent vertebral bone loss in early menopause.

METHODS

To identify genetically susceptible factors of osteoporosis, we discovered the variations in CALCR gene, genotyped in Korean postmenopausal women (n = 729), and examined the potential involvement of seven single-nucleotide polymorphism (SNPs) and their haplotypes in linkage disequilibrium block (BL_hts).

RESULTS

The SNPs, +43147G > C (intron 7), +60644C > T (exon13, 3' untranslated region), and their haplotypes, BL2_ht1 and BL2_ht2, showed a significant association with risk of vertebral fracture (p = 0.048-0.004) and BL2_ht1 showed a highly significant protective effect. Moreover, the polymorphism +60644C > T showed a highly significant association with BMD at both lumbar spine and femoral neck. The subjects carrying CC and CT genotypes with the SNP, +60644C > T, had higher BMD values at the lumbar spine (p = 0.01-0.001) and femoral neck (p = 0.025-0.009).

CONCLUSION

These results indicate that the CALCR gene may regulate bone metabolism, and +60644C > T in the CALCR gene may genetically modulate bone phenotype.

Consumption of a flaxseed-rich food is not more effective than a placebo in alleviating the climacteric symptoms of postmenopausal women

Our objective in this work was to test the effects of daily intake of bread produced with partially defatted ground flaxseed on the climacteric symptoms and endometrial thickness of postmenopausal women. A double-blind, placebo-controlled, randomized clinical trial was performed with 38 women who had been postmenopausal for 1-10 y and consumed 2 slices of bread containing 25 g of flaxseed (46 mg lignans) or wheat bran (<1 mg lignans; control) every day for 12 consecutive weeks. The outcome variables were the daily number of hot flashes, the Kupperman Menopausal Index (KMI), and endometrial thickness. The plasma lipid profile (total cholesterol and HDL, LDL, and VLDL cholesterol fractions and triglycerides) and the hormones estradiol, follicle-stimulating hormone, thyroid-stimulating hormone, and free thyroxine also were measured. Food intake was evaluated by means of 2 24-h recalls, before and after the treatment. Twenty patients in the study group and 18 in the control group completed the study. The general characteristics did not differ between the 2 groups at the start of the study. Both had significant, but similar, reductions in hot flashes and KMI after 3 mo of treatment. Moreover, endometrial thickness was not affected in either group. Our findings clearly show that although flaxseed is safe, its consumption at this level (46 mg lignans/d) is no more effective than placebo for reducing hot flashes and KMI.

Correlates and predictors of self-rated health and ambulatory status among elderly women - Cross-sectional and 10 years population-based cohort study

AIM

To investigate the correlates and predictors of self-rated health (SRH) and self-reported ambulatory status (AMB) among elderly women.

SUBJECTS AND METHODS

A random sample of 1620 postmenopausal women aged 53-66 years in 1994 was selected from Osteoporosis Risk Factor and Prevention (OSTPRE) - study cohort in Finland. SRH and AMB were assessed in baseline (1994) and after 10-year follow-up (2004). A prognostic model was developed to predict the probability of good 10-year SRH and AMB.

RESULTS

Full AMB was correlated with and predicted by good SRH (OR=4.3, p<0.001). Good quality of life (QoL) was both correlate and predictor of good 10-year SRH (OR=2.0, p<0.001) and full AMB (OR=2.6, p<0.001). Low BMI was associated with good SRH (OR=0.97, p<0.049) and full AMB (OR=0.92, p<0.001), good grip strength with good SRH (OR=2.7, p<0.001) and ability to squat down with full AMB (OR=1.7, p=0.002). Cardiovascular diseases, arthritis and back pain were common significant negative correlates (p<0.001) of baseline AMB and SRH out of variety of chronic diseases with significant association with either one. The significant (p<0.05) baseline predictors in final prognostic model for good 10-year SRH included baseline AMB and SRH, QoL, age, BMI, grip strength and psychiatric diseases (C-index=0.81) and for full 10-year AMB ability to squat, baseline AMB and SRH, QoL, BMI, hypertension and arthritis (C-index=0.81). These risk scores had better predictive power in comparison to that of baseline SRH and AMB alone (p<0.001 in univariate Z-score test).

CONCLUSIONS

Among elderly women AMB is strongly linked to SRH. SRH and AMB are affected mostly by musculoskeletal, cardiovascular and psychiatric diseases as well as body anthropometry, muscle strength and subjective QoL. The present study provides a novel algorithm for predicting probability of full AMB and good SRH in postmenopausal women.

Knowledge and compliance from patients with postmenopausal osteoporosis treatment

OBJECTIVE

The aim of this study was to evaluate the knowledge, attitudes and expectations of patients receiving treatment for postmenopausal osteoporosis, analysing the factors related to good compliance with treatment.

METHODS

A national, epidemiological, cross-sectional study collected information on personal medical history, family history, bone densitometry, and treatment and compliance of patients over 45 years who were receiving treatment for osteoporosis and provided their informed consent. The patients anonymously completed a questionnaire about their knowledge of osteoporosis and the Morisky and Green treatment compliance evaluation test.

RESULTS

Three hundred and fifteen specialists in gynaecology participated, recruiting 1179 patients with postmenopausal osteoporosis. The mean age was 59.9 years (standard deviation [SD] = 7.5). Only 22.6% of the patients showed an acceptable knowledge of osteoporosis (the criterion established was correct response to 80% of the questions). Treatment compliance was evaluated using a combination of Morisky-Green and Haynes-Sackett criteria. Of the patients 39.2% were classified as compliant, 74.6% of the patients were very or quite concerned about their condition and 53.3%; described their health status as excellent or good. However, 63.6% of the patients indicated that they needed more information about osteoporosis. The factors related to good compliance were the existence of one or no concomitant disease (odds ratio [OR] = 1.38, P = 0.025) and the type of knowledge about their disease (acceptable knowledge: OR = 1.33, P = 0.043).

CONCLUSIONS

Correct knowledge about osteoporosis would increase the possibility of appropriate compliance with the prescribed treatment, thus reducing the risk of osteoporotic fractures.