Vasomotor symptoms are associated with a lower bone mineral density

The association of vasomotor symptoms with fracture risk and bone mineral density in postmenopausal women: a systematic review and meta-analysis of observational studies

BACKGROUND/AIMS

Vasomotor symptoms (VMS) adversely affect postmenopausal quality of life. However, their association with bone health has not been elucidated. This study aimed to systematically review and meta-analyze the evidence regarding the association of VMS with fracture risk and bone mineral density (BMD) in peri- and postmenopausal women.

METHODS

A literature search was conducted in PubMed, Scopus and Cochrane databases until 31 August 2023. Fracture, low BMD (osteoporosis/osteopenia) and mean change in lumbar spine (LS) and femoral neck (FN) BMD were assessed. The results are presented as odds ratio (OR) and mean difference (MD), respectively, with a 95% confidence interval (95% CI). The I2 index quantified heterogeneity.

RESULTS

Twenty studies were included in the qualitative and 12 in the quantitative analysis (n=49,659). No difference in fractures between women with and without VMS was found (n=5, OR 1.04, 95% CI 0.93-1.16, I2 16%). However, VMS were associated with low BMD (n=5, OR 1.54, 95% CI 1.42-1.67, I2 0%). This difference was evident for LS (MD -0.019 g/cm2, 95% CI -0.03 to -0.008, I2 85.2%), but not for FN BMD (MD -0.010 g/cm2, 95% CI -0.021 to 0.001, I2 78.2%). These results were independent of VMS severity, age and study design. When the analysis was confined to studies that excluded menopausal hormone therapy use, the association with BMD remained significant.

CONCLUSIONS

The presence of VMS is associated with low BMD in postmenopausal women, although it does not seem to increase fracture risk.

Physical activity and menopausal symptoms: evaluating the contribution of obesity, fitness, and ambient air pollution status

OBJECTIVE

The menopausal transition is accompanied by transient symptoms that have been linked to subclinical cardiovascular disease (CVD); CVD has also been linked to air pollution. Physical activity (PA) reduces CVD, improves body composition, and can reduce menopausal symptoms. The purpose of this study was to assess the links between PA and menopausal symptoms and whether obesity, fitness, and air pollution status play a role in this relationship.

METHODS

Women (40-60 y; N = 243; mean [SD] age, 47.8 [5.6] y) from areas with high versus low air pollution enrolled in the Healthy Aging in Industrial Environment Program 4 prospective cohort study completed psychological, cardiorespiratory fitness, body composition, and menopausal status screening followed by a 14-day prospective assessment of menopausal symptoms (Menopause Rating Scale) using a mobile application. Daily PA was assessed objectively across 14 days via Fitbit Charge 3 monitor. General linear mixed models were conducted and controlled for age, menopausal status, day in the study, wear time, and neuroticism.

RESULTS

Peri/postmenopausal women ( β = 0.43, P < 0.001) and those residing in a high-air-pollution environment ( β = 0.45, P < 0.05) reported more somatovegetative symptoms. Hot flashes alone were associated with peri/postmenopausal status ( β = 0.45, P < 0.001), and for women residing in a high-air-pollution environment, lower reporting of hot flashes was observed on days when a woman was more physically active than usual ( β = -0.15, P < 0.001). No associations were found for cardiorespiratory fitness and visceral fat with any of the symptoms.

CONCLUSIONS

PA may enhance resilience to hot flashes, especially when residing in high-air-pollution environments where we also observed higher reporting of somatovegetative menopausal symptoms.

The effect of genetic variation in estrogen transportation and metabolism on the severity of menopause symptoms: A study from the RIGHT 10K cohort

OBJECTIVE

The severity of menopause-related symptoms varies considerably among women. The determinants of this variation are incompletely understood. The aim of this study was to assess the association between genetic variation in estrogen metabolism and transport pathways and the severity of menopause symptoms.

METHODS

This was a cross-sectional study of 60 peri- and postmenopausal women in the Mayo Clinic RIGHT study (which involved sequencing of genes involved in drug metabolism and transport), who had also been evaluated in the Women's Health Clinic at Mayo Clinic in Rochester, MN. All participants completed the Menopause Rating Scale (MRS) for assessment of menopause symptoms, including hot flashes. The association between severity of menopause symptoms and the variation in genes encoding 8 enzymes and transporters involved in estrogen metabolism was evaluated.

RESULTS

Lower CYP3A4 activity and higher COMT activity were associated with lower severity of somatic menopause symptoms (p = 0.04 and 0.06, respectively). These associations did not persist after adjustment for hormone therapy use. No differences in MRS scores or hot flash severity were noted among other genetic variant groups. Age at natural menopause was not affected by variations in the genes studied.

CONCLUSION

The current study did not show an association between genetic variation in estrogen metabolism and transport pathways and the severity of menopause symptoms. Further studies with larger sample sizes may be required to understand this potentially complex association.

Vasomotor Symptoms: More Than Temporary Menopausal Symptoms

Vasomotor symptoms (VMS), such as hot flashes and night sweating, are classic menopausal symptoms experienced by a majority of perimenopausal and postmenopausal women. VMS have received a great deal of attention due to their relationship with cardiometabolic risk. Further, accumulating evidence indicates that VMS are associated with an increased risk of several chronic diseases, including metabolic syndrome, type 2 diabetes mellitus, nonalcoholic fatty liver diseases, and osteoporosis in perimenopausal and postmenopausal women. These findings suggest VMS as biomarkers of impaired cardiometabolic conditions rather than just temporary symptoms in menopausal women, warranting further studies to confirm the casual relationship of VMS with these diseases and the exact underlying mechanism in this context.

Bone Health During the Menopause Transition and Beyond

The menopause transition is a critical period for bone health, with rapid losses in bone mass and strength occurring in a 3-year window bracketing the date of the final menstrual period. Declines in bone mass are accompanied by deleterious changes in bone macrostructure and microarchitecture, which may be captured by changes in composite strength indices and indices of trabecular thickness and connectivity. The onset of the rapid bone loss phase is preceded by changes in sex steroid hormones and increases in markers of bone resorption, measurements of which may be clinically useful in predicting the onset of the rapid loss phase and in identifying the women who will lose the most bone strength over the menopause transition.

Relationship between vasomotor symptoms and metabolic syndrome in postmenopausal women

Objective This study was performed to compare the vasomotor symptoms and bone mineral density of postmenopausal women with and without metabolic syndrome. Methods We performed a cross-sectional study of 200 postmenopausal women attending routine health check-ups at Marmara Faculty of Medicine Pendik Training and Research Hospital from June 2015 to December 2015. The vasomotor symptoms scored were hot flashes and night sweats. Metabolic syndrome was defined using the consensus criteria of the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. Results Women with vasomotor symptoms had no metabolic syndrome and were younger than those without vasomotor symptoms. There was no significant difference in vasomotor symptoms between patients with osteopenia in the femoral neck, total femur, and spine and patients with normal bone mineral density. The vasomotor symptoms were similar between smokers and nonsmokers. Conclusion The presence of metabolic symptoms is inversely associated with metabolic syndrome in postmenopausal women. Lipid abnormalities and a high body mass index may be important metabolic components associated with these symptoms. No relationship is present between vasomotor symptoms and the bone mineral density of the spine, femoral neck, and total femur.

Women's Mid-Life Night Sweats and 2-Year Bone Mineral Density Changes: A Prospective, Observational Population-Based Investigation from the Canadian Multicentre Osteoporosis Study (CaMos)

Women’s hot flushes and night sweats, collectively called vasomotor symptoms (VMS), are maximal (79%) in late perimenopause. The evidence describing whether VMS are associated with loss of areal bone mineral density (BMD) is mixed. We examined baseline and 2-year data for 1570 randomly selected women aged 43–63 in the Canadian Multicentre Osteoporosis Study (CaMos), a prospective Canada-wide study; we used linear regression to assess the relationship of night sweats (VMSn) with BMD and its changes. Clinically important VMSn occurred for 12.2%. Women with VMSn were slightly younger (54.5 vs. 55.3 years, p = 0.02) and less likely to use sex steroid therapies (39.8% vs. 51.4%, p < 0.05). BMD at the lumbar spine (L1-4), femoral neck (FN) and total hip (TH) were similar between those with/without VMSn. In adjusted models, we did not find a significant association between VMSn and 2-year change in L1-4, FN and TH BMD. Age, reproductive status, weight, sex steroid therapy and smoking status were associated with 2-year change in BMD. Incident fractures over 2 years also did not differ by VMSn. Our analyses were restricted to VMSn and may not truly capture the relationship between VMS and BMD. Additional research involving VMS, bone loss and fracture incidence is needed.

Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases?

Menopausal disorders may include shorter-term symptoms, such as hot flushes and night sweats (vasomotor symptoms, VMS) and longer-term chronic conditions such as cardiovascular disease (CVD), osteoporosis, and cognitive impairment. Initially, no clear link between the shorter-term symptoms and longer-term chronic conditions was evident and these disorders seemed to occur independently from each other. However, there is a growing body of evidence demonstrating that VMS may be a biomarker for chronic disease. In this review, the association between VMS and a range of chronic postmenopausal conditions including CVD, osteoporosis, and cognitive decline is discussed. Prevention of CVD in women, as for men, should be started early, and effective management of chronic disease in postmenopausal women has to start with the awareness that VMS during menopause are harbingers of things to come and should be treated accordingly.

Vasomotor symptoms and osteoporosis in Korean postmenopausal women

OBJECTIVES

This study examined the relationships between vasomotor symptoms (VMS), bone mineral density (BMD) and osteoporosis in postmenopausal women.

STUDY DESIGN

A cross-sectional study was conducted of 1390 postmenopausal Korean women aged 45-65 years who attended a routine health check-up at a single institution. Their results on the Menopause Rating Scale were used to assess VMS, and moderate, severe, and very severe VMS were combined into moderate-to-severe VMS.

MAIN OUTCOME MEASURES

The relationships of VMS with BMD and osteoporosis in the lumbar spine and femoral neck bone were analyzed by multivariate regression analyses.

RESULTS

The mean age of all participants was 54.63 ± 4.78 years. Four hundred seventy-one (33.9%) women reported mild VMS and 344 (24.7%) reported moderate-to-severe VMS. Osteoporosis was newly diagnosed in 156 (11.2%) women. BMD levels were not significantly different among the no/mild/moderate-to-severe VMS groups, despite the significant differences in the prevalence of osteoporosis in the femoral neck bone. Women with mild VMS and those with moderate-to-severe VMS had a lower BMD than women without VMS after adjustment for age, years since menopause, years of reproductive age, BMI, insulin resistance, smoking, alcohol, steroids use, exercise, previous fracture and parental history of hip fracture. And moderate-to-severe VMS was significantly associated with the risk of osteoporosis in the femoral neck bone (OR = 2.97, 95% CI = 1.41-6.26) and in the lumbar spine (OR = 1.93, 95% CI = 1.09-3.40).

CONCLUSIONS

VMS are associated with decreased BMD, and moderate-to-severe VMS in particular are independently associated with the risk of osteoporosis in otherwise healthy postmenopausal Korean women.

Intake of Novel Red Clover Supplementation for 12 Weeks Improves Bone Status in Healthy Menopausal Women

Objective. To investigate the effect by which daily consumption of a novel red clover (RC) extract influences bone health, inflammatory status, and cardiovascular health in healthy menopausal women. Design. A 12-week randomized, double-blinded, placebo-controlled trial involving 60 menopausal women receiving a daily dose of 150 mL RC extract containing 37.1 mg isoflavones (33.8 mg as aglycones) or placebo. Methods. Bone parameters were changes in bone mineral density (BMD), bone mineral content (BMC), and T-score at the lumbar spine and femoral neck. Bone turnover (CTx) and inflammatory markers were measured in plasma and finally blood pressure (BP) was evaluated. Results. RC extract had positive effect on bone health, and only the women receiving the placebo experienced a decline in BMD (p < 0.01) at the lumbar spine. T-score at the lumbar spine only decreased in the placebo group (p < 0.01). CTx decreased in the RC group with -9.94 (±4.93)%, although not significant. Conclusion. Daily consumption of RC extract over a 12-week period was found to have a beneficial effect on bone health in menopausal women based on BMD and T-score at the lumbar spine and plasma CTx levels. No changes in BP or inflammation markers were found and no side effects were observed.

Associations of menopausal vasomotor symptoms with fracture incidence

CONTEXT

Vasomotor symptoms (VMS) are common. Whether VMS are associated with fracture incidence or bone mineral density (BMD) levels is unknown.

OBJECTIVE

This study aimed to examine associations of baseline VMS with fracture incidence and BMD.

DESIGN

This was a prospective observational study with mean (SD) followup of 8.2 (1.7) years (1993-2005).

SETTING

Forty United States clinical centers.

PARTICIPANTS

We examined data from Women's Health Initiative Clinical Trial participants (n = 23 573) age 50-79 years not using menopausal hormone therapy, and 4,867 participants of the BMD sub-study.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

We measured baseline VMS, incident adjudicated fractures, and BMD (baseline, annual visits 1, 3, 6, and 9).

RESULTS

After adjustment for baseline age, body mass index, race/ethnicity, smoking, and education, the hazard ratio for hip fracture among women with baseline moderate/severe VMS (vs no VMS) was 1.78 (95% confidence interval [CI], 1.20-2.64; P = .01). There was no association between VMS and vertebral fracture. VMS severity was inversely associated with BMD during followup (P = .004 for femoral neck, P = .045 for lumbar spine). In repeated measures models, compared with women who reported no VMS, women with moderate/severe VMS had 0.015 g/cm(2) lower femoral neck BMD (95% CI, -0.025--0.005) and 0.016 g/cm(2) lower lumbar spine BMD (95% CI, -0.032--0.004).

CONCLUSIONS

Women with moderate/severe VMS have lower BMD and increased hip fracture rates. Elucidation of the biological mechanisms underlying these associations may inform the design of preventive strategies for at-risk women prior to occurrence of fracture.

Relationship between the body iodine status and menopausal symptoms during postmenopausal period

AIM

The aim of this study was to assess the effect of body iodine status on hot flashes and cardiovascular disease risk in postmenopausal women.

METHODS

Two hundred and ten consecutive postmenopausal women without known any risk factor for cardiovascular disease risk or systemic disorder were recruited for the study. All participants underwent serum screening consisted of lipid profile including lipoprotein-a (Lp(a)) and urinary iodine excretion. Participants were also asked for the frequency and the duration of hot flashes. All parameters were assessed for the association between urine iodine excretion and other parameters.

RESULTS

Urine spot iodine level was significantly correlated with Lp(a) (r = -0.287, p < 0.001), low-density lipoprotein cholesterol (LDL-C) (r = -0.187, p = 0.006), cholesterol level (r = -0.573, p < 0.001), TG level (r = -0.211, p = 0.02), frequency of hot flashes per a day (r = -0.467, p < 0.001), durations of hot flashes (r = -0.424, p < 0.001), fasting glucose level (r = 0.331, p < 0.001), and fT3 level (r = 0.475, p < 0.001). In multivariate analysis, Lp(a) levels were significantly associated with the urine iodine level (beta coefficient = -0.342, p < 0.001) after adjustment for LDL-C (beta coefficient = 0.225, p < 0.001), glucose (beta coefficient = 0.303, p < 0.001), and age (beta coefficient = 0.146, p < 0.017).

CONCLUSION

Body iodine status during postmenopausal period is associated with the menopausal symptoms and lipid profile including Lp(a).

Postmenopausal hot flushes and bone mineral density: a longitudinal study

OBJECTIVE

To study the possible association between menopausal hot flushes and bone mineral density.

DESIGN

Observational study.

SETTING

University clinic.

POPULATION

Healthy women (n = 143) with or without hot flushes, 6-36 months postmenopausal after participating in a 6-month hormone therapy trial.

METHODS

The women prospectively recorded the number and severity of hot flushes for 2 weeks. Bone mineral density in lumbar and hip bones was measured with dual-energy X-ray absorptiometry at recruitment and reassessed in 114 women approximately 6.2 years later.

MAIN OUTCOME MEASURES

Hot flushes and bone mineral density.

RESULTS

At recruitment, hot flushes were absent in 22 women, mild in 32, moderate in 28, and severe in 61. Lumbar bone mineral densities in non-flushing women (1.130 ± 0.022 g/cm(2) ; mean ± SEM), and in those with mild (1.088 ± 0.024 g/cm(2) ), moderate (1.082 ± 0.030 g/cm(2) ) or severe (1.102 ± 0.019 g/cm(2) ) hot flushes did not differ, nor were there differences in hip bone mineral densities between the four study groups. During the follow-up, lumbar bone mineral density decreased by a mean of 0.4 ± 0.1% a year in women not using hormone therapy, and increased by 0.1 ± 0.2% a year in hormone therapy users (p = 0.019). The respective non-significant changes in left and right total hip bone mineral densities were - -0.6 ± 0.01 and -1.0 ± 0.1 for the non-users, and -0.4 ± 0.1 and -0.6 ± 0.2 for hormone therapy users. These changes in bone mineral density bore no relation to the hot flush status at baseline.

CONCLUSION

In recently menopausal women, hot flushes do not appear to determine bone mass density.

Severity of menopausal symptoms and cardiovascular and osteoporosis risk factors

OBJECTIVES

To assess whether the severity of menopausal symptoms is related to increased cardiovascular and osteoporosis risk factors, and to determine whether women with more severe menopausal symptoms present a greater percentage of osteoporosis disease.

METHODS

This was a cross-sectional, descriptive study encompassing women aged 45-65 years in the whole Spanish territory. The study population sample was collected through random sampling. A total of 10 514 women were included. Their sociodemographic, medical history and lifestyle data were assessed by means of a survey. The Kupperman Index was used to assess the severity of menopausal symptoms. Bone mineral density was measured by the dual X-ray absorptiometry method.

RESULTS

The prevalences of risk factors for osteoporosis and cardiovascular disease were 67.6% and 74.8%, respectively. Women with a higher intensity of symptoms also had a greater percentage of cardiovascular (p < 0.001) and osteoporosis (p < 0.001) risk factors and suffered more from osteoporosis disease (p < 0.001). In the logistic regression analysis, those variables that contributed to the severity of menopausal symptoms were: arterial hypertension (odds ratio (OR) 2.14; 95% confidence interval (CI) 1.49-2.79; p < 0.001), dyslipidemia (OR 1.94; 95% CI 1.48-2.4; p < 0.001), obesity (OR 2.23; 95% CI 1.55-2.91; p < 0.001), family history (OR 1.38; 95% CI 1.17-1.59; p < 0.01), medication use (OR 1.12; 95% CI 0.52-1.72; p < 0.01) and osteoporosis disease (OR 3.71; 95% CI 2.9-4.52; p < 0.001).

CONCLUSIONS

Women with more severe menopausal symptoms had a greater prevalence of cardiovascular and osteoporosis disease risk factors and suffered more from osteoporosis disease compared to those who had milder or no menopausal symptoms.

Hormone therapy and coronary heart disease risk by vasomotor menopausal symptoms

OBJECTIVES

We examined whether the association between hormone therapy (HT) use and coronary heart disease (CHD) risk differed between women with and without vasomotor symptoms (VMS).

STUDY DESIGN

We used data from a Dutch (EPOS) and Swedish (WHILA) population-based sample of 8865 women, aged 46-64 years, and free of CHD, stroke, venous thrombosis/pulmonary embolism or cancer at baseline. Data on HT use, VMS and potential confounders were collected by questionnaires.

MAIN OUTCOME MEASURES

CHD endpoints, obtained via registries.

RESULTS

252 CHD cases occurred during 10.3 years of follow-up. Neither for women with nor for women without flushing or (night) sweats ever HT use was associated with CHD risk, compared with never HT use. Among women with intense VMS, ever HT use borderline significantly decreased CHD risk compared with never HT use (HR 0.48 [95% CI 0.20-1.03]). Among women without intense VMS, ever HT use was associated with a borderline significant increased CHD risk (HR 1.28 [95% CI 0.96-1.70]; P for interaction=0.02). However, after multivariate adjustment, as compared to never HT use, ever HT use was not associated with risk of CHD among women with or without intense VMS.

CONCLUSIONS

In both groups of women with and without VMS, HT use does not seem to be associated with the risk of CHD. Hence, our findings do not support the view that HT use increases the CHD risk among women with an indication, i.e. VMS, but this needs to be confirmed in specifically designed studies.

Assessing osteoporosis risk factors in Spanish menopausal women

OBJECTIVES

(1) To assess the prevalence of osteoporosis risk factors in Spanish menopausal women; (2) to detect medical and lifestyle risk factor differences between perimenopausal and postmenopausal women; (3) and to identify the main factors responsible for osteoporosis.

METHODS

Cross-sectional descriptive study encompassing women aged 45-65 across Spain. The study population sample was collected through random sampling and a total of 10,514 women were included. Socio-demographic, medical history, and lifestyle data were assessed.

RESULTS

The prevalence of osteoporosis risk factors was 67.6%. The most common risk factors were physical inactivity (53.6%), use of medication related to osteoporosis risk (45.9%), and low calcium intake (30.1%). There were statistically significant differences between peri- and postmenopausal women in terms of smoking status, alcohol intake, personal history, poor dairy product intake, and medication use that could increase risk. Logistic regression analysis showed that osteoporosis was significantly associated with age, family history, age at onset of menopause, Kupperman Index, prolonged immobilization, weight loss, and other diseases that increase the probability of developing osteoporosis.

CONCLUSIONS

A high prevalence of women taking osteoporosis risk-related medication was observed in our study. There was correlation between the menopausal symptoms' degree of severity and the risk of suffering from osteoporosis.

Increased cortisol level: a possible link between climacteric symptoms and cardiovascular risk factors

OBJECTIVE

Vasomotor symptoms may increase the risk for cardiovascular diseases through still elusive mechanisms. Increased cortisol release may favor atherosclerosis. In this study, we tested whether vasomotor and psychological symptoms are associated with an increase in cortisol levels.

METHODS

A cross-sectional investigation on women in early menopause enrolled consecutively between January and June 2009 was conducted. This study was set at a menopause outpatient service at University Hospital. Participants included 85 healthy women who were 6 months to 5 years postmenopause. The 24-hour urinary cortisol level and Greene Climacteric Scale scores were evaluated. Anthropometric parameters and fasting blood samples for the determination of high-density lipoprotein (HDL) cholesterol, total cholesterol, triglycerides, glucose, and insulin levels were measured. Body mass index, waist-to-hip ratio, and homeostatic model assessment of insulin resistance were calculated. The relation between Greene Climacteric Scale scores and 24-hour urinary cortisol level and between 24-hour urinary cortisol level and lipid levels or insulin resistance was determined.

RESULTS

The Greene Climacteric Scale score for climacteric symptoms (coefficient of regression [CR], 1.343; 95% CI, 0.441-2.246) and body mass index (CR, 4.469; 95% CI, 1.259-7.678) explained 32.5% and 10.3%, respectively, of the variance in 24-hour urinary cortisol level (r = 0.428; P = 0.0003). Twenty-four-hour urinary cortisol level was inversely related to HDL-cholesterol level (CR, -0.065; 95% CI, -0.114 to -0.017; r = 0.283; P = 0.009) and was related to waist girth (CR, 0.685; 95% CI, 0.306-1.063) and homeostatic model assessment of insulin resistance (CR, 0.097; 95% CI, 0.032-0.162; r = 0.510; P = 0.0001).

CONCLUSIONS

In early postmenopausal women, the Greene Climacteric Scale score is associated with increased 24-hour urinary cortisol level. Increased cortisol level is associated with known risk factors for cardiovascular disease, such as insulin resistance and decreased HDL-cholesterol level.

Association of menopausal vasomotor symptoms with increased bone turnover during the menopausal transition

The purpose of this study was to determine the longitudinal association between menopausal vasomotor symptoms (VMS) and urinary N-telopeptide level (NTX) according to menopausal stage. We analyzed data from 2283 participants of the Study of Women's Health Across the Nation, a longitudinal community-based cohort study of women aged 42 to 52 years at baseline. At baseline and annually through follow-up visit 8, participants provided questionnaire data, urine samples, serum samples, and anthropometric measurements. Using multivariable repeated-measures mixed models, we examined associations between annually assessed VMS frequency and annual NTX measurements. Our results show that mean adjusted NTX was 1.94 nM of bone collagen equivalents (BCE)/mM of creatinine higher among early perimenopausal women with any VMS than among early perimenopausal women with no VMS (p < .0001). Mean adjusted NTX was 2.44 nM BCE/mM of creatinine higher among late perimenopausal women with any VMS than among late perimenopausal women with no VMS (p = .03). Among premenopausal women, VMS frequency was not significantly associated with NTX level. When NTX values among women with frequent VMS (≥6 days in past 2 weeks) were expressed as percentages of NTX values among women without frequent VMS, the differences were 3% for premenopausal women, 9% for early perimenopausal women, 7% for late perimenopausal women, and 4% for postmenopausal women. Adjustment for serum follicle-stimulating hormone (FSH) level greatly reduced the magnitudes of associations between VMS and NTX level. We conclude that among early perimenopausal and late perimenopausal women, those with VMS had higher bone turnover than those without VMS. Prior to the final menstrual period, VMS may be a marker for risk of adverse bone health.

Impact of hot flashes and night sweats on carotid intima-media thickness and bone mineral density among postmenopausal women

OBJECTIVE

To determine whether postmenopausal women with vasomotor symptoms have a lower bone mineral density (BMD) and a higher carotid intima-media thickness (CIMT) than those without vasomotor symptoms.

METHODS

Postmenopausal women with (n=87) or without (n=117) vasomotor symptoms who did not receive hormone therapy were included. The CIMT and BMD were determined and the relationship with vasomotor symptoms evaluated.

RESULTS

The presence of both hot flashes and night sweats was associated with a CIMT of more than 0.80 mm after adjusting for age, time since menopause, and body mass index (adjusted odds ratio 3.2; 95% confidence interval [CI], 2.3-4.5; P<0.001). The adjusted odds ratio for a CIMT higher than 0.80 mm in women with night sweats was 3.6 (95% CI 1.5-8.9; P=0.006); the adjusted odds ratio in women with hot flashes was 23.1 (95% CI 9.1-58.4; P<0.001). The mean CIMT was 0.65±0.08 mm in the asymptomatic group and 0.81±0.06 mm in the symptomatic group (P<0.001). The mean lumbar (L1, L2, and L3) and total hip BMD values were lower in the symptomatic group (P<0.05).

CONCLUSION

Hot flashes and night sweats in postmenopausal women are associated with a higher CIMT and a lower BMD.

Vasomotor symptoms and coronary artery calcium in postmenopausal women

OBJECTIVE

We assessed whether vasomotor symptoms (VMS) are associated with coronary artery calcium (CAC) and how hormone therapy (HT) may influence this association.

METHODS

Participants were a subset of women aged 50 to 59 years with a history of hysterectomy who were enrolled in the Women's Health Initiative (WHI) estrogen-alone clinical trial and underwent a CT scan of the chest at the end of the trial to determine CAC. Participants provided information about VMS (hot flashes and/or night sweats), as well as HT use, on self-administered questionnaires at trial baseline.

RESULTS

The sample consisted of 918 women with a mean (SD) age of 55.1 (2.8) years at WHI randomization and 64.8 (2.9) years at CAC ascertainment. The prevalence of a CAC score higher than 0 was 46%, whereas the prevalence of a CAC score of 10 or higher and higher than 100 was 39% and 19%, respectively. At randomization, 77% reported a history of any VMS at any time before or at enrollment in the WHI, whereas 20% reported any VMS present only at enrollment. Compared with those without a history of any VMS and after adjustment for potential confounders, a history of any VMS at any time up to and including WHI enrollment was associated with significantly reduced odds for CAC higher than 0 (odds ratio, 0.66; 95% CI, 0.45-0.98). Moreover, as duration of HT increased, the inverse association between any VMS and CAC moved toward the null.

CONCLUSIONS

A history of any VMS was significantly associated with reduced odds for CAC independent of traditional cardiovascular disease risk factors and other relevant covariates. This association seems to be influenced by duration of HT.