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Zhang J, Hu W, Zou Z, Li Y, Kang F, Li J, Dong S. The role of lipid metabolism in osteoporosis: Clinical implication and cellular mechanism. Genes Dis 2024; 11:101122. [PMID: 38523674 PMCID: PMC10958717 DOI: 10.1016/j.gendis.2023.101122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/02/2023] [Accepted: 08/13/2023] [Indexed: 03/26/2024] Open
Abstract
In recent years, researchers have become focused on the relationship between lipids and bone metabolism balance. Moreover, many diseases related to lipid metabolism disorders, such as nonalcoholic fatty liver disease, atherosclerosis, obesity, and menopause, are associated with osteoporotic phenotypes. It has been clinically observed in humans that these lipid metabolism disorders promote changes in osteoporosis-related indicators bone mineral density and bone mass. Furthermore, similar osteoporotic phenotype changes were observed in high-fat and high-cholesterol-induced animal models. Abnormal lipid metabolism (such as increased oxidized lipids and elevated plasma cholesterol) affects bone microenvironment homeostasis via cross-organ communication, promoting differentiation of mesenchymal stem cells to adipocytes, and inhibiting commitment towards osteoblasts. Moreover, disturbances in lipid metabolism affect the bone metabolism balance by promoting the secretion of cytokines such as receptor activator of nuclear factor-kappa B ligand by osteoblasts and stimulating the differentiation of osteoclasts. Conclusively, this review addresses the possible link between lipid metabolism disorders and osteoporosis and elucidates the potential modulatory mechanisms and signaling pathways by which lipid metabolism affects bone metabolism balance. We also summarize the possible approaches and prospects of intervening lipid metabolism for osteoporosis treatment.
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Affiliation(s)
- Jing Zhang
- College of Bioengineering, Chongqing University, Chongqing 400044, China
- Department of Biomedical Materials Science, College of Biomedical Engineering, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Wenhui Hu
- Department of Biomedical Materials Science, College of Biomedical Engineering, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Zhi Zou
- College of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Yuheng Li
- Department of Biomedical Materials Science, College of Biomedical Engineering, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Fei Kang
- Department of Biomedical Materials Science, College of Biomedical Engineering, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Jianmei Li
- Department of Biomedical Materials Science, College of Biomedical Engineering, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Shiwu Dong
- Department of Biomedical Materials Science, College of Biomedical Engineering, Army Medical University (Third Military Medical University), Chongqing 400038, China
- State Key Laboratory of Trauma and Chemical Poisoning, Army Medical University (Third Military Medical University), Chongqing 400038, China
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Xia B, Dai X, Shi H, Yin J, Xu T, Liu T, Yue G, Guo H, Liang R, Liu Y, Gao J, Wang X, Chen X, Tang J, Wang L, Zhu R, Zhang D. Lycopene Promotes Osteogenesis and Reduces Adipogenesis through Regulating FoxO1/PPARγ Signaling in Ovariectomized Rats and Bone Marrow Mesenchymal Stem Cells. Nutrients 2024; 16:1443. [PMID: 38794681 PMCID: PMC11123960 DOI: 10.3390/nu16101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/25/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Recent interest in preventing the development of osteoporosis has focused on the regulation of redox homeostasis. However, the action of lycopene (LYC), a strong natural antioxidant compound, on osteoporotic bone loss remains largely unknown. Here, we show that oral administration of LYC to OVX rats for 12 weeks reduced body weight gain, improved lipid metabolism, and preserved bone quality. In addition, LYC treatment inhibited ROS overgeneration in serum and bone marrow in OVX rats, and in BMSCs upon H2O2 stimulation, leading to inhibiting adipogenesis and promoting osteogenesis during bone remodeling. At the molecular level, LYC improved bone quality via an increase in the expressions of FoxO1 and Runx2 and a decrease in the expressions of PPARγ and C/EBPα in OVX rats and BMSCs. Collectively, these findings suggest that LYC attenuates osteoporotic bone loss through promoting osteogenesis and inhibiting adipogenesis via regulation of the FoxO1/PPARγ pathway driven by oxidative stress, presenting a novel strategy for osteoporosis management.
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Affiliation(s)
- Bingke Xia
- Diabetes Research Center, Traditional Chinese Medicine School, Beijing University of Chinese Medicine, Beijing 100029, China; (B.X.); (X.D.); (H.S.); (J.Y.); (T.X.); (T.L.); (G.Y.); (H.G.); (R.L.); (Y.L.)
| | - Xuan Dai
- Diabetes Research Center, Traditional Chinese Medicine School, Beijing University of Chinese Medicine, Beijing 100029, China; (B.X.); (X.D.); (H.S.); (J.Y.); (T.X.); (T.L.); (G.Y.); (H.G.); (R.L.); (Y.L.)
| | - Hanfen Shi
- Diabetes Research Center, Traditional Chinese Medicine School, Beijing University of Chinese Medicine, Beijing 100029, China; (B.X.); (X.D.); (H.S.); (J.Y.); (T.X.); (T.L.); (G.Y.); (H.G.); (R.L.); (Y.L.)
| | - Jiyuan Yin
- Diabetes Research Center, Traditional Chinese Medicine School, Beijing University of Chinese Medicine, Beijing 100029, China; (B.X.); (X.D.); (H.S.); (J.Y.); (T.X.); (T.L.); (G.Y.); (H.G.); (R.L.); (Y.L.)
| | - Tianshu Xu
- Diabetes Research Center, Traditional Chinese Medicine School, Beijing University of Chinese Medicine, Beijing 100029, China; (B.X.); (X.D.); (H.S.); (J.Y.); (T.X.); (T.L.); (G.Y.); (H.G.); (R.L.); (Y.L.)
| | - Tianyuan Liu
- Diabetes Research Center, Traditional Chinese Medicine School, Beijing University of Chinese Medicine, Beijing 100029, China; (B.X.); (X.D.); (H.S.); (J.Y.); (T.X.); (T.L.); (G.Y.); (H.G.); (R.L.); (Y.L.)
| | - Gaiyue Yue
- Diabetes Research Center, Traditional Chinese Medicine School, Beijing University of Chinese Medicine, Beijing 100029, China; (B.X.); (X.D.); (H.S.); (J.Y.); (T.X.); (T.L.); (G.Y.); (H.G.); (R.L.); (Y.L.)
| | - Haochen Guo
- Diabetes Research Center, Traditional Chinese Medicine School, Beijing University of Chinese Medicine, Beijing 100029, China; (B.X.); (X.D.); (H.S.); (J.Y.); (T.X.); (T.L.); (G.Y.); (H.G.); (R.L.); (Y.L.)
| | - Ruiqiong Liang
- Diabetes Research Center, Traditional Chinese Medicine School, Beijing University of Chinese Medicine, Beijing 100029, China; (B.X.); (X.D.); (H.S.); (J.Y.); (T.X.); (T.L.); (G.Y.); (H.G.); (R.L.); (Y.L.)
| | - Yage Liu
- Diabetes Research Center, Traditional Chinese Medicine School, Beijing University of Chinese Medicine, Beijing 100029, China; (B.X.); (X.D.); (H.S.); (J.Y.); (T.X.); (T.L.); (G.Y.); (H.G.); (R.L.); (Y.L.)
- Food and Pharmacy College, Xuchang University, 88 Bayi Road, Xuchang 461000, China
| | - Junfeng Gao
- The Scientific Research Center, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China; (J.G.); (X.W.)
| | - Xinxiang Wang
- The Scientific Research Center, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China; (J.G.); (X.W.)
| | - Xiaofei Chen
- Department of Pharmacology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450003, China; (X.C.); (J.T.)
| | - Jinfa Tang
- Department of Pharmacology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450003, China; (X.C.); (J.T.)
| | - Lili Wang
- Department of TCM Pharmacology, Chinese Material Medica School, Beijing University of Chinese Medicine, Beijing 102488, China
| | - Ruyuan Zhu
- Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Dongwei Zhang
- Diabetes Research Center, Traditional Chinese Medicine School, Beijing University of Chinese Medicine, Beijing 100029, China; (B.X.); (X.D.); (H.S.); (J.Y.); (T.X.); (T.L.); (G.Y.); (H.G.); (R.L.); (Y.L.)
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Sundell M, Brynhildsen J, Fredrikson M, Hoffmann M, Spetz Holm AC. Insufficient use of menopausal hormone therapy in Swedish women with early or premature menopause caused by bilateral oophorectomy: a register-based study. BJOG 2024; 131:500-507. [PMID: 37667667 DOI: 10.1111/1471-0528.17647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/14/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To investigate the use of menopausal hormone therapy (MHT) in premenopausal women after bilateral oophorectomy. DESIGN Retrospective register-based cohort study. SETTING Sweden. POPULATION Swedish women aged 35-44 years without malignancy who underwent bilateral oophorectomy in 2005-2020 were identified using The Swedish National Quality Register of Gynaecological Surgery (GynOp). METHODS Data from GynOp were cross-linked with data on dispensed drugs extracted from the Swedish Prescribed Drug Register. MAIN OUTCOME MEASURES Proportion of women dispensed MHT at least once within 1 year after surgery. Repeated treatment episodes were defined, and the proportion of 'person time' covered by dispensations was analysed. RESULTS In total, 1231 of all women (n = 1706) were dispensed MHT at some point after surgery, with 1177 women dispensed MHT within 1 year. This proportion increased from 64% in 2005 to 84% in 2019 (p < 0.001). In the total population, 4537 'treatment years' transpired, corresponding to 43% of the mean time covered. In women dispensed MHT within 1 year, the proportion of time covered was 63%. CONCLUSIONS Only 69% of all women without malignancy of any kind who underwent bilateral oophorectomy were dispensed MHT within 1 year after surgery, and the duration of treatment was limited. It is important to study further the reasons behind the low dispensation rate in this group to increase adherence to current treatment guidelines, improve quality of life, and avoid increased morbidity and mortality.
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Affiliation(s)
- Micaela Sundell
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynaecology, Kalmar County Hospital, Kalmar, Sweden
| | - Jan Brynhildsen
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mikael Hoffmann
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- The NEPI Foundation, Stockholm, Sweden
| | - Anna-Clara Spetz Holm
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynaecology, Linköping University Hospital, Linköping, Sweden
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Kim HY, Park J, Moon SJ, Jeong S, Hong JH, Lee JK, Cho GJ, Cho HW. Short-term Impact of Hormone Replacement Therapy on Risk of Breast Cancer in BRCA Mutation Carriers: A Nationwide Study in South Korea. Cancer Res Treat 2024; 56:143-148. [PMID: 37591780 PMCID: PMC10789953 DOI: 10.4143/crt.2023.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023] Open
Abstract
PURPOSE BRCA1/2 mutations are well-known risk factors for breast and ovarian cancers in women. Risk-reducing salpingo-oophorectomy (RRSO) is the standard treatment for preventing ovarian cancer with BRCA mutations. Postmenopausal syndrome (symptoms after RRSO can be alleviated by hormone replacement therapy (HRT); however, the use of HRT in carriers of BRCA mutations has been controversial because of the concern that HRT increases the risk of breast cancer. This study aimed to evaluate the effects of HRT in BRCA mutation carriers who underwent RRSO. MATERIALS AND METHODS A total of 151 carriers, who underwent RRSO between 2013 and 2020 after the diagnosis of BRCA1 or BRCA2 mutations were selected and followed up for a median of 3.03 years. Patients were divided into two groups: those who received HRT after RRSO (n=33) and those who did not (n=118). We compared the incidence of breast cancer over time between these two groups. RESULTS There was no significant difference in the incidence of breast cancer between women who received HRT and those who did not (p=0.229). Multivariate logistic regression analysis, adjusted for age and parity revealed no significant difference in the risk of breast cancer between these two groups (hazard ratio, 0.312; 95% confidence interval, 0.039 to 2.480; p=0.278). CONCLUSION In this study, we found no relationship between post-RRSO HRT and breast cancer in the population with BRCA mutations. Therefore, healthcare providers may consider the alleviation of symptoms of postmenopausal syndrome through HRT in patients who underwent RRSO.
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Affiliation(s)
- Hye Yeon Kim
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jisoo Park
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seok Joo Moon
- Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sohyeon Jeong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun-Woong Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Rai P, Bhattacharya S, Raj M, Bala S. Early surgical menopause and its correlates: A case series from a tertiary healthcare institute in a tribal area of Jharkhand, India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:394. [PMID: 38333146 PMCID: PMC10852157 DOI: 10.4103/jehp.jehp_617_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/10/2023] [Indexed: 02/10/2024]
Abstract
In India, unjustified and mass hysterectomy is an alarming issue in rural and semi-urban areas. Fear of cancer and reiterating the idea that uterus removal will alleviate unrelated somatic issues are two methods used to persuade women to have the surgery. It becomes easier to counsel them for hysterectomy, especially when they belong to the rural population, come from lower socioeconomic strata, are young and illiterate, and do nothing for their livelihood. Many patients from the Santhal Pargana division (tribal region) came to gynecology Out Patient Department after having a hysterectomy without any medical indication at an age below 30 years to cure their common symptoms such as lower abdominal pain and vaginal discharge, and this is our major concern from them. We have taken three patients for this case series to highlight this problem at the community level. Unfortunately, the adverse health consequences of early loss of ovarian function accelerate the menopause state, affect multiple systems including cardiovascular, neurological, bone, and connective tissues, and, most importantly, affect the quality of life owing to vasomotor symptoms, mood, sleep, and sexual function. This case series emphasizes the serious complications of unnecessary hysterectomies and problems and gender inequities in the healthcare system for poor women.
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Affiliation(s)
- Priyanka Rai
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Sudip Bhattacharya
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Manish Raj
- Department of Orthopedics, All India Institute of Medical Sciences Deoghar, Jharkhand, India
| | - Swapnil Bala
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
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Haber HR, French HM, Movilla PR, Isaacson KB, Morris SN. Take it or leave it: oophorectomy at the time of benign hysterectomy. Curr Opin Obstet Gynecol 2023; 35:344-351. [PMID: 37266568 DOI: 10.1097/gco.0000000000000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE OF REVIEW Previous modeling data suggest ovarian conservation up to age 65 for women without adnexal disease and at average risk of ovarian cancer because of an increase in mortality associated with ovarian removal. Recent modeling data challenges this practice. This review of recent literature will update providers regarding consideration for oophorectomy at time of benign hysterectomy. RECENT FINDINGS Oophorectomy at time of hysterectomy for women less than 50 years with estrogen supplementation and greater than 50 years without estrogen supplementation is not associated with increased mortality. SUMMARY Although not associated with increased mortality, the decision to remove the ovaries at time of hysterectomy in women older than 50 years is nuanced and requires careful shared decision-making, considering unique patient factors.
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Affiliation(s)
- Hilary R Haber
- Minimally Invasive Gynecologic Surgery, Women's Health Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
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Gebhart P, Singer CF, Gschwantler-Kaulich D. CA125 Levels in BRCA mutation carriers - a retrospective single center cohort study. BMC Cancer 2023; 23:610. [PMID: 37393265 DOI: 10.1186/s12885-023-11116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Ovarian cancer screening in BRCA1/2 mutation carriers utilizes assessment of carbohydrate antigen 125 (CA125) and transvaginal ultrasound (TVU), despite low sensitivity and specificity. We evaluated the association between CA125 levels, BRCA1/2 mutation status and menopausal status to provide more information on clinical conditions that may influence CA125 levels. METHODS We retrospectively analyzed repeated measurements of CA125 levels and clinical data of 466 women at high risk for ovarian cancer. CA125 levels were compared between women with and without deleterious mutations in BRCA1/2. Pearson's correlation was used to determine the association between age and CA125 serum level. Differences in CA125 levels were assessed with the Mann-Whitney U test. The effect of BRCA1/2 mutation status and menopausal status on the change in CA125 levels was determined by Two-factor analysis of variance (ANOVA). RESULTS The CA125 serum levels of premenopausal women (median, 13.8 kU/mL; range, 9.4 - 19.5 kU/mL) were significantly higher than in postmenopausal women (median, 10.4 kU/mL; range, 7.7 - 14.0 kU/mL; p < .001). There was no significant difference in the CA125 levels of BRCA mutation carriers and non-mutation carriers across all age groups (p = .612). When investigating the combined effect of BRCA1/2 mutation and menopausal status, variance analysis revealed a significant interaction between BRCA1/2 mutation status and menopausal status on CA125 levels (p < .001). There was a significant difference between the CA125 levels of premenopausal and postmenopausal women, with a large effect in BRCA mutation carriers (p < .001, d = 1.05), whereas in non-mutation carriers there was only a small effect (p < .001, d = 0.32). CONCLUSION Our findings suggest that hereditary mutations in BRCA1/2 affect the decline of CA125 levels with increasing age. To prove a definite effect of this mutation on the CA125 level, prospective trials need to be conducted to define new cut-off levels of CA 125 in mutation carriers and optimize ovarian cancer screening.
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Affiliation(s)
- P Gebhart
- Department of Obstetrics and Gynaecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- Department of Obstetrics and Gynecology, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - C F Singer
- Department of Obstetrics and Gynaecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Obstetrics and Gynecology, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - D Gschwantler-Kaulich
- Department of Obstetrics and Gynaecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Obstetrics and Gynecology, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Depypere H. Treatment of women with BRCA mutation. Climacteric 2023; 26:235-239. [PMID: 37011662 DOI: 10.1080/13697137.2023.2189583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 04/05/2023]
Abstract
The cumulative risk for breast and ovarian cancer is high in BRCA1 or BRCA2 mutation carriers. The lifetime risk of breast cancer by the age of 80 years is respectively up to 72% and 69% in BRCA1 and BRCA2 mutation carriers. The risk of ovarian cancer is higher (44%) in BRCA1 than in BRCA2 (17%) mutation carriers. Breast and ovarian cancers tend to arise earlier in BRCA1 mutation carriers. Breast cancers in BRCA1 mutation carriers are more frequently (up to 70%) triple negative while the majority (up to 80%) of breast cancers in BRCA2 mutation carriers are hormone sensitive. Many issues remain to be resolved. In daily practice we are often confronted with patients having BRCA mutations classified as variants of unknown significance, who do have breast cancer personally or have a strong family history of breast cancer. On the other hand, 30-40% of mutation carriers will not develop breast cancer. Moreover, it is very difficult to predict the age at which cancer will arise. In a multidisciplinary setting we need to offer BRCA and other mutation carriers a wide range of information, advice and support.
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Affiliation(s)
- H Depypere
- Menopause and Breast Clinic, University Hospital and Coupure Menopause Center, Gent, Belgium
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Common Regulators of Lipid Metabolism and Bone Marrow Adiposity in Postmenopausal Women. Pharmaceuticals (Basel) 2023. [DOI: 10.3390/ph16020322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
A variety of metabolic disorders are associated with a decrease in estradiol (E2) during natural or surgical menopause. Postmenopausal women are prone to excessive fat accumulation in skeletal muscle and adipose tissue due to the loss of E2 via abnormalities in lipid metabolism and serum lipid levels. In skeletal muscle and adipose tissue, genes related to energy metabolism and fatty acid oxidation, such as those encoding peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α) and estrogen-related receptor alpha (ERRα), are downregulated, leading to increased fat synthesis and lipid metabolite accumulation. The same genes regulate lipid metabolism abnormalities in the bone marrow. In this review, abnormalities in lipid metabolism caused by E2 deficiency were investigated, with a focus on genes able to simultaneously regulate not only skeletal muscle and adipose tissue but also bone metabolism (e.g., genes encoding PGC-1α and ERRα). In addition, the mechanisms through which mesenchymal stem cells lead to adipocyte differentiation in the bone marrow as well as metabolic processes related to bone marrow adiposity, bone loss, and osteoporosis were evaluated, focusing on the loss of E2 and lipid metabolic alterations. The work reviewed here suggests that genes underlying lipid metabolism and bone marrow adiposity are candidate therapeutic targets for bone loss and osteoporosis in postmenopausal women.
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Mansour SW, Selim SA, Salama SA, Hussein S, Abozaid ER. Anti-apoptotic effect of menaquinone-7 protects the brain of ovariectomized rats. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2023. [DOI: 10.1186/s43088-023-00359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Abstract
Background
Mood and memory deterioration occurs after ovariectomy (OVX) with various degrees and sometimes requires medical intervention. Menaquinone-7 (MK-7) is a potent isoform of vitamin K2 and has many effects on the bone and cardiovascular system. However, the effect of MK-7 on the brain and its mechanisms of action are still unclear. This study was performed to investigate the effect of MK-7 on mood and memory disorders following ovariectomy. Thirty-two female albino rats were divided into four groups (n = 8). Group I (control group) included sham-operated rats with sunflower oil intake. Group II (K2) included sham-operated rats with an intake of MK-7 dissolved in sunflower oil. Group III (K2 OVX) included ovariectomized rats with an intake of MK-7 dissolved in sunflower oil. Group IV(OVX) included ovariectomized rats with sunflower oil intake. Working memory, anxiety, depression, and sociability behaviors were investigated in all groups. Gene expression of BAX, BCL2, and p53 was measured in the hippocampus of all groups by real-time PCR. Besides, BAX/BCL2 ratio was calculated.
Results
Working memory, anxiety, depression, and sociability behaviors in the OVX rats showed a significant change compared to the sham-operated. However, the intake of MK-7 after the OVX resulted in significant improvement. Regarding hydrogen peroxide and MDA activity, they were significantly higher in the OVX group compared to the sham-operated groups, while in the K2OVX group, their activity showed a significant decrease in comparison with the OVX group. However, catalase and total antioxidant capacity were significantly lower in the OVX group compared to the sham-operated group, while in the k2OVX group, their activity showed a significant increase in comparison with the OVX group. The OVX group showed a significant elevation in the BAX, BAX/BCl2 ratio, and P53, but BCL2 was significantly reduced. However, the intake of MK-7 caused a significant improvement.
Conclusions
Our study showed that the OVX group showed significant physiological, biochemical, and molecular changes, which can be prevented by MK-7 intake.
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11
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Buyuk GN, Ozdemir EU, Halilzade I, Kokanali MK, Ozaksit MG. Anogenital index and bone mineral density associations after natural and surgical menopause: a preliminary study. Rev Assoc Med Bras (1992) 2022; 68:1737-1741. [PMID: 36449803 PMCID: PMC9779961 DOI: 10.1590/1806-9282.20220918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate postmenopausal women to determine whether an anogenital index (AGI) is associated with bone mineral density (BMD) based on the hypothesis that the effects of menopause are similar for both. METHODS A total of 338 generally healthy postmenopausal women who were referred for a routine annual check and 140 women who met the inclusion criteria were enrolled in the study. Based on the menopausal status, the women were classified into natural menopause and surgical menopause. AGI was calculated by dividing anogenital distance by body mass index. The BMD of the femoral neck, body of the femur, and lumbar spine (L1 and L2) was measured using dual-energy x-ray absorptiometry. RESULTS There was a statistically significant and same-directional correlation between age and AGI for all cases (r=0.234 and p=0.005). The AGI level decreased as the parity increased (r=-0.582 and p<0.001). The AGI level decreased significantly as the menopause duration was prolonged (r=0.288 and p<0.001). While there was no statistically significant correlation between L2-L4 BMD and AGI (p=0.128), as the femur and femoral neck BMD levels increased, the AGI level increased statistically significantly (r=0.330 and p<0.001, r=0.292 and p<0.001). CONCLUSION The AGI levels in healthy postmenopausal women give preliminary information about their BMD status. A decrease in AGI levels may predict lower BMD in postmenopausal women. Further larger and well-controlled studies may be required to determine the relationship between AGI and BMD in the future.
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Affiliation(s)
- Gul Nihal Buyuk
- Ministry of Health Ankara City Hospital, Department of Obstetrics and Gynecology – Ankara, Turkey.,Corresponding author:
| | - Eda Ureyen Ozdemir
- Ministry of Health Ankara City Hospital, Department of Obstetrics and Gynecology – Ankara, Turkey
| | - Inci Halilzade
- Ministry of Health Ankara City Hospital, Department of Obstetrics and Gynecology – Ankara, Turkey
| | - Mahmut Kuntay Kokanali
- Ministry of Health Ankara City Hospital, Department of Obstetrics and Gynecology – Ankara, Turkey
| | - Muzeyyen Gulnur Ozaksit
- Ministry of Health Ankara City Hospital, Department of Obstetrics and Gynecology – Ankara, Turkey
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12
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Sobecki J, Weigman B, Anderson-Carter I, Barroilhet L, Chandereng T, Kliewer M, Hartenbach E. Opportunistic osteoporosis screening using routine computed tomography images to identify bone loss in gynecologic cancer survivors. Int J Gynecol Cancer 2022; 32:1050-1055. [DOI: 10.1136/ijgc-2021-003169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
ObjectiveCancer treatment-induced bone loss is a known side effect of cancer therapy. Computed tomography (CT) bone mineral density screening is a novel tool for identifying bone loss. This study aims to use routine CT images to determine long-term bone mineral density changes and osteoporosis risk among women with gynecologic cancers.MethodsBone loss was evaluated in a retrospective cohort of women ≤65 years old with gynecologic cancer who underwent oophorectomy from January 2010 to December 2014. Opportunistic CT-based bone mineral density measurements (Hounsfield units, HU) were performed at baseline and intervals up to 5 years after cancer diagnosis. Osteoporosis risk was categorized by HU. Bivariate and multivariate analyses were performed to compare baseline to follow-up bone mineral density at 1, 3, and 5 years and to identify predictors of bone loss following diagnosis.ResultsA total of 185 patients (median age 53 years, range 23–65 years, 78.1% ovarian cancer) were included. Bone mineral density significantly decreased between baseline and 1 year (p<0.001), 3 years (p<0.001), and 5 years (p<0.001). Half with normal bone mineral density at baseline had risk for osteopenia or osteoporosis at 5 years. Four percent had osteoporosis risk at baseline compared with 1 year (7.4%), 3 years (15.7%), and 5 years (18.0%). Pre-treatment bone mineral density was a significant predictor at 1 and 5 years (1 year: p<0.01; 5 years: p<0.01). History of chemotherapy predicted bone loss at 1 year (p=0.03). More lifetime chemotherapy cycles were associated with increased risk of osteoporosis at 1 year (p=0.03) and 5 years (p=0.01).ConclusionsWomen with gynecologic cancers may experience accelerated cancer treatment-induced bone loss. Routine CT imaging is a convenient screening modality to identify those at highest risk for osteoporosis who warrant further evaluation with dual-energy X-ray absorptiometry. Routine bone mineral density assessments 1 year following oophorectomy for cancer treatment may be warranted in this population.
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Mirinezhad MR, Ghazizadeh H, Aghsizadeh M, Zamiri Bidary M, Naghipour A, Hasanzadeh E, Yaghooti-Khorasani M, Ebrahimi Dabagh A, Moghadam MRSF, Sheikh Andalibi N, Naseri Far Z, Esmaily H, Ferns GA, Hamzehloei T, Pasdar A, Ghayour-Mobarhan M. The relationship between genetic variants associated with primary ovarian insufficiency and lipid profile in women recruited from MASHAD cohort study. BMC Womens Health 2022; 22:2. [PMID: 34996442 PMCID: PMC8742392 DOI: 10.1186/s12905-021-01550-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 11/23/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND AIM Primary Ovarian Insufficiency (POI) is defined by the occurrence of menopause before the age of 40 years. It is often associated with cardiovascular disease (CVD). The purpose of this study was to explore the relationship between POI-associated genotypes cardiometabolic disorder risk factors. METHODS One hundred seventeen women with POI and one hundred eighty-three healthy women without POI were recruited in this study. DNA was extracted and analyzed using ASO-PCR or Tetra ARMS-PCR. Lipid profiles were also assessed. RESULTS Multivariate logistic regression analysis showed that individuals with GG vs. TT genotype of the rs1046089 SNP were more likely to have a higher serum LDL (p = 0.03) compared to the control group. There was also a significant association between low serum HDL and rs2303369 and rs4806660 SNP genotypes in the POI group. In the POI group, the percentage of those with high total cholesterol was lower in those with a CC genotype compared to those with a TT genotype (p = 0.03). CONCLUSION Some SNPs reported to be associated with POI appear to be independently associated with dyslipidemia. These results may be helpful to identify subjects with POI who may be susceptible to CVD.
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Affiliation(s)
- Mohammad Reza Mirinezhad
- Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamideh Ghazizadeh
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Metabolic Syndrome Research Center, 99199-91766, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maliheh Aghsizadeh
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Metabolic Syndrome Research Center, 99199-91766, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Alireza Naghipour
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elahe Hasanzadeh
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ali Ebrahimi Dabagh
- Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | | | | | - Zeynab Naseri Far
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Division of Medical Education, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9PH, Sussex, UK
| | - Tayebeh Hamzehloei
- Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Pasdar
- Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Division of Applied Medicine, Medical School, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
- Metabolic Syndrome Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Majid Ghayour-Mobarhan
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Metabolic Syndrome Research Center, 99199-91766, Mashhad, Iran.
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14
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do Valle HA, Kaur P, Kwon JS, Cheifetz R, Dawson L, Hanley GE. Bone health after RRBSO among BRCA1/2 mutation carriers: a population-based study. J Gynecol Oncol 2022; 33:e51. [PMID: 35557034 PMCID: PMC9250858 DOI: 10.3802/jgo.2022.33.e51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/28/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Examine the risks of fractures and osteoporosis after risk-reducing bilateral salpingo-oophorectomy (RRBSO) among women with BRCA1/2 mutations. Methods In this retrospective population-based study in British Columbia, Canada, between 1996 to 2017, we compared risks of osteoporosis and fractures among women with BRCA1/2 mutations who underwent RRBSO before the age of 50 (n=329) with two age-matched groups without known mutations: 1) women who underwent bilateral oophorectomy (BO) (n=3,290); 2) women with intact ovaries who had hysterectomy or salpingectomy (n=3,290). Secondary outcomes were: having dual-energy X-ray absorptiometry (DEXA) scan, and bisphosphonates use. Results The mean age at RRBSO was 42.4 years (range, 26–49) and the median follow-up for women with BRCA1/2 mutations was 6.9 years (range, 1.1–19.9). There was no increased hazard of fractures for women with BRCA1/2 mutations (adjusted hazard ratio [aHR]=0.80; 95% confidence interval [CI]=0.56–1.14 compared to women who had BO; aHR=1.02; 95% CI=0.65–1.61 compared to women with intact ovaries). Among women who had DEXA-scan, those with BRCA1/2 mutations had higher risk of osteoporosis (aHR=1.60; 95% CI=1.00–2.54 compared to women who had BO; aHR=2.49; 95% CI=1.44–4.28 compared to women with intact ovaries). Women with BRCA1/2 mutations were more likely to get DEXA-scan than either control groups, but only 46% of them were screened. Of the women with BRCA1/2 mutations diagnosed with osteoporosis, 36% received bisphosphonates. Conclusion Women with BRCA1/2 mutations had higher risk of osteoporosis after RRBSO, but were not at increased risk of fractures during our follow-up. Low rates of DEXA-scan and bisphosphonates use indicate we can improve prevention of bone loss. BRCA mutations carriers had higher osteoporosis risk after risk-reducing bilateral salpingo-oophorectomy (RRBSO) than the groups without mutations. However, they were not at increased risk of fractures during the study period. Only 46% of BRCA mutations carriers were screened for bone loss after RRBSO. The rate of bisphosphonates use was also low.
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Affiliation(s)
- Helena Abreu do Valle
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
| | - Paramdeep Kaur
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
| | - Janice S. Kwon
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
| | - Rona Cheifetz
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- High-Risk Clinic, Hereditary Cancer Program, BC Cancer Agency, Vancouver, BC, Canada
| | - Lesa Dawson
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Gillian E. Hanley
- Division of Gynaecologic Oncology, Department of Gynaecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
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15
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Ko SH, Jung Y. Energy Metabolism Changes and Dysregulated Lipid Metabolism in Postmenopausal Women. Nutrients 2021; 13:nu13124556. [PMID: 34960109 PMCID: PMC8704126 DOI: 10.3390/nu13124556] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/13/2022] Open
Abstract
Aging women experience hormonal changes, such as decreased estrogen and increased circulating androgen, due to natural or surgical menopause. These hormonal changes make postmenopausal women vulnerable to body composition changes, muscle loss, and abdominal obesity; with a sedentary lifestyle, these changes affect overall energy expenditure and basal metabolic rate. In addition, fat redistribution due to hormonal changes leads to changes in body shape. In particular, increased bone marrow-derived adipocytes due to estrogen loss contribute to increased visceral fat in postmenopausal women. Enhanced visceral fat lipolysis by adipose tissue lipoprotein lipase triggers the production of excessive free fatty acids, causing insulin resistance and metabolic diseases. Because genes involved in β-oxidation are downregulated by estradiol loss, excess free fatty acids produced by lipolysis of visceral fat cannot be used appropriately as an energy source through β-oxidation. Moreover, aged women show increased adipogenesis due to upregulated expression of genes related to fat accumulation. As a result, the catabolism of ATP production associated with β-oxidation decreases, and metabolism associated with lipid synthesis increases. This review describes the changes in energy metabolism and lipid metabolic abnormalities that are the background of weight gain in postmenopausal women.
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Affiliation(s)
- Seong-Hee Ko
- Department of Microbiology, College of Medicine, Gachon University, Incheon 21999, Korea;
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Korea
| | - YunJae Jung
- Department of Microbiology, College of Medicine, Gachon University, Incheon 21999, Korea;
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, Korea
- Correspondence: ; Tel.: +82-32-899-6415
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Hickey M, Moss KM, Mishra GD, Krejany EO, Domchek SM, Wark JD, Trainer A, Wild RA. What Happens After Menopause? (WHAM): A prospective controlled study of cardiovascular and metabolic risk 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy. Gynecol Oncol 2021; 162:88-96. [PMID: 33972087 DOI: 10.1016/j.ygyno.2021.04.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/29/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To prospectively measure cardiometabolic risk 12 months after premenopausal risk-reducing bilateral salpingo-oophorectomy (RRBSO) compared to a similar age comparison group, and the effects of Hormone Therapy (HT) on cardiometabolic risk. METHODS Prospective observational study of 95 premenopausal women planning RRBSO and 99 comparisons who retained their ovaries. At baseline and 12 months, blood pressure (BP), Body Mass Index (BMI), waist and hip circumference, fasting total, HDL and LDL cholesterol, triglycerides, high-sensitivity C-reactive protein, glucose and insulin were measured and HOMA-IR was calculated. Chi-square tests, t-tests and adjusted logistic regression models were used to compare groups. RESULTS Baseline cardiometabolic phenotypes were similar between groups but more RRBSO participants were overweight/obese with higher waist/hip ratios. By 12 months, BP and cardiometabolic phenotypes were largely unchanged. Paired t-tests showed statistically significant increases in BMI (p = 0.037) and weight (p = 0.042) and larger increases in waist circumference (p < 0.001) and waist-hip ratio (p = 0.009) after RRBSO vs comparisons. However, these were not significant when adjusted for baseline values. After RRBSO 60% initiated Hormone Therapy (HT). Paired t-tests demonstrated that non-HT users had a significantly greater mean increase in waist circumference of 4.3 cm (95% CI 2.0-6.5) compared to 1.3 cm in HT users (95% CI -0.2-2.7, p < 0.001), which remained significant when adjusted for baseline values (p = 0.02). At 12 months, mean waist circumference was 2.94 cm greater in non-HT users compared to HT users. CONCLUSIONS Cardiometabolic risk markers are largely unchanged 12 months after RRBSO. Hormone Therapy after RRBSO may prevent against an increase in waist circumference.
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Katrina M Moss
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Gita D Mishra
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Efrosinia O Krejany
- Gynaecology Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Susan M Domchek
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, USA
| | - John D Wark
- Bone and Mineral Medicine, Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alison Trainer
- Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Robert A Wild
- Departments of Obstetrics and Gynecology, Biostatistics and Epidemiology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
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17
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Kauffman RP, Young C, Castracane VD. Perils of prolonged ovarian suppression and hypoestrogenism in the treatment of breast cancer: Is the risk of treatment worse than the risk of recurrence? Mol Cell Endocrinol 2021; 525:111181. [PMID: 33529690 DOI: 10.1016/j.mce.2021.111181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/04/2021] [Accepted: 01/21/2021] [Indexed: 01/18/2023]
Abstract
Premenopausal breast cancer is usually estrogen receptor positive, and hence, prolonged ovarian suppression by medical or surgical means to prevent recurrence has become standard of management to improve disease-free survival. Ten-year adjuvant tamoxifen therapy is associated with 3.5% fewer recurrences compared to five years. The SOFT trial demonstrated small but statistically significant incremental improvements in long-term disease-free survival by the addition of gonadotropin-releasing hormone analog treatment (triptorelin) to an aromatase inhibitor (exemestane). Profound hypoestrogenism in the premenopausal age group may not be well tolerated due to a host of bothersome side effects (primarily vasomotor symptoms, musculoskeletal complaints, genitourinary syndrome of menopause, and mood disorders). Prolonged hypoestrogenism in younger women is associated with premature development of cardiovascular disease, bone loss, cognitive decline, and all-cause mortality. This paper explores multi-system consequences of prolonged hypoestrogenism in premenopausal women derived from studies of women with and without breast cancer. Pretreatment counseling in estrogen receptor positive breast cancer should emphasize the benefit of prolonged estrogen suppression on breast cancer recurrence and established risks of lifelong hypoestrogenism on quality of life and all-cause mortality. Future genomic research may help identify the best candidates for extended ovarian suppression to avoid treating many women when only a minority benefit.
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Affiliation(s)
- Robert P Kauffman
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, 1400 S. Coulter Rd, Amarillo, TX, 79106, USA.
| | - Christina Young
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, 1400 S. Coulter Rd, Amarillo, TX, 79106, USA
| | - V Daniel Castracane
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, School of Medicine, 1400 S. Coulter Rd, Amarillo, TX, 79106, USA
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18
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Samad N, Nguyen HH, Ebeling PR, Milat F. Musculoskeletal Health in Premature Ovarian Insufficiency. Part Two: Bone. Semin Reprod Med 2021; 38:289-301. [PMID: 33784746 DOI: 10.1055/s-0041-1722849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Accelerated bone loss and muscle loss coexist in women with premature ovarian insufficiency (POI), but there are significant gaps in our understanding of musculoskeletal health in POI. This review describes estrogen signaling in bone and its role in skeletal health and disease. Possible mechanisms contributing to bone loss in different forms of POI and current evidence regarding the utility of available diagnostic tests and therapeutic options are also discussed. A literature review from January 2000 to March 2020 was conducted to identify relevant studies. Women with POI experience significant deterioration in musculoskeletal health due to the loss of protective effects of estrogen. In bone, loss of bone mineral density (BMD) and compromised bone quality result in increased fracture risk; however, tools to assess bone quality such as trabecular bone score (TBS) need to be validated in this population. Timely initiation of HRT is recommended to minimize the deleterious effects of estrogen deficiency on bone in the absence of contraindications; however, the ideal estrogen replacement regimen remains unknown. POI is associated with compromised bone health, regardless of the etiology. Ongoing research is warranted to refine our management strategies to preserve bone health in women with POI.
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Affiliation(s)
- Navira Samad
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.,Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Hanh H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Frances Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria, Australia
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19
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Schipper I, Louwers YV. Premature and Early Menopause in Relation to Cardiovascular Disease. Semin Reprod Med 2021; 38:270-276. [PMID: 33511582 DOI: 10.1055/s-0040-1722318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Postmenopausal women have an increased risk for cardiovascular diseases. It has been postulated that the loss of ovarian function and subsequent deficiency of endogenous estrogens after menopause contributes to this elevated risk of cardiovascular disease in postmenopausal women. Compared with woman entering menopause at the mean age of 51 years, in women with early menopause or premature ovarian insufficiency the risk for cardiovascular disease is even greater. These women lack the cardioprotective effect of endogenous estrogens for many more years than do women entering natural menopause. The majority of data assessing the risk of cardiovascular disease in relation to age at menopause and specifically premature menopause are derived from large epidemiological cohort studies. In addition, observations in women undergoing bilateral oophorectomy at an early age provide convincing evidence regarding association between early menopause or POI and the development of cardiovascular events and mortality. Moreover, genetic variants associated with earlier age at menopause have also been found to increase the risk of cardiovascular events in women. It has been substantiated that hormone replacement therapy (HRT) decreases the risk for ischemic heart disease and eliminates the increased cardiovascular disease mortality. It is therefore crucial to start HRT as soon as possible, particularly in women with premature ovarian insufficiency.
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Affiliation(s)
- Izaäk Schipper
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynecology, Erasmus MC University Center, Rotterdam, The Netherlands
| | - Yvonne V Louwers
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynecology, Erasmus MC University Center, Rotterdam, The Netherlands
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20
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Sobecki JN, Rice LW, Hartenbach EM. Bone health and osteoporosis screening in gynecologic cancer survivors. Gynecol Oncol 2020; 160:619-624. [PMID: 33309416 DOI: 10.1016/j.ygyno.2020.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/26/2020] [Indexed: 01/22/2023]
Abstract
Cancer treatment-induced bone loss is a known side effect of cancer therapy that increases the risk of osteoporosis and bone fracture. Women with gynecologic cancer are at increased risk of bone loss secondary to the combined effect of oophorectomy and adjuvant therapies. Data regarding bone loss in women with gynecologic cancers are overall lacking compared to other cancer populations. Consequently, guidelines for osteoporosis screening in women with cancer are largely based on data generated among non-gynecologic cancer survivors. This article reviews current available data of bone health in women with gynecologic cancer, summarizes best-available guidelines for screening for osteoporosis in women with cancer, and provides guidance for osteoporosis screening in women with gynecologic cancers based on best available evidence.
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Affiliation(s)
- Janelle N Sobecki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine and Public Health, United States.
| | - Laurel W Rice
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine and Public Health, United States
| | - Ellen M Hartenbach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine and Public Health, United States
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22
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Yeganeh L, Boyle JA, Gibson-Helm M, Teede H, Vincent AJ. Women’s perspectives of early menopause: development of a word cloud. Climacteric 2020; 23:417-420. [DOI: 10.1080/13697137.2020.1730318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- L. Yeganeh
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - J. A. Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Menopause Unit, Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, VIC, Australia
| | - M. Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - H. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Endocrinology, Monash Health, Monash University, Melbourne, VIC, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Monash University, Melbourne, VIC, Australia
- Monash Partners Academic Health Sciences Centre, Monash University, Melbourne, VIC, Australia
| | - A. J. Vincent
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Menopause Unit, Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Endocrinology, Monash Health, Monash University, Melbourne, VIC, Australia
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Walker M, Jacobson M, Sobel M. Management of ovarian cancer risk in women with BRCA1/2 pathogenic variants. CMAJ 2019; 191:E886-E893. [PMID: 31405835 PMCID: PMC6690830 DOI: 10.1503/cmaj.190281] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Melissa Walker
- Department of Obstetrics and Gynaecology (Walker), University of Toronto; Department of Obstetrics & Gynaecology (Walker, Jacobson, Sobel), Women's College Hospital; Department of Obstetrics & Gynaecology (Jacobson, Sobel), Sinai Health System, Toronto, Ont.
| | - Michelle Jacobson
- Department of Obstetrics and Gynaecology (Walker), University of Toronto; Department of Obstetrics & Gynaecology (Walker, Jacobson, Sobel), Women's College Hospital; Department of Obstetrics & Gynaecology (Jacobson, Sobel), Sinai Health System, Toronto, Ont
| | - Mara Sobel
- Department of Obstetrics and Gynaecology (Walker), University of Toronto; Department of Obstetrics & Gynaecology (Walker, Jacobson, Sobel), Women's College Hospital; Department of Obstetrics & Gynaecology (Jacobson, Sobel), Sinai Health System, Toronto, Ont
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Maffei S, Guiducci L, Cugusi L, Cadeddu C, Deidda M, Gallina S, Sciomer S, Gastaldelli A, Kaski JC. Women-specific predictors of cardiovascular disease risk - new paradigms. Int J Cardiol 2019; 286:190-197. [DOI: 10.1016/j.ijcard.2019.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/19/2018] [Accepted: 02/04/2019] [Indexed: 01/19/2023]
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25
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Yue D, Li Fei S, Jing C, Ru Xin W, Rui Tong D, Ai Lian L, Luo YH. The relationship between calcium (water) density and age distribution in adult women with spectral CT: initial result compared to bone mineral density by dual-energy X-ray absorptiometry. Acta Radiol 2019; 60:762-768. [PMID: 30249113 DOI: 10.1177/0284185118801139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Calcium (water) density (DCa(Wa)) of gemstone spectral imaging by spectral computed tomography (CT) is a new method of evaluating bone structures. PURPOSE To investigate age-related change of DCa(Wa) of a chosen lumbar vertebra in adult women with spectral CT and the correlation between the DCa(Wa) and bone mineral density (BMD) of dual-energy X-ray absorptiometry (DXA). MATERIAL AND METHODS A total of 305 adult women underwent spectral CT, 127 of whom simultaneously underwent DXA. All the patients were divided into 11 subgroups based on age. DCa(Wa) and BMD were measured at the second lumbar vertebra on the calcium (water)-based material decomposition images of spectral CT and DXA, respectively. A one-way analysis of variance (ANOVA) was performed for the difference of the measurements among adjacent age subgroups. Pearson correlation was used to assess the association between age and DCa(Wa), age and BMD, as well as DCa(Wa) and BMD. RESULTS There was a significant negative correlation between DCa(Wa) and age (r = -0.719) as well as BMD and age(r = -0.851). The mean DCa(Wa) of L2 vertebral body was significantly different between the 40-44- and 45-49-, 45-49- and 50-54-, 55-59- and 60-64-, 65-69- and 70-74-year-old age subgroups. BMD was significantly different between the 35-39- and 40-44-, 45-49- and 50-54-, and 65-69- and 70-74-year-old age subgroups. There was a significant positive correlation between DCa(Wa) and BMD. CONCLUSIONS The DCa(Wa) of lumbar vertebra by spectral CT demonstrated similar age distribution as BMD of DXA and could be used as a method of measuring the vertebral bone mineral density in adult women.
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Affiliation(s)
- Dong Yue
- Department of Radiology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital, Shenyang, Liaoning, PR China
| | - Sun Li Fei
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Chen Jing
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Wang Ru Xin
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Dong Rui Tong
- Department of Radiology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital, Shenyang, Liaoning, PR China
| | - Liu Ai Lian
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Ya Hong Luo
- Department of Radiology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital, Shenyang, Liaoning, PR China
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Menopausal hormone therapy for primary prevention: why the USPSTF is wrong. Menopause 2019; 24:1101-1112. [PMID: 28872490 DOI: 10.1097/gme.0000000000000983] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Habermehl TL, Parkinson KC, Hubbard GB, Ikeno Y, Engelmeyer JI, Schumacher B, Mason JB. Extension of longevity and reduction of inflammation is ovarian-dependent, but germ cell-independent in post-reproductive female mice. GeroScience 2019; 41:25-38. [PMID: 30547325 PMCID: PMC6423149 DOI: 10.1007/s11357-018-0049-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/26/2018] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular disease, rare in premenopausal women, increases sharply at menopause and is typically accompanied by chronic inflammation. Previous work in our laboratory demonstrated that replacing senescent ovaries in post-reproductive mice with young, actively cycling ovaries restored many health benefits, including decreased cardiomyopathy and restoration of immune function. Our objective here was to determine if depletion of germ cells from young transplanted ovaries would alter the ovarian-dependent extension of life and health span. Sixty-day-old germ cell-depleted and germ cell-containing ovaries were transplanted to post-reproductive, 17-month-old mice. Mean life span for female CBA/J mice is approximately 644 days. Mice that received germ cell-containing ovaries lived 798 days (maximum = 815 days). Mice that received germ cell-depleted ovaries lived 880 days (maximum = 1046 days), 29% further past the time of surgery than mice that received germ cell-containing ovaries. The severity of inflammation was reduced in all mice that received young ovaries, whether germ cell-containing or germ cell-depleted. Aging-associated inflammatory cytokine changes were reversed in post-reproductive mice by 4 months of new-ovary exposure. In summary, germ cell depletion enhanced the longevity-extending effects of the young, transplanted ovaries and, as with germ cell-containing ovaries, decreased the severity of inflammation, but did so independent of germ cells. Based on these observations, we propose that gonadal somatic cells are programed to preserve the somatic health of the organism with the intent of facilitating future germline transmission. As reproductive potential decreases or is lost, the incentive to preserve the somatic health of the organism is lost as well.
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Affiliation(s)
- Tracy L Habermehl
- Department of Animal, Dairy and Veterinary Sciences, Center for Integrated BioSystems, School of Veterinary Medicine, Utah State University, 4700 Old Main Hill, Logan, UT, 84322, USA
| | - Kate C Parkinson
- Department of Animal, Dairy and Veterinary Sciences, Center for Integrated BioSystems, School of Veterinary Medicine, Utah State University, 4700 Old Main Hill, Logan, UT, 84322, USA
| | - Gene B Hubbard
- Barshop Institute for Longevity and Aging Studies, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
- Department of Pathology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Yuji Ikeno
- Barshop Institute for Longevity and Aging Studies, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
- Department of Pathology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
- Geriatric Research and Education Clinical Center, Audie L. Murphy VA Hospital, South Texas Veterans Health Care System, San Antonio, TX, 78229, USA
| | - Jennifer I Engelmeyer
- The Institute for Genome Stability in Ageing and Disease, Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Diseases (CECAD) Research Center, University of Cologne, Joseph-Stelzmann-Straße 26, 50931, Köln, Germany
| | - Björn Schumacher
- The Institute for Genome Stability in Ageing and Disease, Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Diseases (CECAD) Research Center, University of Cologne, Joseph-Stelzmann-Straße 26, 50931, Köln, Germany
| | - Jeffrey B Mason
- Department of Animal, Dairy and Veterinary Sciences, Center for Integrated BioSystems, School of Veterinary Medicine, Utah State University, 4700 Old Main Hill, Logan, UT, 84322, USA.
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Risk of Hyperlipidemia in Women with Hysterectomy-A Retrospective Cohort Study in Taiwan. Sci Rep 2018; 8:12956. [PMID: 30154502 PMCID: PMC6113310 DOI: 10.1038/s41598-018-31347-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/17/2018] [Indexed: 12/17/2022] Open
Abstract
Hysterectomy has been associated with metabolic change and cardiovascular risk for women after removing the uterus, but inconclusive. This large retrospective cohort study evaluated the hyperlipidemia risk for women with a hysterectomy and/or oophorectomy. From claims data of one million people in the National Health Insurance (NHI) database of Taiwan, we established a cohort consisting of 5887 women newly received a surgery of hysterectomy from 2000-2013, 563 women had a hysterectomy and a oophorectomy, and 556 women had a oophorectomy. From the claims data, 28024 women without any of the surgeries were identified to form the comparison cohort, frequency matched by birth year and surgery year of the women with hysterectomy. By the end of 2013, the incidence of hyperlipidemia was 1.3 times greater in women with a hysterectomy than in comparison women (3.43 vs. 2.65 per 100 person-years), with an adjusted hazard ratio (aHR) of 1.27 (95% CI = 1.19-1.35) for hysterectomy women after controlling for age, oophorectomy, hormone therapy and comorbidities. The incidence of hyperlipidemia increased to 4.93 per 100 person-years in women with both a hysterectomy and an oophorectomy. The relative risk of hyperlipidemia was higher for young women than the elderly women with the surgery. Women with comorbidity of obesity, hypertension or diabetes had a higher incidence of hyperlipidemia. In conclusion, the risk of developing hyperlipidemia could be elevated for women who had a hysterectomy and/or an oophorectomy. Women with hysterectomy should routinely monitor their metabolic status, particularly for young women and those with comorbidity of metabolic symptoms.
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Bone loss in women with BRCA1 and BRCA2 mutations. Gynecol Oncol 2018; 148:535-539. [DOI: 10.1016/j.ygyno.2018.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/11/2018] [Accepted: 01/13/2018] [Indexed: 11/22/2022]
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Bone loss after oophorectomy among high-risk women: an NRG oncology/gynecologic oncology group study. Menopause 2018; 23:1228-1232. [PMID: 27433858 DOI: 10.1097/gme.0000000000000692] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Women undergoing premenopausal oophorectomy for a variety of reasons, including to reduce ovarian or breast cancer risk were evaluated for accelerated bone loss. METHODS The Gynecologic Oncology Group (GOG)-0215 randomized phase-II trial of zoledronic acid was initiated to determine if postoophorectomy bisphosphonate therapy could prevent this bone loss. The study was closed after slow accrual prevented evaluation of the primary study endpoint. We analyzed changes in bone mineral density (BMD) among the 80 women randomized to the observation arm of this study, as measured 3, 9, and 18 months postenrollment. RESULTS The mean change in BMD from baseline to 18 months was -0.09 (95% CI, -0.12 to -0.07), -0.05 (95% CI, -0.07 to -0.03), and -0.06 (95% CI, -0.07 to -0.05) g/cm across the lumbar spine, right hip, and left hip, respectively. This represents a BMD decrease of -8.5% for the lumbar spine and -5.7% for both the right and left hips from baseline to 18 months' observation. CONCLUSIONS These results demonstrate that premenopausal women undergoing oophorectomy clearly experience bone loss, an adverse effect of oophorectomy, which requires attention and active management. BMD should be monitored postoophorectomy, and treated per standard practice guidelines. Future studies will be required to determine if early treatment can mitigate fracture risk, and to test promising therapeutic interventions and novel prevention strategies, such as increased physical activity or alternative medications, in randomized trials.
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Babaei P, Shirkouhi SG, Hosseini R, Soltani Tehrani B. Vitamin D is associated with metabotropic but not neurotrophic effects of exercise in ovariectomized rats. Diabetol Metab Syndr 2017; 9:91. [PMID: 29177013 PMCID: PMC5688735 DOI: 10.1186/s13098-017-0288-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/01/2017] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Here, we studied the beneficial effects of aerobic exercise on metabolic syndrome components, cognitive performance, brain derived neurotrophic factor (BDNF) and irisin in ovariectomized rats with different serum vitamin D (Vit D) status. METHODS Eighty female wistar rats were divided into 2 groups of sham operated (sham, n = 8), and ovariectomized (OVX, n = 72). Then OVX were divided into 9 groups of receiving combination of exercise protocol with low dose of Vit D (OVX + EXE + LD), high dose of Vit D (OVX + EXE + HD), Vit D deficiency (OVX + EXE - D), and (OVX + EXE + Veh). Also non exercised groups of OVX receiving high dose of Vit D (OVX + HD), low dose of Vit D (OVX + LD), Vit D deficiency (OVX - D), and Veh (OVX + Veh) were included. After 2 months of related interventions, spatial memory was assessed using Morris water maze (MWM), and then metabolic syndrome components were measured. RESULTS High dose of Vit D supplementation showed significant reduction in weight (p = 0.001), lipid profiles (p = 0.001), visceral fat (p = 0.001) and waist circumference (p = 0.001) regardless of exercising or not, with no change in cognitiive function. Serum BDNF level was significantly higher in Vit D deficient group (p = 0.001), and was decreased in the OVX + HD. In contrary, irisin did not show any significant relationship with serum concentration of Vit D, while it was significantly elevated in the exercised groups compared with non-exercised counterparts. CONCLUSION Vit D insufficiency deteriorates metabolic syndrome components, and elevates serum BDNF as a compensatory metabotropic factor, and further supplementation significantly attenuates these components parallel with reduction in BDNF. In addition, aerobic exercise successfully induces various metabolic benefits, provided optimum serum level of Vit D.
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Affiliation(s)
- Parvin Babaei
- Cellular & Molecular Research Center, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, 2263 Iran
- Department of Physiology, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Ghorbani Shirkouhi
- Cellular & Molecular Research Center, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, 2263 Iran
- Department of Physiology, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Rastegar Hosseini
- Department of Physical Education and Sport Sciences, Kermanshah Branch, Islamic Azad University, Kermanshah, Iran
| | - Bahram Soltani Tehrani
- Cellular & Molecular Research Center, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, 2263 Iran
- Department of Pharmacology, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Langer RD, Simon JA, Pines A, Lobo RA, Hodis HN, Pickar JH, Archer DF, Sarrel PM, Utian WH. Menopausal hormone therapy for primary prevention: why the USPSTF is wrong. Climacteric 2017; 20:402-413. [DOI: 10.1080/13697137.2017.1362156] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- R. D. Langer
- Principal Scientist, Jackson Hole Center for Preventive Medicine, Jackson, WY, Associate Dean for Clinical and Translational Research and Professor of Family Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| | - J. A. Simon
- Clinical Professor, Department of Obstetrics and Gynecology, George Washington University, Washington, DC, USA
| | - A. Pines
- Clinical Professor of Internal Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - R. A. Lobo
- Professor of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - H. N. Hodis
- Harry J. Bauer and Dorothy Bauer Rawlins Professor of Cardiology, Professor of Medicine and Preventive Medicine and Director, Atherosclerosis Research Unit, Division of Cardiovascular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - J. H. Pickar
- Adjunct Associate Professor of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - D. F. Archer
- Professor of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - P. M. Sarrel
- Emeritus Professor of Obstetrics, Gynecology, Reproductive Sciences, and Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - W. H. Utian
- Professor Emeritus, Reproductive Biology, Case Western Reserve University, Cleveland, OH, USA
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The management of sexuality, intimacy, and menopause symptoms (SIMS) after prophylactic bilateral salpingo-oophorectomy: How to maintain sexual health in "previvors". Maturitas 2017; 105:46-51. [PMID: 28602465 DOI: 10.1016/j.maturitas.2017.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/18/2017] [Accepted: 06/01/2017] [Indexed: 01/23/2023]
Abstract
"Previvors", or "pre-survivors", are individuals who do not have cancer but have a genetic predisposition to cancer. One such example is women with BRCA mutations. As a result of their predisposition to cancer, many will undergo a bilateral salpingo-oophorectomy when they are premenopausal. For premenopausal women, the removal of ovaries results in the depletion of estrogen, immediate menopause, and, in many cases, resultant Sexuality, Intimacy, and Menopausal Symptoms (SIMS). Furthermore, they may undergo changes in body image. SIMS are underreported by patients and underdiagnosed by practitioners. At the time of diagnosis or at preoperative visits, women should be informed of the potential physiologic, hormonal, and psychosocial effects of their risk-reducing surgery. There are many modalities for management of these symptoms. Successful treatment requires the provider's awareness of the problem, ability to identify it, and willingness to treat it.
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Vermeulen RFM, Beurden MV, Korse CM, Kenter GG. Impact of risk-reducing salpingo-oophorectomy in premenopausal women. Climacteric 2017; 20:212-221. [PMID: 28509627 DOI: 10.1080/13697137.2017.1285879] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To describe implications of premenopausal risk-reducing salpingo-oophorectomy (RRSO) on quality of life, endocrine symptoms, sexual function, osteoporosis, cardiovascular health, metabolic syndrome, cognitive impairment and safety of hormone replacement therapy. METHODS We searched the following electronic databases: The Cochrane Library, EMBASE, PsycInfo, and MEDLINE. We selected controlled and uncontrolled trials of premenopausal women undergoing RRSO. Two authors independently assessed studies for inclusion. Reference lists of included reports were searched manually for additional studies. RESULTS Surgical menopause leads to more menopausal complaints and sexual dysfunction than natural menopause. Overall quality of life is not affected by surgery. In the limited literature, there is no evidence that RRSO leads to more osteopenia in comparison with natural menopause at a young age. Cohort studies show a slight impaired cardiovascular health. Cognitive function decreases later in life in premenopausal oophorectomized women. Short-term hormone replacement therapy seems to decline postmenopausal complaints and does not seem to increase the risk for breast carcinoma in mutation carriers without a personal history of breast carcinoma. CONCLUSIONS The conclusions of this systematic review are limited by the absence of randomized, controlled trials. There is growing evidence from observational studies that RRSO may impact negatively on all-cause non-survival endpoints.
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Affiliation(s)
- R F M Vermeulen
- a Department of Gynecology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - M van Beurden
- a Department of Gynecology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.,c Center for Gynecologic Oncology Amsterdam , Amsterdam , The Netherlands
| | - C M Korse
- b Department of Clinical Chemistry , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - G G Kenter
- a Department of Gynecology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.,c Center for Gynecologic Oncology Amsterdam , Amsterdam , The Netherlands
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Sarrel PM, Sullivan SD, Nelson LM. Hormone replacement therapy in young women with surgical primary ovarian insufficiency. Fertil Steril 2016; 106:1580-1587. [PMID: 27793381 PMCID: PMC5248494 DOI: 10.1016/j.fertnstert.2016.09.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 08/26/2016] [Accepted: 09/09/2016] [Indexed: 12/24/2022]
Abstract
Bilateral oophorectomy performed in women before they are menopausal induces surgical primary ovarian insufficiency, an acute and chronic deficiency of the hormones normally produced by the ovaries. Without hormone replacement therapy (HRT) most of these women develop severe symptoms of estrogen (E) deficiency and are at increased risk for osteoporosis, cardiovascular disease, cognitive decline, dementia, and the associated increases in morbidity and mortality. In cases in which a hysterectomy has been performed at the time of bilateral oophorectomy transdermal or transvaginal E2 replacement therapy without cyclic progestin replacement is the optimum hormonal management for these women. There is substantial evidence this approach even reduces the risk for breast cancer. Unfortunately, unwarranted fear of all menopausal HRTs has become widespread following the reports of the Women's Health Initiative studies. This fear has led to a steep decline in use of E therapy, even in women in whom HRT is clearly indicated. Discussion of possible ovarian conservation in women who are premenopausal is an integral part of the preoperative planning for any women undergoing hysterectomy. Timely and effective HRT for women who will experience surgical primary ovarian insufficiency is clearly indicated.
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Affiliation(s)
- Philip M Sarrel
- Departments of Obstetrics, Gynecology and Reproductive Sciences and PsychiatryYale University, New Haven, Connecticut
| | | | - Lawrence M Nelson
- CAPT US Public Health Service, Intramural Research Program, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
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Abstract
The term premature ovarian insufficiency (POI) describes a continuum of declining ovarian function in a young woman, resulting in an earlier than average menopause. It is a term that reflects the variable nature of the condition and is substantially less emotive than the formerly used “premature ovarian failure” which signaled a single event in time. Contrary to the decline in the age of menarche seen over the last 3-4 decades there has been no similar change in the age of menopause. In developed nations, the average age for cessation of menstrual cycles is 50-52 years. The age is younger among women from developing nations. Much has been written about POI despite a lack of good data on the incidence of this condition. It is believed that 1% of women under the age of 40 years and 0.1% under the age of 30 years will develop POI. Research is increasingly providing information about the pathogenesis and treatments are being developed to better preserve ovarian function during cancer treatment and to improve fertility options. This narrative review summarizes the current literature to provide an approach to best practice management of POI.
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Affiliation(s)
- Anna J Fenton
- Women's Health Division, Christchurch Women's Hospital, Christchurch, New Zealand
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Impact of estrogens on atherosclerosis and bone in the apolipoprotein E-deficient mouse model. Menopause 2016; 22:428-36. [PMID: 25203894 DOI: 10.1097/gme.0000000000000328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The common inflammatory pathophysiology has nourished the hypothesis of a relationship between osteoporosis and cardiovascular disease. Estrogens are key agents in the modulation of both processes. We investigated whether induction of atherosclerosis affects bone and whether estrogens modulate both processes. METHODS Female apolipoprotein E-deficient mice (a well-established model of atherogenesis) were ovariectomized or falsely operated and fed either standard diet or high-fat diet (HFD). Six animals were included in each of the four groups. To clarify mechanisms, we treated preosteoblastic MC3T3-E1 cells with mouse serum. RESULTS Physiological levels of estrogens in falsely operated mice limited atherosclerotic burden in the thoracic aorta, but not in the aortic arch. Bone resorption, as assessed by C-telopeptides, was increased by ovariectomy in animals fed standard diet, but not in animals fed HFD. Bone microstructural properties at the distal femur showed deteriorated trabecular architecture in bone volumetric fraction and trabecular number after ovariectomy, but trabecular pattern factor, trabecular thickness, trabecular spacing, or the structural model index remained unchanged. Changes in cortical parameters were not significant. Volumetric bone mineral density was reduced in trabecular bone, but not in cortical bone, in ovariectomized mice fed standard diet. Preosteoblastic MC3T3-E1 cells exhibited increased cellular proliferation and viability and alkaline phosphatase activity after treatment with sera from animals fed HFD. CONCLUSIONS Endogenous estrogens partially reduce atherogenic burden in female apolipoprotein E-deficient mice. Ovariectomy increases bone resorption, but not under exacerbated proatherogenic conditions induced by HFD. The absence of apolipoprotein E might have an influence on the asymmetric responses of atherogenesis and bone resorption.
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Faubion SS, Files JA, Rocca WA. Elective Oophorectomy: Primum Non Nocere. J Womens Health (Larchmt) 2016; 25:200-2. [PMID: 26741200 DOI: 10.1089/jwh.2015.5656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stephanie S Faubion
- 1 Division of General Internal Medicine, Mayo Clinic Rochester , Women's Health Clinic, Rochester, Minnesota
| | - Julia A Files
- 2 Division of Women's Health Internal Medicine, Mayo Clinic in Arizona , Scottsdale, Arizona
| | - Walter A Rocca
- 3 Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic Rochester , Rochester, Minnesota.,4 Department of Neurology, Mayo Clinic Rochester , Rochester, Minnesota
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Abstract
In addition to the common symptoms that occur after natural menopause, special considerations apply to women who have had their ovaries removed, particularly when oophorectomy occurs before age 45 years. Women with premenopausal oophorectomy have more severe and prolonged menopausal symptoms. Their risks of adverse mood, heart disease, excessive bone resorption, sexual dysfunction, and cognitive disorders are increased compared with the general population. Retention of the ovaries carries a survival benefit for women at low risk of ovarian malignancy. Women facing oophorectomy should understand the balance of risks and benefits in order to make an informed decision.
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Affiliation(s)
- Maria Rodriguez
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 2622 South Tower, Los Angeles, CA 90048, USA
| | - Donna Shoupe
- Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA.
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Osteoporosis risk and management in BRCA1 and BRCA2 carriers who undergo risk-reducing salpingo-oophorectomy. Gynecol Oncol 2015; 138:723-6. [PMID: 26086567 DOI: 10.1016/j.ygyno.2015.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/12/2015] [Accepted: 06/14/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Characterize current management of osteoporosis risk in BRCA carriers following risk-reducing salpingo-oophorectomy (RRSO). METHODS Women with a BRCA1 or BRCA2 mutation who underwent RRSO were identified from a community-based health system in Northern California from 1995 to 2012. Retrospective chart review using the electronic medical record was performed. The primary outcome was the number of women who had a dual-energy X-ray absorptiometry scan post-RRSO. Secondary outcomes included new diagnoses of osteopenia, osteoporosis, and fracture. Information on the following risk factors was also recorded: calcium and vitamin D use, history of breast cancer, chemotherapy, use of aromatase inhibitors, and use of hormone replacement therapy. RESULTS Two hundred and twenty five women tested positive for a BRCA1 or BRCA2 mutation and underwent RRSO. Median follow-up was 41 months from testing. Ninety-nine (44.0%) had at least one DXA scan following testing. The median time from RRSO to a diagnosis of bone disease was 29 months (range 1-170). Seventy-two percent had only one DXA scan (range 1-7) following testing. Thirty-two percent had normal results, 55.6% had osteopenia and 12.1% had osteoporosis. Four percent of women had an atraumatic fracture after surgery. Age, breast cancer history, prior chemotherapy, and tamoxifen or aromatase inhibitor (AI) use were not associated with having osteoporosis or osteopenia. CONCLUSIONS Women with BRCA mutations who undergo RRSO have many risk factors for bone loss. The majority of these women are not being screened for bone loss. A clear guideline for screening needs to be established to improve detection of post-RRSO bone disease.
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Faubion SS, Kuhle CL, Shuster LT, Rocca WA. Long-term health consequences of premature or early menopause and considerations for management. Climacteric 2015; 18:483-91. [PMID: 25845383 PMCID: PMC4581591 DOI: 10.3109/13697137.2015.1020484] [Citation(s) in RCA: 300] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM To review the current evidence concerning the long-term harmful effects of premature or early menopause, and to discuss some of the clinical implications. MATERIAL AND METHODS Narrative review of the literature. RESULTS Women undergoing premature or early menopause, either following bilateral salpingo-oophorectomy or because of primary ovarian insufficiency, experience the early loss of estrogen and other ovarian hormones. The long-term consequences of premature or early menopause include adverse effects on cognition, mood, cardiovascular, bone, and sexual health, as well as an increased risk of early mortality. The use of hormone therapy has been shown to lessen some, although not all of these risks. Therefore, multiple medical societies recommend providing hormone therapy at least until the natural age of menopause. It is important to individualize hormone therapy for women with early estrogen deficiency, and higher dosages may be needed to approximate physiological concentrations found in premenopausal women. It is also important to address the psychological impact of early menopause and to review the options for fertility and the potential need for contraception, if the ovaries are intact. CONCLUSIONS Women who undergo premature or early menopause should receive individualized hormone therapy and counseling.
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Affiliation(s)
- Stephanie S. Faubion
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, 200 First Street, Rochester, MN, USA 55905
| | - Carol L. Kuhle
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, 200 First Street, Rochester, MN, USA 55905
| | - Lynne T. Shuster
- Women’s Health Clinic, Division of General Internal Medicine, Mayo Clinic, 200 First Street, Rochester, MN, USA 55905
| | - Walter A. Rocca
- Division of Epidemiology, Department of Health Sciences Research, and Department of Neurology, Mayo Clinic, 200 First Street, Rochester, MN, USA 55905
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Bone Density and Fractures in HIV-infected Postmenopausal Women: A Systematic Review. J Assoc Nurses AIDS Care 2015; 26:387-98. [PMID: 26066693 DOI: 10.1016/j.jana.2015.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/31/2015] [Indexed: 01/28/2023]
Abstract
With the development of effective antiretroviral therapy, HIV-infected women are living longer and transitioning through menopause. The purpose of our study was to systematically examine the evidence that menopause is an additional risk predictor for osteoporosis and fractures in HIV-infected women. Electronic databases were searched for studies of low bone density or fractures in HIV-infected postmenopausal women. Studies that met the inclusion criteria (n = 10) were appraised using a validated quality assessment tool. The majority of studies were rated as good quality and the remaining were fair. The prevalence of osteoporosis reported in these studies ranged from 7.3% to 84% and 0.7% to 23% in HIV-infected and uninfected postmenopausal women, respectively. In the two qualifying studies, postmenopausal status was not a predictor of fractures in HIV-infected women. Findings suggest that HIV care providers should accurately assess postmenopausal status and modifiable risk factors for osteoporosis in all older HIV-infected women.
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How do Japanese gynecologists view hormone replacement therapy for survivors of endometrial cancer? Japanese Gynecologic Oncology Group (JGOG) survey. Int J Clin Oncol 2015; 20:997-1004. [PMID: 25744579 DOI: 10.1007/s10147-015-0808-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This survey sought to determine Japanese gynecologists' attitudes concerning administering hormone replacement therapy (HRT) for patients after surgery for endometrial cancer (EC). METHODS Eight hundred and eighty-eight members of the Japanese Gynecologic Oncology Group (JGOG) were asked to respond to an anonymous questionnaire on the JGOG website. The survey asked whether or not HRT was to be administered when surgery was performed (including a hysterectomy and bilateral oophorectomy) to treat EC before or after menopause. If HRT was not to be administered, respondents were asked the reason why. Respondents were presented with the same hypothetical patients that were featured in a previous survey in Germany, and differences in the mindsets of Japanese and German physicians were compared. RESULTS Responses from 363 individuals (response rate 40.9 %) were analyzed. Seventy-eight percent of physicians considered HRT for patients undergoing surgery before menopause. The most prevalent reason of refusal to prescribe HRT was the risk of EC recurrence. Forty-eight percent of physicians considered HRT for patients undergoing surgery after menopause. The most prevalent reasons of refusal of HRT were its limited benefit and the availability of alternative therapies. Sixty-five percent of Japanese physicians responded that they would administer HRT to patients with low risk of recurrence vs. 46 % of physicians in Germany (P < 0.0002). Forty-nine percent of Japanese physicians approved of prescribing HRT for patients with high risk of recurrence vs. 25 % of physicians in Germany (P < 0.0001). CONCLUSION Many Japanese gynecologists have a favorable attitude toward prescribing HRT after treatment of EC.
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Efficacy of Raloxifene Hydrochloride for the Prevention of Health Care Problems in Patients Who Undergo Surgery for Endometrial Cancer: A Multicenter Randomized Clinical Trial. Int J Gynecol Cancer 2015; 25:288-95. [DOI: 10.1097/igc.0000000000000333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveRemoval of the ovaries is common during surgery for endometrial cancer. However, because loss of the ovaries can cause several health problems in patients, strategies for the prevention of such problems need to be established. Hence, we decided to conduct a multicenter randomized clinical trial to assess the effect of raloxifene on bone mineral density (BMD), bone metabolism, and the lipid profile of patients who had undergone surgery for patients with endometrial cancer.Materials and MethodsPatients with endometrial cancer were enrolled after treatment. The participants were randomized into 2 groups: group 1 included 39 women who received alfacalcidol (1 μg/d) alone and group 2 included 37 women who received alfacalcidol and the test drug, raloxifene hydrochloride, at a dose of 60 mg/d. The BMD of lumbar spine and femoral neck, serum bone markers, as well as lipid profile parameters were evaluated at enrollment as well as 6, 12, and 24 months after the enrollment. The primary efficacy end point was the percentage change from baseline to 24 months in lumbar spine (L2-L4) and femoral neck BMD.ResultsSixty-four women completed the 24-month study. At 24 months, the lumbar and femoral neck BMDs were significantly increased in group 2 compared with group 1 (3.5% vs −0.8% and 2.3% vs −2.8%, respectively). In group 2, low-density lipoprotein-cholesterol levels were significantly reduced by 13.6% and serum N-terminal telopeptide of type I collagen as well as bone-specific alkaline phosphatase values were significantly reduced by 16.7% and 25.7%, respectively. The patients who received adjuvant therapy for endometrial cancer showed a significantly higher response to raloxifene (5.8% vs 1.9%). Recurrence was detected in 2 (2.6%) patients in group 1. No severe adverse events were noted in any patient during the study period.ConclusionsRaloxifene exerts positive effects on BMD, bone metabolism, and lipid profile parameters and could provide an improved therapeutic option for patients with endometrial cancer.
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Hussain Y, Ding Q, Connelly PW, Brunt JH, Ban MR, McIntyre AD, Huff MW, Gros R, Hegele RA, Feldman RD. G-protein estrogen receptor as a regulator of low-density lipoprotein cholesterol metabolism: cellular and population genetic studies. Arterioscler Thromb Vasc Biol 2014; 35:213-21. [PMID: 25395619 DOI: 10.1161/atvbaha.114.304326] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Estrogen deficiency is linked with increased low-density lipoprotein (LDL) cholesterol. The hormone receptor mediating this effect is unknown. G-protein estrogen receptor (GPER) is a recently recognized G-protein-coupled receptor that is activated by estrogens. We recently identified a common hypofunctional missense variant of GPER, namely P16L. However, the role of GPER in LDL metabolism is unknown. Therefore, we examined the association of the P16L genotype with plasma LDL cholesterol level. Furthermore, we studied the role of GPER in regulating expression of the LDL receptor and proprotein convertase subtilisin kexin type 9. APPROACH AND RESULTS Our discovery cohort was a genetically isolated population of Northern European descent, and our validation cohort consisted of normal, healthy women aged 18 to 56 years from London, Ontario. In addition, we examined the effect of GPER on the regulation of proprotein convertase subtilisin kexin type 9 and LDL receptor expression by the treatment with the GPER agonist, G1. In the discovery cohort, GPER P16L genotype was associated with a significant increase in LDL cholesterol (mean±SEM): 3.18±0.05, 3.25±0.08, and 4.25±0.33 mmol/L, respectively, in subjects with CC (homozygous for P16), CT (heterozygotes), and TT (homozygous for L16) genotypes (P<0.05). In the validation cohort (n=339), the GPER P16L genotype was associated with a similar increase in LDL cholesterol: 2.17±0.05, 2.34±0.06, and 2.42±0.16 mmol/L, respectively, in subjects with CC, CT, and TT genotypes (P<0.05). In the human hepatic carcinoma cell line, the GPER agonist, G1, mediated a concentration-dependent increase in LDL receptor expression, blocked by either pretreatment with the GPER antagonist G15 or by shRNA-mediated GPER downregulation. G1 also mediated a GPER- and concentration-dependent decrease in proprotein convertase subtilisin kexin type 9 expression. CONCLUSIONS GPER activation upregulates LDL receptor expression, probably at least, in part, via proprotein convertase subtilisin kexin type 9 downregulation. Furthermore, humans carrying the hypofunctional P16L genetic variant of GPER have increased plasma LDL cholesterol. In aggregate, these data suggest an important role of GPER in the regulation of LDL receptor expression and consequently LDL metabolism.
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Affiliation(s)
- Yasin Hussain
- From the Robarts Research Institute (Y.H., Q.D., M.R.B., A.D.M., M.W.H., R.G., R.A.H., R.D.F.) and Departments of Medicine (M.W.H., R.G., R.A.H., R.D.F.), Physiology and Pharmacology (R.G., R.A.H., R.D.F.), and Biochemistry (M.W.H.), Western University, London, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada (P.W.C.); and Department of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada (J.H.B.)
| | - Qingming Ding
- From the Robarts Research Institute (Y.H., Q.D., M.R.B., A.D.M., M.W.H., R.G., R.A.H., R.D.F.) and Departments of Medicine (M.W.H., R.G., R.A.H., R.D.F.), Physiology and Pharmacology (R.G., R.A.H., R.D.F.), and Biochemistry (M.W.H.), Western University, London, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada (P.W.C.); and Department of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada (J.H.B.)
| | - Philip W Connelly
- From the Robarts Research Institute (Y.H., Q.D., M.R.B., A.D.M., M.W.H., R.G., R.A.H., R.D.F.) and Departments of Medicine (M.W.H., R.G., R.A.H., R.D.F.), Physiology and Pharmacology (R.G., R.A.H., R.D.F.), and Biochemistry (M.W.H.), Western University, London, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada (P.W.C.); and Department of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada (J.H.B.)
| | - J Howard Brunt
- From the Robarts Research Institute (Y.H., Q.D., M.R.B., A.D.M., M.W.H., R.G., R.A.H., R.D.F.) and Departments of Medicine (M.W.H., R.G., R.A.H., R.D.F.), Physiology and Pharmacology (R.G., R.A.H., R.D.F.), and Biochemistry (M.W.H.), Western University, London, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada (P.W.C.); and Department of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada (J.H.B.)
| | - Matthew R Ban
- From the Robarts Research Institute (Y.H., Q.D., M.R.B., A.D.M., M.W.H., R.G., R.A.H., R.D.F.) and Departments of Medicine (M.W.H., R.G., R.A.H., R.D.F.), Physiology and Pharmacology (R.G., R.A.H., R.D.F.), and Biochemistry (M.W.H.), Western University, London, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada (P.W.C.); and Department of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada (J.H.B.)
| | - Adam D McIntyre
- From the Robarts Research Institute (Y.H., Q.D., M.R.B., A.D.M., M.W.H., R.G., R.A.H., R.D.F.) and Departments of Medicine (M.W.H., R.G., R.A.H., R.D.F.), Physiology and Pharmacology (R.G., R.A.H., R.D.F.), and Biochemistry (M.W.H.), Western University, London, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada (P.W.C.); and Department of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada (J.H.B.)
| | - Murray W Huff
- From the Robarts Research Institute (Y.H., Q.D., M.R.B., A.D.M., M.W.H., R.G., R.A.H., R.D.F.) and Departments of Medicine (M.W.H., R.G., R.A.H., R.D.F.), Physiology and Pharmacology (R.G., R.A.H., R.D.F.), and Biochemistry (M.W.H.), Western University, London, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada (P.W.C.); and Department of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada (J.H.B.)
| | - Robert Gros
- From the Robarts Research Institute (Y.H., Q.D., M.R.B., A.D.M., M.W.H., R.G., R.A.H., R.D.F.) and Departments of Medicine (M.W.H., R.G., R.A.H., R.D.F.), Physiology and Pharmacology (R.G., R.A.H., R.D.F.), and Biochemistry (M.W.H.), Western University, London, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada (P.W.C.); and Department of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada (J.H.B.)
| | - Robert A Hegele
- From the Robarts Research Institute (Y.H., Q.D., M.R.B., A.D.M., M.W.H., R.G., R.A.H., R.D.F.) and Departments of Medicine (M.W.H., R.G., R.A.H., R.D.F.), Physiology and Pharmacology (R.G., R.A.H., R.D.F.), and Biochemistry (M.W.H.), Western University, London, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada (P.W.C.); and Department of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada (J.H.B.)
| | - Ross D Feldman
- From the Robarts Research Institute (Y.H., Q.D., M.R.B., A.D.M., M.W.H., R.G., R.A.H., R.D.F.) and Departments of Medicine (M.W.H., R.G., R.A.H., R.D.F.), Physiology and Pharmacology (R.G., R.A.H., R.D.F.), and Biochemistry (M.W.H.), Western University, London, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada (P.W.C.); and Department of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada (J.H.B.).
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Matsumura S, Ohta T, Takahashi T, Yamazaki T, Takahashi K, Kurachi H. Non-sex cord-stromal ovarian tumors frequently produce and secrete estrogen in postmenopausal women: impact on bone metabolism and abnormal endometrial histology. J Clin Endocrinol Metab 2013; 98:2775-82. [PMID: 23780377 DOI: 10.1210/jc.2013-1267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We investigated whether the estrogen released from non-sex cord-stromal ovarian tumors has biological effects on bone and endometrial tissue in postmenopausal women. MATERIALS AND METHODS A total of 132 patients with malignant (n = 112) or benign (n = 20) gynecological disease with normal postmenopausal ovaries were recruited as a control group (group C). The 75 patients with ovarian tumors were divided into 2 groups: group L (serum estradiol [E2] level of < 20 pg/ml; n = 42) and group H (serum E2 level of > 20 pg/ml; n = 33). The subjects' serum E2 levels, bone mineral density, urinary levels of the N-telopeptide of type I collagen, and serum levels of bone-specific alkaline phosphatase were measured before and after surgery. Histological examinations of the endometrium were carried out in the 75 patients with non-sex cord-stromal ovarian tumors. RESULTS High serum E2 levels were detected in 33 (44%) of 75 patients with ovarian tumors. The serum E2 levels of group H were significantly decreased after surgery. In the other subjects, there were no significant differences between the serum E2 levels observed before and after surgery. The mean preoperative N-telopeptide of type I collagen and bone-specific alkaline phosphatase levels of group H were significantly lower than those of group C. The bone mineral density values of groups L and H were significantly decreased after surgery. Five (6.7%) of 75 patients with non-sex cord-stromal ovarian tumors displayed abnormal endometrial histology, including 4 patients with grade 1 endometrioid cancer. CONCLUSIONS The E2 released from ovarian tumors might have biological effects on bone metabolism and the incidence of abnormal endometrial histology.
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Affiliation(s)
- Sohei Matsumura
- Department of Obstetrics and Gynecology, Yamagata University, Faculty of Medicine, Yamagata 990-9585, Japan
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Nishio K, Tanabe A, Maruoka R, Nakamura K, Takai M, Sekijima T, Tunetoh S, Terai Y, Ohmichi M. Bone mineral loss induced by anticancer treatment for gynecological malignancies in premenopausal women. Endocr Connect 2013; 2:11-7. [PMID: 23781313 PMCID: PMC3680962 DOI: 10.1530/ec-12-0043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 10/11/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although surgical menopause may increase the risks of osteoporosis, few studies have investigated the influence of chemotherapy and radiation therapy. The aim of this study is to evaluate the effects of treatments for gynecological malignancies on bone mineral density (BMD). METHODS This study enrolled 35 premenopausal women (15 ovarian cancers (OCs), 9 endometrial cancers (ECs), and 11 cervical cancers (CCs)) who underwent surgical treatment that included bilateral oophorectomy with or without adjuvant platinum-based chemotherapy in OC and EC patients, or concurrent chemo-radiation therapy (CCRT) in CC patients according to the established protocols at the Osaka Medical College Hospital between 2006 and 2008. The BMD of the lumbar spine (L1-L4) was measured by dual-energy X-ray absorptiometry, and urine cross-linked telopeptides of type I collagen (NTx) and bone alkaline phosphatase (BAP) were assessed for evaluation of bone resorption and bone formation respectively. These assessments were performed at baseline and 12 months after treatment. RESULTS Although the serum BAP was significantly increased only in the CC group, a rapid increase in the bone resorption marker urinary NTx was observed in all groups. The BMD, 12 months after CCRT was significantly decreased in the CC group at 91.9±5.9% (P<0.05 in comparison to the baseline). CONCLUSION This research suggests that anticancer therapies for premenopausal women with gynecological malignancies increase bone resorption and may reduce BMD, particularly in CC patients who have received CCRT. Therefore, gynecologic cancer survivors should be educated about these potential risks and complications.
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Affiliation(s)
| | - Akiko Tanabe
- Correspondence should be addressed to A Tanabe Email
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Burra P, De Martin E, Gitto S, Villa E. Influence of age and gender before and after liver transplantation. Liver Transpl 2013; 19:122-34. [PMID: 23172830 DOI: 10.1002/lt.23574] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 11/08/2012] [Indexed: 12/15/2022]
Abstract
Women constitute a particular group among patients with chronic liver disease and in the post-liver transplantation (LT) setting: they are set apart not only by traditional differences with respect to men (ie, body mass index, different etiologies of liver disease, and accessibility to transplantation) but also in increasingly evident ways related to hormonal changes that characterize first the fertile age and subsequently the postmenopausal period (eg, disease course variability and responses to therapy). The aim of this review is, therefore, to evaluate the role of the interplay of factors such as age, gender, and hormones in influencing the natural history of chronic liver disease before and after LT and their importance in determining outcomes after LT. As the population requiring LT ages and the mean age at transplantation increases, older females are being considered for transplantation. Older patients are at greater risk for nonalcoholic steatohepatitis, osteoporosis, and a worse response to antiviral therapy. Female gender per se is associated with a greater risk for osteoporosis because of metabolic changes after menopause, the bodily structure of females, and, in the population of patients with chronic liver disease, the greater prevalence of cholestatic and autoimmune liver diseases. With menopause, the fall of protective estrogen levels can lead to increased fibrosis progression, and this represents a negative turning point for women with chronic liver disease and especially for patients with hepatitis C. Therefore, the notion of gender as a binary female/male factor is now giving way to the awareness of more complex disease processes within the female gender that follow hormonal, social, and age patterns and need to be addressed directly and specifically.
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Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy.
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Finch A, Evans G, Narod SA. BRCA carriers, prophylactic salpingo-oophorectomy and menopause: clinical management considerations and recommendations. ACTA ACUST UNITED AC 2012; 8:543-55. [PMID: 22934728 DOI: 10.2217/whe.12.41] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Women who inherit a mutation in either the BRCA1 or BRCA2 gene have greatly elevated lifetime risks of ovarian cancer, fallopian tube cancer and breast cancer. Preventive surgical removal of the ovaries and fallopian tubes (salpingo-oophorectomy) is recommended to these women, often prior to natural menopause, to prevent cancer. The ensuing hormone deprivation may impact on health and quality of life. Most of these women experience menopausal symptoms shortly after surgery; however, there may also be longer term consequences that are less well understood. In this review, we highlight recent studies that examine the implications of salpingo-oophorectomy on health and quality of life in BRCA-positive women and we discuss the care of women following prophylactic surgery.
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Affiliation(s)
- Amy Finch
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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Britto R, Araújo L, Barbosa I, Silva L. Improvement of the lipid profile in post menopausal women who use estradiol and testosterone implants. Gynecol Endocrinol 2012; 28:767-9. [PMID: 22397585 DOI: 10.3109/09513590.2012.664191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study evaluating the lipid profile in women in post menopause using the hormone therapy (HT) with implants of estradiol and testosterone. METHOD One year prospective cohort with 122 patients separated in group 1, not using HT, group 2 starting the use of HT, and group 3 with prior use of implants of estradiol and testosterone. All patients performed serum dosages of total cholesterol, HDL and triglycerides, in the beginning of the study and after 1 year. DISCUSSION The use of E and T implants showed some statistically significant decrease in TC at the beginning of the HT and some decrease in LDL in the group using HT. In the group without HT there was no difference in lipid profile.
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Affiliation(s)
- Renata Britto
- Department of Gynecology, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.
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