Selección de Resúmenes de Menopausia
Semana del 1 a 7 de junio 2022
María Soledad Vallejo. Clínica Quilín. Universidad de Chile
JBJS Rev. 2022 Jun 3;10(6). doi: 10.2106/JBJS.RVW.22.00013. eCollection 2022 Jun 1.
What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?: A Systematic Review
Robinson E Pires, Igor G N Reis, Gustavo S Waldolato, Diego D Pires, Fernando Bidolegui, Vincenzo Giordano
COVID-19 is a disease that is challenging science, health-care systems, and humanity. An astonishingly wide spectrum of manifestations of multi-organ damage, including musculoskeletal, can be associated with SARS-CoV-2. In the acute phase of COVID-19, fatigue, myalgia, and arthralgia are the most common musculoskeletal symptoms. Post-COVID-19 syndrome is a group of signs and symptoms that are present for >12 weeks. The associated musculoskeletal manifestations are fatigue, arthralgia, myalgia, new-onset back pain, muscle weakness, and poor physical performance. Data on COVID-19 complications are growing due to large absolute numbers of cases and survivors in these 2 years of the pandemic. Additional musculoskeletal manifestations encountered are falls by the elderly, increased mortality after hip fracture, reduced bone mineral density and osteoporosis, acute sarcopenia, rhabdomyolysis, Guillain-Barré syndrome, muscle denervation atrophy, fibromyalgia, rheumatological disease triggering, septic arthritis, adhesive capsulitis, myositis, critical illness myopathy, onset of latent muscular dystrophy, osteonecrosis, soft-tissue abscess, urticarial vasculitis with musculoskeletal manifestations, and necrotizing autoimmune myositis. A wide range of signs and symptoms involving the musculoskeletal system that affect quality of life and can result in a decrease in disability-adjusted life years. This powerful and unpredictable disease highlights the importance of multimodality imaging, continuing education, and multidisciplinary team care to support preventive measures, diagnosis, and treatment.
Pain Physician. 2022 May;25(3):E457-E468.
Association Between Abdominal Obesity and Subsequent Vertebral Fracture Risk
Hao-Wei Xu 1, Hao Chen, Shu-Bao Zhang, Yu-Yang Yi, Xin-Yue Fang, Tao Hu, Xiao-Yong Ge, Shan-Jin Wang 3
Background: Obesity had been previously considered to be a protective factor against osteoporosis or fractures; however, recent research indicates that obesity, especially abdominal obesity, may increase the risk of some types of fractures. Objective: We explored the effects of abdominal obesity on subsequent vertebral fracture (SVF) after percutaneous vertebral augmentation (PVA). Study design: A prospective observational cohort study.Setting: Department of Spinal Surgery of a hospital affiliated with a medical university. Methods: A total of 390 women and 237 men aged > 50 years suffering from osteoporotic vertebral fracture (OVF) were included. Weight, height, bone mineral density (BMD), abdominal circumference, and other basic information were measured at baseline and 1-year follow-up visit. Results: During follow-up, 80 (33.7%) men and 143 (36.7%) women incurred SVF. Greater waist circumference (WC) and waist-to-hip ratio (WHR) increased the risk of SVF in men (WC: HR 1.83, P = 0.016; WHR: HR 1.63, P = 0.045) and women (WC: HR 2.75, P = 0.001; WHR: HR 2.63, P = 0.001) after adjustment for BMD and other potential confounders. Compared with normal BMI, being overweight was associated with lower SVF risk (women: HR 0.55, P = 0.044; men: HR 0.46, P = 0.046), and obesity was associated with greater SVF risk (women: HR 4.53, P < 0.001; men: HR 3.77, P < 0.001) in both genders. We observed a nonlinear relationship between BMI and SVF with a U-shaped curve; after adjusting BMD, this became a reverse J-curve. Limitations: There was no further statistical analysis of the relationship between abdominal obesity and other fracture sites. Asymptomatic SVF may underestimate the impact of abdominal obesity on the occurrence of SVF. Conclusions: Abdominal obesity was significantly associated with a higher risk of SVF after PVA. Management of body type after PVA may be an effective prevention strategy against SVF.
J Obstet Gynaecol. 2022 Jun 1;1-6. doi: 10.1080/01443615.2022.2062224. Online ahead of print.
Relationship between menopausal symptoms and sleep quality in women during the climacteric period: a cross-sectional study
Ferdane Koçoğlu 1, Semra Kocaöz 2, Pınar Kara 1, Özlem Aşcı 3
The aim of this study was to evaluate the relationship between the menopausal symptoms and sleep quality in women in the climacteric period. This cross-sectional study was conducted on 383 women aged 40-64 years at the Cancer Early Diagnosis Screening and Training Centre. The data were collected with the questionnaire form, Menopause Rating Scale (MRS) and the Pittsburgh Sleep Quality Index (PSQI). The sleep quality was poor in 77.8% of the women in the study. A significant relationship was found between PSQI scores and the somatic and psychological subscale scores of the MRS in the presence of other variables that could affect sleep according to multiple linear regression analysis (p < .05). We recommend training and consulting services provided by health care professionals and further experimental studies on the subject to decrease the negative effects of the somatic and psychological symptoms found to worsen sleep quality in women in the climacteric period. IMPACT STATEMENTWhat is already known on this subject? Sleep problems are a common health problem in women in the climacteric period. What do the results of this study add? The most common menopausal symptoms were joint and muscle problems, physical and emotional fatigue, nervousness, hot flushes, unhappiness, anxiety, and sleep problems in order of frequency. There was a weak positive significant relationship between the total PSQI score and the psychological and urogenital subscale scores of the MRS, in addition to a moderate positive significant relationship between the total PSQI scores and the total and somatic subscale scores of the MRS.What are the implications of these findings for clinical practice and/or further research? We believe effective management of the somatic and psychological symptoms during the climacteric period with health care staff providing training and consultancy services to the women aimed at decreasing the symptoms according to evidence-based procedures could help improve the sleep quality. Conducting multicenter studies with a larger subject group where the effect of menopausal symptoms on sleep quality in addition to that of multifactorial causes are evaluated in depth is recommended.
J Bone Miner Res. 2022 May 29. doi: 10.1002/jbmr.4613. Online ahead of print.
Cumulative Endogenous Estrogen Exposure is Associated with Postmenopausal Fracture Risk: The Women's Health Initiative Study
Erin S LeBlanc 1, Kathleen M Hovey 2, Jane A Cauley 3, Marcia Stefanick 4, Rachel Peragallo 5, et al.
We aimed to evaluate the relationship between cumulative endogenous estrogen exposure and fracture risk in 150,682 postmenopausal women (aged 50-79 years at baseline) who participated in the Women's Health Initiative. We hypothesized that characteristics indicating lower cumulative endogenous estrogen exposure would be associated with increased fracture risk. We determined ages at menarche and menopause as well as history of irregular menses from baseline questionnaires, and calculated years of endogenous estrogen exposure from ages at menarche and menopause. Incident clinical fractures were self-reported over an average 16.7 years of follow-up. We used multivariable proportional hazards models to assess the associations between the estrogen-related variables and incidence of any clinical fracture. In fully adjusted models, those with the fewest years of endogenous estrogen exposure (<30) had an 11% higher risk of developing central body fractures and a 9% higher risk of lower extremity fractures than women with 36-40 years of endogenous estrogen exposure (the reference category). In contrast, women with the most years of endogenous estrogen exposure (more than 45 years) had a 9% lower risk of lower extremity fractures than the reference category. Women with irregular (not monthly) menstrual cycles were 7% to 8% more likely to experience lower extremity fractures than women with regular monthly cycles. Our findings support the hypothesis that characteristics signifying lower cumulative endogenous estrogen exposure are associated with higher fracture risk.
J Pediatr Adolesc Gynecol. 2022 May 26;S1083-3188(22)00220-0. doi: 10.1016/j.jpag.2022.05.004.
Effects of hormone replacement therapy on low bone mineral density in adolescents and young women with hypogonadism: comparison of oral and transdermal 17 beta-estradiol administration
Ozlem Dural 1, Hevra Ekin Ulusoy 2, Muge Ates Tikiz 2, Turkane Gurbanova 3, Cenk Yasa 2, et al.
Study objective: To evaluate the effects of physiological dose 17 beta-estradiol (E2) replacement on low bone mineral density (BMD) and compare the results of oral and transdermal (TD) E2 administration in adolescents and young women with hypogonadism. Design, setting, and participants: We retrospectively reviewed the medical records of patients aged 15 to 24 years who were diagnosed with hypogonadism, started on oral or TD E2 replacement and whose initial dual-energy X-ray absorptiometry (DEXA) scan detected a lumbar spine BMD Z-score of -1 or lower, between 2014 and 2018. The patients were divided into 2 groups according to the E2 route of administration as those who received 2 mg oral (Group 1) and 0.1 mg TD (Group 2). Interventions: None MAIN OUTCOME MEASURE: : BMD scans of the patients at baseline and repeated within 2 years after E2 replacement RESULTS: : In total, 43 patients, who met the inclusion and exclusion criteria, were included in the study. Two groups did not differ for BMD scores at baseline. A significant improvement in BMD was observed with physiological dose E2 replacement in both groups. Mean BMD Z-score increased by +0.7 [95%CI: 0.47 to 0.93] in response to TD E2 administration, compared with +0.41 [95%CI: 0.25 to 0.58] during oral E2 replacement (p=0.037). Conclusion: We conclude that physiological dose E2 replacement, even within a short period of 2 years, has a significant beneficial effect on the bone mass acquisition on the lumbar spine. Our study also demonstrates the possible superiority of TD E2 replacement over the oral route in increasing lumbar spine BMD.
Iran J Med Sci. 2022 May;47(3):173-193. doi: 10.30476/ijms.2020.87687.1817.
The Efficacy and Safety of Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors in the Treatment of Menopausal Hot Flashes: A Systematic Review of Clinical Trials
Marzieh Azizi 1 2, Soghra Khani 3, Mahsa Kamali 4, Forouzan Elyasi 5
Background: Hot flashes (HF) are a common symptom during the menopausal transition. It is therefore important to identify effective drugs that can alleviate HF. This study aimed to systematically review published clinical trials on the efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in the treatment of HF in healthy menopausal women. Methods: In this systematic review, articles published during 2003-2019 in PubMed, MEDLINE, Web of Science, Scopus, Science Direct, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, and Google Scholar as well as Iranian databases such as SID, and Magiran were searched. The quality of the selected articles was assessed using the Jadad score calculation. Results: Thirty-six articles on randomized controlled trials were included in this study, out of which 27 articles had acceptable, and nine had weak methodological quality. Findings on SSRIs class of drugs indicated that escitalopram, paroxetine, and fluoxetine have higher efficacy and safety in the treatment of menopausal HF than other drugs. Studies on the effectiveness of sertraline, citalopram, and fluvoxamine are limited in number or show inconsistent results. Therefore, further high-quality studies are required to confirm their effectiveness in alleviating HF. Within the SNRIs class, venlafaxine and desvenlafaxine showed significant efficacy in the treatment of menopausal HF. However, studies on the effectiveness of duloxetine are also limited, which requires further research. Conclusion: Most studies have indicated the efficacy and safety of some antidepressants, such as SSRIs and SNRIs, in decreasing the frequency and severity of HF. These drugs are therefore recommended for the treatment of menopausal HF.