RESUMO
OBJECTIVE: To compare the effectiveness in the control of climacteric symptoms, the tolerability and the uterine bleeding pattern between two types of hormone replacement therapy. MATERIAL AND METHODS: 81 postmenopausal women between 40 and 60 years age with vasomotor symptoms were studied. Randomly it was administered: I. Conjugated equine estrogens (CEE)-Medroxyprogesterone acetate (MPA): 21 tablets with 0.625 mg of CEE and 10 tablets with 5 mg of MPA which were taken with the last ten tablets of CEE in each cycle (n = 3 7). II. E2V-CPA: 11 tablets with 2 mg of E2V and 10 tablets with 2 mg of E2V and 1 mg of CPA (n = 44). Each cycle comprised 28 days. The treatments were compared with squared Chi and Mann-Whitney U test. RESULTS: The hot flushes presence was significantly greater in the group with CEE-MPA (p < 0.03). Severe throbs at the end of the study had a trend to be more frequent in the group with EC-MPA (p < 0.06). At the end of the study there was a greater frequency of breast tenderness in the group with CEE-MPA (P = 0.009). CONCLUSIONS: Both treatments have good effectiveness, tolerability and same bleeding pattern. Only the frequency of hot flushes, the presence of severe throbs and breast tenderness were lower in the group with E2V-CPA, that makes this preparation an option that can have a better acceptance by the women.
Assuntos
Climatério , Acetato de Ciproterona/uso terapêutico , Estradiol/análogos & derivados , Estradiol/uso terapêutico , Estrogênios Conjugados (USP)/uso terapêutico , Terapia de Reposição Hormonal , Acetato de Medroxiprogesterona/uso terapêutico , Congêneres da Progesterona/uso terapêutico , Adulto , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To determine de sensitivity and specificity of a questionnaire of osteoporosis risk factors. MATERIAL AND METHODS: In 1,088 files of postmenopausal women, osteoporosis risk factors such as age, time since menopause, former hormone replacement therapy (HRT) use, current use of HRT, former and current HRT use, fractures after 45 years age, actual weight, corticosteroid use and hyperthyroidism were analyzed, giving them different punctuation. Every punctuation was added in each patient. In all of them a dual emission X ray (DEXA) absorptiometry was done from lumbar column and hip (femoral neck, trochanter and Ward's triangle). Odds ratio, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for every one of the variables and DEXA T score as well as Spearman correlation coefficient. RESULTS: Odds ratio increased as the punctuation of the questionnaire increased. With four points in the questionnaire the PPV was 41%, the NPV 86%, the sensitivity 16% and the specificity 96%. A significant negative correlation was found between age, time since menopause, current use of HRT, former and current use of HRT and column and hip T scores, and with the punctuation for all the regions. A positive correlation was found between former fracture and column and femoral neck T scores, and with actual weight in all regions. CONCLUSIONS: This study showed that the questionnaire can be a useful instrument to identify patients at high risk of osteoporosis.
Assuntos
Osteoporose Pós-Menopausa/epidemiologia , Inquéritos e Questionários , Absorciometria de Fóton , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Colo do Fêmur/diagnóstico por imagem , Fraturas Ósseas/epidemiologia , Terapia de Reposição Hormonal , Humanos , Vértebras Lombares/diagnóstico por imagem , Pessoa de Meia-Idade , Razão de Chances , Osteoporose Pós-Menopausa/diagnóstico por imagem , Osteoporose Pós-Menopausa/prevenção & controle , Valor Preditivo dos Testes , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
The objective was to know the characteristics of presentation, its clinical aspects and the modification in the diagnostic tools in a selected population of Mexican women with spontaneous menopause. The age at menarche, age at menopause, marital status, age at marriage, number of pregnancies and occupation of 1,099 women with spontaneous menopause were studied. In 619 women which were not receiving nor had received hormone replacement therapy the clinical, laboratory such as glucose, lipids, hormones, bone remodeling biochemistry; and X ray studies such as densitometry and mammography were analyzed. The age average of menarche presentation was at 13 years, and that of spontaneous menopause at 48.1 years 78% were married, with an age at marriage of 23 years, 66% had home duties. The screening tests showed that 30% of patients required cardiovascular evaluation, 40% showed alterations on lipids levels and at least 40% had some alteration on bone remodeling biochemistry or in densitometry. The mammography was normal in 81%. This study showed that most of the data in these group of women were similar to those of other populations, and many of them need intensive surveillance and adequate therapeutic prescriptions to diminish risk factors.
Assuntos
Pós-Menopausa , Adolescente , Adulto , Fatores Etários , Análise de Variância , Densidade Óssea , Calcificação Fisiológica , Feminino , Humanos , Estado Civil , Menarca , Pessoa de Meia-Idade , Osteoporose/etiologia , Osteoporose/prevenção & controle , ParidadeRESUMO
The purpose of this trial is to demonstrate that a women with high body mass index (BMI > or = 28) has greater bone mineral density (BMD) from that with lower BMI. We studied 922 healthy women who met the inclusion criteria. They were classified into four groups according to their BMI (> or = 28 and < 28) and age (> or = 35 and < 35 years). Bone mineral measurement was performed by dual-energy X-ray absorptiometry (DEXA) in the hip and at the lumbar region. BMD in overweight women older than 35 years was significantly higher in comparison with that of women with lower BMI, both in the hip and the lumbar spine. In overweight women younger than 35 years, we found greater BMD in the hip reaching statistical significance, but not at the lumbar spine. We conclude that obesity is associated with greater BMD (4% at the lumbar spine; 11% at the hip) probably due to both greater physical stress and higher estrogen levels.
Assuntos
Índice de Massa Corporal , Densidade Óssea , Calcificação Fisiológica , Obesidade/metabolismo , Adulto , Estrogênios/análise , Feminino , Articulação do Quadril/química , Humanos , Vértebras Lombares/química , México , Estudos de AmostragemRESUMO
OBJECTIVE: To determine bone density in the third lumbar vertebra in a group of men and women from the Mexico City correlating the morphometric characteristics of vertebral body by specific techniques and to detect groups with alterations like osteoporosis or osteopenia. METHODOLOGY: The study was made in third lumbar vertebra from 23 patients dead of the Medical Service Forense-México, 8 women between 31 to 72 years old and 15 men between 25 yo 62 years old. The studies were: Radiological, bone densitometry and by image in which was determined density of vertical and horizontal trabeculaes. With x-ray technique in scanning electron microscopy was determined in form semiquantitative the presence of Ca, P, Mg and Na, and Ca distribution by technique of x-ray energy dispersed. RESULTS: In the radiological trail all vertebras of the female group were abnormal, the major finding was degenerative feature; 5 Showed trabeculation increased 3 fractured; in the males group 7 patients were normal, degenerative fracture in 8; of these six had densitometry with DEXA; in the females group only one was normal, 3 osteopenia, 5 osteoporosis; in the male group: 5 osteopenia and 5 osteoporosis. Scanning electron microscopy examination exhibit a homogeneous and dense expression pattern, wherever SEM demonstrated the absence or decrease of deposit calcium in osteoporosis. A morphometric examination of the trabecular thickness demonstrates a difference between the two sexes. The normal median was 222.1 microns, the osteoporosis range was 126.3 to 156.2 microns in the female osteoporosis, in male group was found two normal values with a trabecular density mean of 249.7 microns, in the last two cases one with osteopenia and the other with osteoporosis, the mean value was 186.4 microns. CONCLUSIONS: In the present study, was demonstrated that the degenerative alterations in osteoporosis and osteopenia in young people are more frequent to respect other reports. The following observations require special emphasis either because they provide clues to the mechanism of altered expression of calcium: Genetic, ethnic, consume, sedentary and others.
Assuntos
Vértebras Lombares/diagnóstico por imagem , Osteoporose/diagnóstico , Adulto , Idoso , Densidade Óssea , Doenças Ósseas Metabólicas , Densitometria , Feminino , Humanos , Vértebras Lombares/patologia , Masculino , México/epidemiologia , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Osteoporose/patologia , Radiografia , Fatores SexuaisRESUMO
The objective was to identify climateric woman with cardiovasculary risk by the relation between size and weight, known as corporal mass index. Seven hundred and ninety seven postmenopausal patients, were studied; they attended the CECLIMEN, with one or two years of spontaneous menopause, and they were not receiving, nor had received replacement hormonal therapy (RHT). In all of them clinical history was taken, and blood pressure, weight, size and corporal mass index (CMI) (weight/(size)2), were evaluated; considering normal weight when CMI was < or = 27, and obesity when this index was greater than 27. Fastening and postprandial glucose at two hours, was determined, as well as total cholesterol, HDL-C, cholesterol of low density lipoproteins (LDL-C), triglicéridos (Tg), and aterogenic index was calculated by CtHDL-C. Besides, estradiol (E2) and follicle stimulating hormone (FSH) were measured in serum by radioimmunoanalysis RIA. Results were considered in the two groups, according to CMI: Group I with CMI < or = 27 (n = 566); and group II, with CMI > 27 (n = 231). Blood pressure, systolic and diastolic, triglicerides and aterogenic index were significantly greater in group II. There were higher levels of glucose in group II (tendency). CMI > 27 is useful to differentiate the postmenopausal women with a higher cardiovasculary risk.