[Osteoporosis in menopausal women between 40 and 65 years old : an algorithm for the gynaecologist]. / Ostéoporose chez les femmes ménopausées entre 40 et 65 ans : algorithme pour le gynécologue.

Osteoporosis is a bone disease that promotes the development of fragility fractures. An algorithm is proposed for the gynaecologists'use to diagnose and treat osteoporosis in young menopausal women. The fracture risk can be calculated with the FRAX tool. If the 10-year fracture risk is ≥ 10 %, a bone densitometry is recommended, and the result is integrated in the FRAX tool. If the risk is between 10 and 20 %, a treatment should be discussed individually and, in some cases, a pharmacologic preventive treatment, by menopause hormonal treatment or SERMs, can be initiated. A pharmacologic treatment (bisphosphonates or dénosumab) is recommended in case of previous fragility fracture or risk ≥ 20 %, independently of a T-score < -2.5 DS. Patients have to be referred in case of treatment failure or intolerance, and at the end of any denosumab therapy.

L'ostéoporose est une maladie de l'os favorisant des fractures de fragilité. L'algorithme proposé est destiné aux gynécologues pour le diagnostic et le traitement de l'ostéoporose chez la jeune femme ménopausée. L'outil FRAX permet de calculer le risque fracturaire ; si le risque est ≥ 10 % sur dix ans, une densitométrie osseuse est recommandée et le résultat sera intégré dans l'outil FRAX. Si le risque est entre 10­20 %, un traitement peut être discuté et, dans certains cas, on proposera une prévention par traitement hormonal de la ménopause ou par un SERM. Un traitement pharmacologique (bisphosphonates ou dénosumab) est recommandé en présence d'antécédent de fracture de fragilité, ou de risque ≥ 20 %, indépendamment d'un T-score < ­2,5 DS. Il faut référer les patientes en cas d'échec ou intolérance au traitement, et à la fin de tout traitement par dénosumab.

Keeping collecting device in liquid medium is mandatory to ensure optimized liquid-based cervical cytologic sampling.

OBJECTIVE: To determine the impact of not keeping the collecting device in liquid-based cytology. Loss of material was computed from a pair of subsamples from the same cervical scrape. One subsample was obtained by rinsing the collecting device in one vial and the other by discarding it in another vial. Homogeneity of endocervical component was assessed between subsamples. MATERIALS AND METHODS: Loss of material was analyzed with a two-way analysis of variance whose two factors were G (five gynecologists) and R (number of rinsing rotations in the first vial). Endocervical clusters were counted on slides prepared from all subsamples. RESULTS: Globally, 37% of cellular material is lost when the collecting device is discarded. Loss of material is different among gynecologists. The more intense the rinsing process, the less the loss, but the latter is never zero and is poorly predictable. The discarded subsample often contains a greater amount of endocervical clusters. CONCLUSIONS: Discarding collecting device in liquid-based cytology reproduces one of the flaws of the conventional smear technique. Losing cellular material may have an impact on cervical cancer detection, but this still has to be evaluated with further investigations.