[Hormone replacement therapy and urogenital disease in postmenopausal women]. / La terapia ormonale sostitutiva e la patologia del pavimento pelvico nelle donne in postmenopausa.

Estrogen deficit in postmenopausal women causes urogenital atrophy, which is responsible for a wide range of urinary disorders (urinary incontinence, urge incontinence, recurrent urinary infections) and genital disorders (prolapse, dispareunya, vaginal dryness). The efficacy of estrogen therapy on urinary incontinence is not yet demonstrated, but it is widely recognized that the topical use of estrogens lowers the risk of recurrent urinary infections and improves urogenital atrophy.

Identification of patients with high osteoporosis risk: analysis of FRAX and phalangeal ultrasonography in a female population in North-East Italy.

AIM: Osteoporosis is a worldwide health problem and bone fractures from osteoporosis are among the major causes of disability, with a great impact on the national health budgets. The aim of our study was to analyze the efficacy of FRAX algorithm and phalanger ultrasound to predict the risk of osteoporotic fractures, in order to identify a high risk population to examine with a second level diagnostic analysis. METHODS: The study population was composed of 1208 premenopausal, perimenopausal, and postmenopausal women, between 40 and 81 years. For each woman phalangeal QUS was performed and FRAX index was calculated. The FRAX index was evaluated according to standard plots available on web (http://www.shed.ac.uk/FRAX/index.htm). RESULTS: Analysing the correlation between women age and phalanger bone ultrasound values we know that all parameter decrease with increasing of age. We found a significant difference between FRAX index and the ultrasound parameters (P<0.05) to predict a major osteoporotic fracture, we did not find differences between age and ultrasound parameters. Furthermore, we show that after correction per age of the women the ultrasound parameters lose their significant correlation with major osteoporotic fractures. Finally, FRAX index showed a good AUC and in our population and a 10-year probability over 9.4% of major osteoporotic fractures had a good specificity (88%) and sensitivity (83%) to predict osteoporotic fractures. CONCLUSION: Our data suggest that FRAX index alone could be used to address high risk women to more invasive tests but we need more data about ultrasound parameters.