Randomized trial: treatment of genitourinary syndrome of menopause using radiofrequency.

OBJECTIVE: A randomized controlled study was conducted to evaluate the safety and efficacy of radiofrequency treatment in postmenopausal women not willing to use or presenting a contraindication for menopause hormone therapy (MHT) and suffering from genitourinary syndrome of menopause (GSM). METHODS: A prospective randomized open study evaluated the effect of radiofrequency treatment versus a gel (control group) in postmenopausal women suffering from GSM. Patients were assessed at baseline and after 10-12 weeks of treatment for severity of vulvovaginal atrophy, dyspareunia, pH, vaginal smear maturation index, Vaginal Health Index and Female Sexual Function Index. The difference at baseline and after 10-12 weeks of treatment and the difference in improvement were tested between groups by a two-sample t-test and the Mann-Whitney test. RESULTS: Due to the COVID-19 pandemic, we were only able to treat 48 patients (24 patients using radiofrequency and 24 patients using a gel). Globally, at the end of the study, there were no differences in changes of the measured outcomes between the group of women treated with radiofrequency and the control group. CONCLUSION: Radiofrequency treatment was found to be safe, but was not superior to a gel, although the study lacked power. The study was registered at ClinicalTrials.gov (NCT03857893).

MOF/Hip Fracture Ratio in a Belgian Cohort of Post-menopausal Women (FRISBEE): Potential Impact on the FRAX® Score.

The ratio between major osteoporotic fractures (MOFs) and hip fractures in the Belgian FRAX® tool to predict fractures is currently based on Swedish data. We determined these ratios in a prospective cohort of Belgian postmenopausal women. 3560 women, aged 60-85 years (70.1 ± 6.4 years), were included in a prospective study from 2007 to 2013 and surveyed yearly (FRISBEE). We analyzed the number of validated incident fractures until October 2020 by age and sites and compared the MOFs/hip ratios in this cohort with those from the Swedish databases. We registered 1336 fractures (mean follow-up of 9.1 years). The MOFs/hip ratios extracted from the FRISBEE cohort were 10.7 [95% CI: (5.6-20.5)], 6.4 [4.7-8.7], and 5.0 [3.9-6.5] for women of 60-69, 70-79, and 80-89 years old, respectively. These ratios were 1.7-1.8 times higher for all age groups than those from the Swedish data, which decreased from 6.5 (60-64 years group) down to 1.8 (85-89 age group). The overall MOFs/hip ratio in Frisbee was 6.0 [5.9-6.1], which was higher than any Swedish ratio between 65 and 85 years. Nevertheless, the decrease of the ratios with age paralleled that observed in Sweden. In this Brussels prospective cohort, MOFs/hip ratios were 1.7-1.8 times those observed in Sweden currently used for MOFs prediction in the Belgian FRAX® version. This discrepancy can greatly modify the estimation of the risk of MOFs, which is among the main criteria used to recommend a pharmacological treatment for osteoporosis in several countries.

Osteoporosis treatment gap in a prospective cohort of volunteer women.

Despite the availability of efficient drugs to prevent osteoporotic fractures, only a minority of women receives osteoporosis therapy after a fracture. The high treatment gap in our cohort consisted of unselected volunteer patients highlights the urgent need of additional education, especially for the medical profession, regarding the risk-benefit balance of treatment. INTRODUCTION: Despite the availability of efficient drugs to prevent osteoporotic fractures, only a minority of women receives osteoporosis therapy after a fracture, with a treatment gap around 80%. This can have dramatic consequences for patients and the healthcare systems. METHODS: In this study based on longitudinal data from the FRISBEE (Fracture RIsk Brussels Epidemiological Enquiry) cohort of 3560 volunteer women aged 60 to 85 years, we evaluated the 1-year treatment gap after a first major incident fragility fracture. RESULTS: There were 386 first validated fragility fractures, 285 major osteoporotic fractures (MOF) and 101 "other major" fractures. The rate of untreated patients was 85.0% (82.8% for MOF versus 91.0 % for "other major" fracture sites) (p = 0.04), with a lower rate for spine (70.5%) and hip (72.5%) versus shoulder (91.6%) and wrist (94.1%) (p < 0.0001). More specifically, the treatment gap for patients with osteoporosis, defined by a T-score < - 2.5 SD was 74.6% versus 76.5% for patients with osteoporosis defined by the presence of hip, shoulder, or spine fractures, independently of DXA results. When considering age groups, the rate of untreated women was 87.9% for women 60-70 years old, 88.2% between 70 and 80 years and 77.8% above 80 years (p = 0.03), with a greater difference between women who were younger or older than 80 years at inclusion: 88.1% versus 77.8% (p = 0.009). A diagnosis of osteoporosis (p = 0.01) and age (p = 0.03) were the only clinical risk factors (CRFs) significantly associated with treatment initiation. CONCLUSIONS: This study highlights the urgent need of additional education, especially for the medical profession, regarding the risk-benefit balance of treatment.

Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis?

We provide an evidence base and guidance for the use of menopausal hormone therapy (MHT) for the maintenance of skeletal health and prevention of future fractures in recently menopausal women. Despite controversy over associated side effects, which has limited its use in recent decades, the potential role for MHT soon after menopause in the management of postmenopausal osteoporosis is increasingly recognized. We present a narrative review of the benefits versus risks of using MHT in the management of postmenopausal osteoporosis. Current literature suggests robust anti-fracture efficacy of MHT in patients unselected for low BMD, regardless of concomitant use with progestogens, but with limited evidence of persisting skeletal benefits following cessation of therapy. Side effects include cardiovascular events, thromboembolic disease, stroke and breast cancer, but the benefit-risk profile differs according to the use of opposed versus unopposed oestrogens, type of oestrogen/progestogen, dose and route of delivery and, for cardiovascular events, timing of MHT use. Overall, the benefit-risk profile supports MHT treatment in women who have recently (< 10 years) become menopausal, who have menopausal symptoms and who are less than 60 years old, with a low baseline risk for adverse events. MHT should be considered as an option for the maintenance of skeletal health in women, specifically as an additional benefit in the context of treatment of menopausal symptoms, when commenced at the menopause, or shortly thereafter, in the context of a personalized benefit-risk evaluation.

[La ménopause et le traitement hormonal de la ménopause : une actualisation]. / Menopause and menopause hormonal treatment : an update.

Postmenopausal hormone therapy (MHT) is mainly used for the relief of menopausal symptoms. It can also be prescribed for the treatment of postmenopausal osteoporosis, but nowadays, other medications are given to older patients for this indication. Current, available data, demonstrates that MHT is beneficial as well as safe for postmenopausal, symptomatic women. Modern regimens of MHT comprise lower dosages of estrogens than in the past, either safer progestins or SERMs. These regimens should be the preferred option for women with a uterus. Non-androgenic progestin may present reduced thrombotic and breast cancer risks, and transdermal oestrogen could have a reduced thrombotic risk. Oestrogen-only therapy is the preferred option for women who underwent a hysterectomy. Vaginal oestrogen therapy is indicated for women with atrophic vaginitis and recurrent urinary tract infections.

Le traitement des symptômes vasomoteurs constitue l'indication principale du traitement hormonal de la ménopause (THM). La seconde indication est le traitement de l'ostéoporose après la ménopause. Toutefois, d'autres produits sont utilisés pour traiter des femmes plus âgées à cette même fin. La balance bénéfice-risque est en faveur du THM pour les femmes postménopausées et symptomatiques, mais les doses d'oestrogène ont été réduites dans les schémas de traitement actualisés. Par ailleurs, ces schémas préconisent l'utilisation soit de progestatifs moins androgéniques et ayant une moindre innocuité que les progestatifs anciens, soit des SERMs. Ces schémas constituent les premiers choix de traitement pour les femmes non-hystérectomisées. Les progestatifs nonandrogéniques sont associés à un risque diminué de thrombose veineuse et de cancer du sein alors que les oestrogènes par voie transdermique présentent un moindre risque de thrombose veineuse. Chez les femmes qui n'ont plus d'utérus, il convient de prescrire des oestrogènes sans progestatifs. Le traitement local par voie vaginale à base d'oestrogènes est indiqué chez les femmes souffrant de vaginite atrophique, entrainant des difficultés sexuelles ou des infections urinaires récidivantes.

[Prolapse and urinary incontinence in women : place of the general practitioner]. / Prolapsus et incontinence urinaire chez la femme : la place du médecin généraliste.

The ageing of the population, having access to good quality of care, will result in an increase in the prevalence of pelvic floor diseases. Those persons, often in good general health, may experience difficulties in accepting functional pathologies, associated with loss in quality of life. One out of 2 women will have a pelvic floor problem and 1 out of 9 will have a surgical perineal procedure before the age of 80 years. The unitary character of the pelvic floor, a complex functional anatomic region, is often forgotten, essentially because the patients complain about one main pathology like urinary incontinence, genital prolapse, constipation and sexual disorders or chronic pain and will consult one specific specialist. Our role as health care professionals is to be aware of those associated pathologies and to obtain an optimal quality of care. The actual evolution towards specific clinical pathways with the integration of office provided care outside the hospital, needs to become the new standard of care. We try to give an overview of the different preventive, diagnostic and therapeutic options, available in a general practitioner's office. Taking care of the pelvic floor needs to be done in a global and pluridisciplinar setting. Referring towards specialised centres as well as the integration of the general practitioner, especially for the more complex cases, is essential.

Le vieillissement de la population ayant un accès à des soins de santé de qualité, mène à une augmentation de la prévalence des pathologies du périnée. Ces personnes, souvent en bonne santé, auront des difficultés à accepter des pathologies fonctionnelles associées à une perte de qualité de vie car ces pathologies du périnée représentent un large éventail de pathologies fonctionnelles. On estime qu'une femme sur 2 aura un jour un problème périnéal, 1 sur 9 devra subir une intervention chirurgicale périnéale avant l'âge de 80 ans. Le caractère unitaire du périnée, région anatomique fonctionnelle complexe, est malheureusement souvent oublié, au départ parce que les patientes se présentent chez leur médecin pour une plainte bien spécifique sans se rendre compte de cette unité et de l'association de différents symptômes comme l'incontinence urinaire, le prolapsus génital, la constipation et des troubles sexuels et douloureux. Notre rôle en tant que professionnel de santé est de ne pas négliger ces plaintes associées, afin d'avoir une qualité de soin optimale. L'évolution actuelle vers le développement des trajets de soin avec l'intégration standardisée des soins en extrahospitalier est évidente. Nous avons tenté dans cet article de donner une revue des moyens préventifs, diagnostiques et thérapeutiques applicables dans le cabinet du médecin généraliste. La prise en charge du périnée devrait toutefois avoir lieu de manière globale et de préférence pluridisciplinaire. La référence vers les centres pluridisciplinaires comme également l'intégration du médecin généraliste dans les trajets de soin, surtout pour les cas plus complexes, est essentielle.

Osteoporosis in Frail Patients: A Consensus Paper of the Belgian Bone Club.

In this consensus paper, the Belgian Bone Club aims to provide a state of the art on the epidemiology, diagnosis, and management of osteoporosis in frail individuals, including patients with anorexia nervosa, patients on dialysis, cancer patients, persons with sarcopenia, and the oldest old. All these conditions may indeed induce bone loss that is superimposed on physiological bone loss and often remains under-recognized and under-treated. This is of particular concern because of the major burden of osteoporotic fractures in terms of morbidity, mortality, and economic cost. Therefore, there is an urgent need to appreciate bone loss associated with these conditions, as this may improve diagnosis and management of bone loss and fracture risk in clinical practice.

The role of biochemical of bone turnover markers in osteoporosis and metabolic bone disease: a consensus paper of the Belgian Bone Club.

The exact role of biochemical markers of bone turnover in the management of metabolic bone diseases remains a topic of controversy. In this consensus paper, the Belgian Bone Club aimed to provide a state of the art on the use of these biomarkers in different clinical or physiological situations like in postmenopausal women, osteoporosis in men, in elderly patients, in patients suffering from bone metastasis, in patients with chronic renal failure, in pregnant or lactating women, in intensive care patients, and in diabetics. We also gave our considerations on the analytical issues linked to the use of these biomarkers, on potential new emerging biomarkers, and on the use of bone turnover biomarkers in the follow-up of patients treated with new drugs for osteoporosis.

How much does the Dallas Pain Questionnaire score have to improve to indicate that patients with chronic low back pain feel better or well?

PURPOSE: The Dallas Pain Questionnaire (DPQ) assesses the impact of low back pain (LBP) on four components (0-100) of daily life. We estimated the minimal clinically important improvement (MCII) and the patient acceptable symptom state (PASS) values of DPQ in LBP patients. METHODS: 142 patients with LBP lasting for at least 4 weeks completed a battery of questionnaires at baseline and 6 months later. Questions for MCII addressed patient-reported response to treatment at 6 months on a five-point Likert scale, while a yes/no question concerning satisfaction with present state was used to determine PASS. MCII was computed as the difference in mean DPQ scores between patients reporting treatment as effective vs. patients reporting treatment as not effective, and PASS was computed as the third quartile of the DPQ score among patients who reported being satisfied with their present state. RESULTS: MCII values were 22, 23, 2 and 10 for daily activities, work and leisure, social interest, and anxiety/depression, respectively. PASS values were 29, 23, 20 and 21 for the four components, respectively. The PASS total score threshold of 24 correctly classified 84.1 % of the patients who reported being unsatisfied with their present state, and 74.7 % of patients reported being satisfied. CONCLUSIONS: These values give information of paramount importance for clinicians in interpreting change in DPQ values over time. Authors should be encouraged to report the percentage of patients who reach MCII and PASS values in randomized clinical trials and cohort studies to help clinicians to interpret clinical results.

Core Outcome Measure Index for low back patients: do we miss anxiety and depression?

PURPOSE: The Core Outcome Measure Index (COMI) is a multidimensional questionnaire that investigates five dimensions in low back pain (LBP) patients, but does not address the psychological dimension. As the biopsychosocial perspective is recognized as important to capture the entire clinical picture of these patients, this multicenter prospective cohort study was designed to investigate the psychometric properties of a modified version of the COMI (COMIAD) which included 2 additional items, exploring anxiety and depression, respectively. METHODS: 168 subacute or chronic LBP patients recruited in spine clinics completed a set of questionnaires before and after treatment (follow-up at 6 months). Construct validity was explored by comparing each item of the COMIAD to validated full-length questionnaires. Thus two additional questionnaires were included to assess the construct validity of the anxiety and depression measures. The psychometric properties of the COMI and COMIAD were then compared. RESULTS: The two new items showed good internal consistency, high correlations with the corresponding full-length questionnaires, no floor or ceiling effect and good reproducibility (test-retest agreement kappa 0.68 for anxiety, 0.62 for depression). The addition of the 2 items did not alter internal validity (Cronbach's alpha = 0.88 and 0.87, respectively). The smallest detectable difference, the Minimal Clinically Important Improvement and the Patient Acceptable Symptom State were only minimally affected by the changes. CONCLUSION: The questions exploring anxiety and depression have good intrinsic and psychometric capacities (i.e., no floor or ceiling effects and high correlations with full-length scales) and did not significantly modify the psychometrics of the original COMI questionnaire. The COMIAD offers the possibility to include the psychological dimension in the multidimensional evaluation without significantly affecting questionnaire length.

[State of contraception in 2016]. / Etat de la contraception en 2016.

INTRODUCTION: The Pill and other forms of hormonal contraception, if taken correctly, are very effective and safe for millions of women, but since a few years, due to the debates and controversies about the third- and fourth-generation pills, other options have gained in popularity. OBJECTIVES: to provide a review of oestroprogestative contraception (OP), progesta-tive contraception, IUDs with a focus on their advantages and side-effects according to the specific needs of women. METHODS: literature review and lessons learned from clinical practice. RESULTS: The importance of family and individual history, the life-style and socio-economic conditions are critical factors for advising women on the 15 contraceptive choices available to them. The risk/benefit ratio of OP contraception needs a yearly follow-up. The progestative contraception is the preferred option for women who have contraindication for oestrogen, are older than forty, and/or have risk factors such as a history of venous thromboembolism, overweight and smoking. The IUD usually is well tolerated and causes few side effects. Among the other contraceptive methods, sterilization and diaphragms are briefly discussed. CONCLUSION: Among the many safe and effective contraceptive methods, it is important for general practitioners to know the advantages and the side effects of each method, as well as the specific conditions of the woman, to propose the best options available. In case of difficulties of follow up or adherence to daily uptake, in particular among adolescents, long-acting methods such as IDU or implants are preferable.

INTRODUCTION: Longtemps préférées des femmes, les pilules sont en recul en Belgique depuis les polémiques sur les pilules de 3e et 4e génération. Si le recours à la contraception orale a diminué, d'autres prat iques contraceptives se sont renforcées. OBJECTIFS: fournir une description détaillée des contraceptifs oestroprogestatifs (OP), des contraceptifs à base de progestatifs seuls et des dispositifs intra-utérins, en soulignant leur intérêt mais aussi les risques de leur utilisation. METHODE: revue de la littérature et expérience clinique. RESULTATS: l'importance des antécédents personnels, familiaux, et du style de vie est déterminante pour évaluer les indications des différentes méthodes. En ce qui concerne les contraceptifs OP, le rapport risque/bénéfice nécessite un suivi annuel. La contraception progestative est une option choisie par de nombreuses femmes, particulièrement celles qui ont plus de 40 ans, et/ou des facteurs de risque comme le tabac, le surpoids ou des antécédents de TEV. Le dispositif intra-utérin est généralement bien toléré comme méthode contraceptive car il présente peu d'effets secondaires ou de complications. Parmi les autres méthodes contraceptives, la stérilisation féminine et le diaphragme sont brièvement discutés. CONCLUSION: Parmi les nombreuses possibilités de choix contraceptifs, il est important de faire connaître les indications et contre-indications en tenant compte de la situation de la personne. En cas de difficulté de suivi et d'observance, en particulier chez les adolescentes, la prescription des méthodes à longue durée d'action est préférable.

Should we abstain from treating women with endometriosis using menopausal hormone therapy, for fear of an increased ovarian cancer risk?

Women suffering from endometriosis often have an early menopause, resulting in severe menopausal symptoms and an increased risk of osteoporosis. They are therefore candidates for menopausal hormone therapy (MHT). Unfortunately, MHT may increase the risk of endometriosis recurrence. Moreover, endometriosis patients are at increased risk of ovarian cancer, which may be further enhanced by MHT use. It is unknown, however, whether MHT more frequently increases type I (low-grade serous tumors), which seem to be increased when endometriosis is present, or type II (the more aggressive high-grade serous) tumors. We propose the following decision-making algorithm for endometriosis patients considering MHT. Those who have been treated with bilateral salpingo-oophorectomy, and in whom there is no residual endometriotic disease, can probably be treated using MHT without risk of endometriosis recurrence or fear of ovarian cancer. For women with significant, residual endometriosis lesions, the benefit may outweigh the risks, when menopause is reached before the age of 45 years or when severe symptoms are present.

Systematic review about breast cancer incidence in relation to hormone replacement therapy use.

BACKGROUND: Several studies report a decrease in breast cancer incidence subsequent to the decrease in hormone replacement therapy (HRT) use. But its magnitude and the time-lag may vary between countries. This may reflect differences in populations, previous type and prevalence of HRT use and breast cancer screening. AIM: To review systematically studies assessing the relation between breast cancer incidence and change of HRT use. MATERIAL AND METHOD: Descriptive analysis of the methodology of the studies including design limitations and presence of confounding factors, data sources for breast cancer and HRT and regimens of HRT used. RESULTS AND DISCUSSION: Eighteen articles were selected. Most studies were ecological and confounding factors such as mammography screening and changes in reproductive and lifestyle habits could not be excluded. Sources of data on breast cancer and HRT were heterogeneous and only few data on HRT regimens used were available. Most studies concluded that the decrease in HRT use during the last decade was probably associated with a decrease in breast cancer incidence, especially for women aged 50 years or more. CONCLUSIONS: Data, mostly from epidemiological studies, suggest that the decrease in breast cancer incidence can be partly attributed to the drop in HRT use. Nevertheless, available studies are hampered by a number of limitations and it remains difficult to evaluate the exact impact of the drop in HRT use on the decrease in breast cancer incidence. Especially, the studies are seldom based on detailed individual data and do not provide information on regimens used, type of cancers and possible confounding factors.

Inflammatory pain pattern and pain with lumbar extension associated with Modic 1 changes on MRI: a prospective case-control study of 120 patients.

PURPOSE: To compare, in a case-control study, clinical characteristics of patients with low back pain (LBP) with and without Modic 1 signal changes on MRI. METHODS: Patients with chronic non-specific LBP and a recent (<6 months) MRI were prospectively screened and included in Modic 1 group or control group. Patients in control group were age- and gender-matched with patients with Modic 1 group. Pain characteristics, including night pain and worse pain on waking and morning stiffness, were recorded. The presence of at least one of these three characteristics indicated an inflammatory pain pattern. Patients were evaluated by questionnaires and physical examination (including lumbar range of motion). Data were analyzed by univariate and multivariate analyses. RESULTS: 120 patients were included (60 in each group). The groups did not differ in sedentary work (p = 0.25), morning stiffness for >60 min (p = 0.19), waking at night (p = 0.08), worse pain on waking (p = 0.09), back stiffness (p = 0.12), or pain with flexion (p = 0.87). Modic 1 patients more frequently exhibited an inflammatory pain pattern (p = 0.006), worse pain with lumbar extension (p < 0.005) and responded better to oral steroids (p = 0.004) than did controls. On multivariate analysis, Modic 1 changes were associated with sedentary work [odds ratio 0.22 (95% confidence interval 0.05-0.93)], pain with lumbar extension [11.2 (3.1-40.4)] and an inflammatory pain pattern [4.5 (1.2-16.9)]. CONCLUSIONS: Characteristics of patients with LBP and Modic 1 changes on MRI consist of an inflammatory pain pattern and pain with lumbar extension. Level of evidence 3b.

Extraskeletal benefits and risks of calcium, vitamin D and anti-osteoporosis medications.

UNLABELLED: Drugs used for the prevention and the treatment of osteoporosis exert various favourable and unfavourable extra-skeletal effects whose importance is increasingly recognized notably for treatment selection. INTRODUCTION: The therapeutic armamentarium for the prevention and the treatment of osteoporosis is increasingly large, and possible extra-skeletal effects of available drugs could influence the choice of a particular compound. METHODS: The present document is the result of a national consensus, based on a systematic and critical review of the literature. RESULTS: Observational research has suggested an inverse relationship between calcium intake and cardiovascular diseases, notably through an effect on blood pressure, but recent data suggest a possible deleterious effect of calcium supplements on cardiovascular risk. Many diverse studies have implicated vitamin D in the pathogenesis of clinically important non-skeletal functions or diseases, especially muscle function, cardiovascular disease, autoimmune diseases and common cancers. The possible effects of oral or intravenous bisphosphonates are well-known. They have been associated with an increased risk of oesophageal cancer or atrial fibrillation, but large-scale studies have not found any association with bisphosphonate use. Selective oestrogen receptor modulators have demonstrated favourable or unfavourable extra-skeletal effects that vary between compounds. Strontium ranelate has a limited number of non-skeletal effects. A reported increase in the risk of venous thromboembolism is not found in observational studies, and very rare cases of cutaneous hypersensitivity reactions have been reported. Denosumab has been introduced recently, and its extra-skeletal effects still have to be assessed. CONCLUSION: Several non-skeletal effects of bone drugs are well demonstrated and influence treatment choices.

Non-pharmacological management of osteoporosis: a consensus of the Belgian Bone Club.

This consensus article reviews the various aspects of the non-pharmacological management of osteoporosis, including the effects of nutriments, physical exercise, lifestyle, fall prevention, and hip protectors. Vertebroplasty is also briefly reviewed. Non-pharmacological management of osteoporosis is a broad concept. It must be viewed as an essential part of the prevention of fractures from childhood through adulthood and the old age. The topic also includes surgical procedures for the treatment of peripheral and vertebral fractures and the post-fracture rehabilitation. The present document is the result of a consensus, based on a systematic review and a critical appraisal of the literature. Diets deficient in calcium, proteins or vitamin D impair skeletal integrity. The effect of other nutriments is less clear, although an excessive consumption of sodium, caffeine, or fibres exerts negative effects on calcium balance. The deleterious effects of tobacco, excessive alcohol consumption and a low BMI are well accepted. Physical activity is of primary importance to reach optimal peak bone mass but, if numerous studies have shown the beneficial effects of various types of exercise on bone mass, fracture data as an endpoint are scanty. Fall prevention strategies are especially efficient in the community setting, but less evidence is available about their effectiveness in preventing fall-related injuries and fractures. The efficacy of hip protectors remains controversial. This is also true for vertebroplasty and kyphoplasty. Several randomized controlled studies had reported a short-term advantage of vertebroplasty over medical treatment for pain relief, but these findings have been questioned by recent sham-controlled randomized clinical studies.

Evolution of breast cancer incidence in relation to hormone replacement therapy use in Belgium.

BACKGROUND: Recent randomized studies concluded that an increased risk of breast cancer is associated with hormone replacement therapy (HRT). Since then, HRT use has decreased in many countries. Several studies have reported a subsequent decrease in breast cancer incidence. AIM: As Belgium has one of the highest incidences of breast cancer in Europe and has a high rate of HRT use, with differences between regions, we assessed the evolution of breast cancer incidence and HRT sales per region and per regimen. MATERIALS AND METHODS: Breast cancer incidence rates (provided by the Belgian Cancer Registry) and HRT sales data (provided by IMS Health®) were analyzed by region, age class and HRT regimens. We also calculated the correlation between breast cancer incidence and HRT sales. RESULTS: Breast cancer incidence decreased from 2003 onwards in Flanders, Brussels and Wallonia, especially in the age group 50-69 years. In the same three regions, HRT use decreased by half from 2002 onwards. Greater decreases were observed for estrogens combined with androgenic progestins, estrogens only and estrogens prescribed with a separate progestin. The correlation between breast cancer incidence rates and HRT sales in the previous year was 0.55 (p=0.04), but, when adjusted for the number of women in the age class 40-69 years in each region, the correlation was no longer statistically significant (r=0.39, p=0.17). CONCLUSION: Although many arguments support the hypothesis that the drop in breast cancer incidence can be partly explained by the decrease in HRT use, we were unable to find a strong association between the two in Belgium.

[Menopausal hormone treatment in 2011]. / Réactualisation du traitement hormonal a la ménopause en 2011.

In this review article an update of the menopause hormone therapy is presented (MHT). MHT is the most efficient therapy for climacteric symptoms. It prevents also osteoporosis. Nevertheless, since prolonged use is associated with increased health risks, other therapies, combined with calcium and vitamin D, are preferred for women who suffer from osteoporosis without climacteric symptoms. Increased breast cancer risk has been reported, after 5 years of use, in women treated with a fixed combined regimen of oestrogen and progestin (0,625 mg conjugated estrogens (CEE) + 5 mg de medroxyprogesteron acetate (MPA) (WHI-EP), while a reduced risk has been reported in women using oestrogen only (0,625 mg conjugated estrogens) (WHI-E). In women without risk factors, the attributable risk of suffering from a stroke or thromboembolism, following using MHT, is slow in women younger than 60 years of age. While, MHT (WHI-EP), was associated with an increased risk of coronary disease, in women who started their treatment around the age of 67 years, oestrogen only treatment (WHI-E), has been associated with a reduced coronary risk in women who initiated the therapy at a younger age (between 50-60 years), suggesting that the risks vary in relation to the used regimen and the treated population.

Discriminating value of HR-pQCT for fractures in women with similar FRAX scores: A substudy of the FRISBEE cohort.

Areal bone mineral density (aBMD) has a low sensitivity to identify women at high fracture risk. The FRAX algorithm, by combining several clinical risk factors, might improve fracture prediction compared to aBMD alone. Several micro-architectural and biomechanical parameters which can be measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) are associated with fracture risk. HR-pQCT in combination or not with finite element analysis (FEA) may be used to improve bone strength prediction. Our aim was to assess whether HR-pQCT measurements (densities, cortical and trabecular microarchitecture, biomechanical proprieties assessed by FEA) had an added value in predicting fractures in a subgroup of women belonging to the Belgian FRISBEE cohort. One hundred nineteen women who sustained a fracture (aged 60 to 85 years) during the initial follow-up of our cohort had a radius and tibia examination by HR-pQCT and were compared with controls matched for their FRAX score at baseline. We found that low distal radius total (OR = 1.41 [1.07-1.86] per SD, p < 0.05) and trabecular densities (OR = 1.45 [1.10-1.90], p < 0.01), trabecular number (OR = 1.32 [1.01-1.72], p < 0.05), intra individual distribution of separation (OR = 0.73 [0.54-0.99], p < 0.05) as several FEA parameters were significantly associated with fractures. At the distal tibia, impaired cortical density (OR = 1.32 [1.03-1.70] per SD, p < 0.05) and thickness (OR = 1.29 [1.01-1.63], p < 0.05) and apparent modulus (OR = 1.30 [1.01-1.66], p < 0.05) were significantly correlated with fractures. A low ultra distal radial aBMD (UDR) measured at the time of HR-pQCT was significantly associated with fractures (OR = 1.67 [1.22-2.28], p < 0.01). Women from both groups were followed further after the realization of the HR-pQCT and 46 new fractures were registered. In this second part of the study, low UDR aBMD (OR = 1.66 [1.18-2.35], p < 0.01), total (OR = 1.48 [1.08-2.03], p < 0.05), cortical (OR = 1.40 [1.04-1.87], p < 0.05) and trabecular (OR = 1.37 [1.01-1.85], p < 0.05) densities or apparent modulus (OR = 1.49 [1.07-2.05], p < 0.05) at the radius were associated with a significant increase of fracture risk. At the tibia, only the cortical density was significantly associated with the fracture risk (OR = 1.34 [1.02-2.76], p < 0.05). These results confirm the interest of HR-pQCT measurements for the evaluation of fracture risk, also in women matched for their baseline FRAX score. They also highlight that UDR aBMD contains pertinent information.