Estrogens and the intervertebral disc.

Intervertebral discs are an integral part of the vertebral column. It has been shown that menopause has a negative effect on bone and on intervertebral discs. Estrogen has a beneficial effect of preserving the health of collagen-containing tissues, including the intervertebral disc. The intervertebral disc allows for mobility of the spine, and maintains a uniform stress distribution of the area of the vertebral endplates. Also, the disc influences spinal height. The disc tissue is adapted for this biomechanical function. The function of the spine is impaired if there is a loss of disc tissue. Narrowing of the disc space due to degeneration of intervertebral discs is associated with a significantly increased risk of vertebral fractures. Estrogen should be seen as the first-choice therapy for bones and other collagen-rich tissues, such as intervertebral discs, because it maintains homeostasis of the bone-remodelling unit. Unlike bisphosphonates, estrogen is unique in its ability to regenerate bone collagen after its disintegration, apart from suppressing osteoclastic activity. Besides, there is insufficient data on deterioration in bone qualities and micro-cracks in patients on long-term bisphosphonates.

Low intervertebral disc height in postmenopausal women with osteoporotic vertebral fractures compared to hormone-treated and untreated postmenopausal women and premenopausal women without fractures.

OBJECTIVE: To assess the intervertebral disc height in postmenopausal women with osteoporotic vertebral fractures. METHODS: A total of 203 women were recruited from a bone densitometer directory. The disc heights measured were those between the 12th thoracic and 3rd lumbar vertebrae. The discs were assigned the symbols D, whereby D(1) refers to the disc between the 12th thoracic and 1st lumbar vertebrae. The disc height of the group of women (n = 38) with osteoporotic vertebral fractures was compared to the disc heights of hormone-treated women (n = 47), untreated postmenopausal women (n = 77) and another group of premenopausal women (n = 41). RESULTS: The total disc height (D(1) - D(3)) (mean +/- standard deviation) in the fracture group was 1.58 +/- 0.1 cm, significantly lower (p < 0.0001) than in the untreated group (1.82 +/- 0.06 cm), which in turn was significantly (p < 0.0001) lower than in the hormone-treated group (2.15 +/- 0.08 cm) and in the premenopausal group (2.01 +/- 0.09 cm). CONCLUSION: The fracture group was noted to have the lowest intervertebral disc height compared to the other three groups. The hormone-treated and the premenopausal women had the highest disc heights recorded. These results may be due to the effect that the menopause and senescence have on the discal connective tissue components. This may lead to loss of the shock-absorbing properties of the intervertebral disc and an altered discoid shape, influencing the occurrence of osteoporotic vertebral body fractures.

Skin ageing.

Cutaneous ageing manifests itself as a progressive reduction in maximum function and reserve capacity of skin tissue. It is not a unique and uniform biological event. Skin comprises three layers: epidermis, dermis and subcutaneous tissue. Collagen atrophy is a major factor in skin ageing. There is a strong correlation between skin collagen loss and estrogen deficiency due to the menopause. Skin ageing, especially in the face, is associated with a progressive increase in extensibility and a reduction in elasticity. With increasing age, the skin also becomes more fragile and susceptible to trauma, leading to more lacerations and bruising. Furthermore, wound healing is impaired in older women. Estrogen use after the menopause increases collagen content, dermal thickness and elasticity, and it decreases the likelihood of senile dry skin. Large-scale clinical trials are necessary to help make informed recommendations regarding postmenopausal estrogen use and its role in the prevention of skin ageing.

Hormone replacement in women with breast cancer: the HABITS study.

Ever since Professor William T. Creasman suggested the use of hormone replacement therapy in breast cancer survivors in the early 1980s, interest in this field has been guarded but present. Prescribing HRT to breast cancer survivors was initially thought of as being outrageous. Yet even then with experience in HRT spanning a good three decades, and with the breast cancer epidemic, so confidently predicted, then as it is now never actually materializing, doctors working in the field had started to question the conventional wisdom. The debate on whether to treat breast cancer survivors with HRT has been revisited from time to time as there has been a powerful demand for a solution for such symptomatic women. The HABITS study was thus designed to investigate the use of HRT in breast cancer survivors.

Carotid artery wall thickness in women treated with hormone replacement therapy.

OBJECTIVE: To measure the thickness of the individual layers (externa, media, intima) of the carotid artery in two groups of postmenopausal women. METHODS: A high resolution ultrasound (25-MHz Osteoson DIII Minhorst) was used to assess the distal end of the common carotid artery. Forty-six women were on hormone replacement therapy (Premarin 0.625 mg and Norgestrel 1 mg) for more than 1 year. The measurements of the treated group were compared to those of 51 postmenopausal women who acted as controls. RESULTS: No significant difference between the externa and media layers of both groups of women were noted. The media showed a tendency to be thicker in the treated group. The intima of the untreated group was found to be significantly thicker than that of the treated group (P < 0.05). Significant correlations were found between the layers of the carotid artery especially between the externa and media both mainly composed of connective tissue (Collagen Type I and III and elastin). The media/intima ratio of the treated women was significantly higher than that of the untreated group (P< 0.003). CONCLUSION: It is postulated that the changes observed may be due to the effect of oestrogen on connective tissue. These arterial changes induced by hormone replacement therapy may partially explain the cardioprotective effect this treatment has on postmenopausal women. The increased intimal thickness in untreated women compared to treated ones on the other hand would represent the reduction in atheromatous plaque formation in women on oestrogen replacement therapy.