Effects of ultra-low dose hormone therapy on biochemical bone turnover markers in postmenopausal women: A randomized, placebo-controlled, double-blind trial.

OBJECTIVE: Evaluate the effects of ultra-low-dose hormone therapy (Ultra-LD HT) with 17ß-estradiol 0.5 mg and norethisterone acetate 0.1 mg (E2 0.5/NETA 0.1) versus placebo on bone turnover markers (BTM) in postmenopausal women. STUDY DESIGN: A multicenter, double-blind, randomized, placebo-controlled study was performed with 107 participants who received one tablet daily of E2 0.5/NETA 0.1 or placebo for 24-weeks. Bone formation markers-N-terminal propeptide of type I procollagen (PINP) and Bone-specific alkaline phosphatase (BSAP), and bone resorption markers-C-telopeptide of type I collagen (CTX-I) and N-telopeptide crosslinked of type I collagen (NTX) were assessed before and at 12 and 24-weeks of treatment. RESULTS: Women treated with E2 0.5/NETA 0.1 had a significant reduction in the PINP marker from baseline (58.49 ± 21.12 µg/L) to week 12 (48.31 ± 20.99 µg/L) and week 24 (39.16 ± 16.50 µg/L). Placebo group, the PINP marker did not differ significantly. The analysis of the BSAP indicated a significant increase in the placebo group (13.8 ± 5.09 µg/L and 16.29 ± 4.3 µg/L, at baseline and week 24, respectively), whereas in the treatment group the values did not change. The analysis of the NTX marker showed a significant reduction only in the treatment group (43.21 ± 15.26 nM/mM and 33.89 ± 14.9 nM/mM, at baseline and week 24, respectively). CTX-I had a significant decrease in the treatment group from baseline (0.3 ± 0.16 ng/L) to week 12 (0.21 ± 0.14 ng/L) and week 24 (0.21 ± 0.12 ng/L). CONCLUSION: Women receiving E2 0.5/NETA 0.1 experienced reductions in bone resorption and formation markers, an expected effect during the anti-resorptive therapy, suggesting a protective bone effect with the Ultra-LD HT.

Association Between Metabolic Syndrome and Immunohistochemical Profile at Breast Cancer Diagnosis in Postmenopausal Women.

BACKGROUND: The aim of this study was to evaluate the association between metabolic syndrome (MetS) and the immunohistochemical profile of breast cancer (BC) in postmenopausal women. METHODS: This cross-sectional cohort study included 189 women, aged 45 to 75years and amenorrhea >12 months, with newly diagnosed BC and no previous cancer treatment. Clinical, anthropometric and biochemical data were collected, as well as data on BC hormone status (estrogen receptor, ER; progesterone receptor, PR; human epidermal growth factor receptor-2, HER-2), and epithelial proliferative activity (Ki-67). Tumors were divided into 5 subtypes:luminal A, luminal B HER-2 negative, luminal B HER-2 positive, non-luminal HER-2, and triple negative. Women with three or more of the following criteria were diagnosed with MetS: waist circumference ≥88cm; triglycerides ≥150mg/dL; HDL-cholesterol <50mg/dL; blood pressure ≥130/85mmHg; glucose ≥100mg/dL. RESULTS: Sixty-three (33.3%) of the 189 patients had MetS at the time of diagnosis. Women with MetS had a higher frequency of tumors ≤ 2cm than women without MetS (49.2% vs. 31.8%) (P = .038). There were no differences in histological grade, staging, or axillary lymph node metastasis (P > .05). The proportion of PR-positive (P = .006), HER-2-negative (P = .034), and luminal B HER-2-negative (P = .038) tumors was higher among patients with MetS compared to women without MetS (79.4% vs. 61.8%, 89.9% vs. 78.6% and 44.5% vs. 27.8%, respectively). Multivariate analysis adjusted for age, time since menopause and BMI showed a higher risk for luminal B HER-2-negative tumors among women with MetS (OR 2.00, 95% CI 1.03-3.89), obese patients (OR 2.03, 95% CI 1.06-3.90), and women with abdominal obesity (OR 1.96, 95% CI 1.01-4.03). CONCLUSION: In postmenopausal women with newly diagnosed BC, the presence of MetS was associated with smaller tumor size, PR-positive and HER-2-negative status, and the luminal B tumor subtype.

Sentinel Lymph Node Biopsy in T3 and T4b Breast Cancer Patients: Analysis in a Tertiary Cancer Hospital and Systematic Literature Review.

INTRODUCTION: Breast cancer represents the most common type of cancer among women in the world. The presence and extent of axillary lymph node involvement represent an important prognostic factor. Sentinel lymph node biopsy (SLNB) is currently accepted for T1 and T2 with negative axillae (N0); however, many patients with T3-T4b tumors with N0 are often submitted to unnecessarily axillary lymph node dissection. MATERIALS AND METHODS: This is a retrospective, observational study of patients treated for breast cancer between 2008 and 2015, with T3/T4b tumors and N0, who underwent SLNB. A systematic review of the literature was also carried out in 5 bases. RESULTS: We analyzed 73 patients, and SLNB was negative for macrometastasis in 60.3% of the cases. With a mean follow-up of 45 months, no ipsilateral axillary local recurrence was observed. In the systematic review, only 7 articles presented data for analysis. Grouping these studies with the present series, the rate of N0 was 32.1% for T3 and 61.0% for T4b; grouping all studies (T3 and T4b n = 431) the rate was 32.5%. CONCLUSIONS: SLNB in T3/T4b tumors is a feasible and safe procedure from the oncological point of view, as it has not been associated with ipsilateral axillary relapse.

High risk for cardiovascular disease in postmenopausal breast cancer survivors.

OBJECTIVE: Breast cancer patients have a higher mortality risk of cardiovascular disease (CVD) than women from the general population. CVD risk may increase significantly in postmenopausal women with early-stage breast cancer. The aim of this study was to evaluate risk factors for CVD in postmenopausal breast cancer survivors. METHODS: In this cross-sectional study, 96 postmenopausal breast cancer survivors were compared with 192 postmenopausal women. The main group included women with amenorrhea >12 months, aged ≥45 years, with breast cancer, and without established CVD. The control group fulfilled the same criteria, but did not have breast cancer. Groups were matched by age, time since menopause, and body mass index, in a ratio of 1 case to 2 controls (1:2). Women with three or more of the following criteria were diagnosed with metabolic syndrome: waist circumference >88 cm; triglycerides ≥150 mg/dL; high-density lipoprotein cholesterol <50 mg/dL; blood pressure ≥130/85 mm Hg; and glucose ≥100 mg/dL. Immunoassays were used (enzyme-linked immunosorbent assay test) for measurement of plasma heat shock proteins (HSP) 60 and 70 concentrations. Atherosclerotic disease was determined by intima-media thickness (>1 mm) of the carotid arteries and/or the presence of atheromatous plaque assessed by carotid artery ultrasound (scanner duplex). RESULTS: Breast cancer patients had higher HSP60 levels and lower HSP70 levels than controls (P < 0.05). Analysis showed that the odds of developing metabolic syndrome (odds ratio [OR] = 4.21, 95% CI, 2.28-7.76), atheromatous plaque (OR = 2.61, 95% CI, 1.19-5.72), diabetes (OR = 4.42; 95% CI, 1.86-10.49), hypertriglyceridemia (OR = 2.32, 95% CI, 1.33-4.0), and increased waist circumference (OR = 11.22, 95% CI, 4.0-31.65) was significantly higher in women treated for cancer than in women without breast cancer. CONCLUSIONS: Postmenopausal breast cancer survivors had a stronger association with risk factors for cardiovascular disease than postmenopausal women without breast cancer.

Low pretreatment serum concentration of vitamin D at breast cancer diagnosis in postmenopausal women.

OBJECTIVE: The aim of the study was to evaluate the rate of and risk factors for low pretreatment vitamin D (VitD) levels in postmenopausal breast cancer (BC) women, compared with postmenopausal women without BC. METHODS: A cross-sectional clinical study was conducted to compare 209 women with BC (case group) to 418 women without BC (control group), age range: 45 to 75 years. The case group consisted of women diagnosed with BC, amenorrhea ≥12 months, aged ≥45 years, without use of medication or clinical conditions that might interfere with VitD levels. The control group consisted of women with amenorrhea ≥12 months, aged ≥45 years, without BC. The groups were matched for age and time since menopause, at a case: control ratio of 1:2. Serum 25-hydroxyvitamin-D [25(OH)D] concentration was measured in all women 10 to 20 days after BC diagnosis and before the proposed treatment. Serum levels ≥30 ng/mL were defined as sufficient. The Student's t test or gamma distribution, χ test, and logistic regression (odds ratio, OR) were used for statistical analysis. RESULTS: The BC group had a higher body mass index (BMI) and higher percentage of obesity than the control group (57.4% vs 40.2%, P < 0.0001). In addition, rates of insufficient (20-29 ng/mL) and deficient (<20 ng/mL) 25(OH)D levels were higher in BC patients than in controls (55.6% vs 49.3%, P = 0.039 and 26.2% vs 20.3%, P = 0.018), respectively. In risk analysis (adjusted for age, time since menopause, and BMI), BC patients had a 1.5-fold higher risk of developing low VitD levels (OR = 1.52, 95% CI, 1.04-2.22, P = 0.029) than women without BC. CONCLUSIONS: Postmenopausal women had an increased risk of VitD deficiency at the time of BC diagnosis, associated with a higher rate of obesity, than women of the same age group without cancer.

Autophagy-related 16-like 1gene polymorphism, risk factors for cardiovascular disease and associated carotid intima-media thickness in postmenopausal women.

BACKGROUND: Early identification of asymptomatic postmenopausal women (PW), who are more predisposed to developing cardiovascular disease (CVD), is an important preventive strategy. Autophagy-related 16-like 1 (ATG16L1) is an autophagy gene known to control host immune responses and is associated with a variety of diseases, including CVD. OBJECTIVE: The aim of the study was to associate the ATG16L1 polymorphism variant with subclinical carotid atherosclerosis in asymptomatic PW. STUDY DESIGN: This cross-sectional study included 210 Brazilian postmenopausal women (age ≥ 45 years with amenorrhea ≥12 months). Clinical, anthropometric and biochemical assessments were performed to evaluate the cardiovascular risk factors. DNA was extracted from buccal cells and the ATG16L1 (T300A) polymorphism was determined by the polymerase chain reaction (PCR). The carotid intima-media thickness and/or the presence of plaques were evaluated by carotid duplex ultrasound. For statistical analysis, the t-test, logistic regression and analysis of covariance (ANCOVA) were used. RESULTS: The presence of the polymorphic allele forATG16L1 (T300A) was found in 77.47% (A/G = 49.87%, G/G = 27.60%). The ATG16L1 (T300A) polymorphism is significantly associated with increased carotid intima-media thickness (IMT) after adjustments of the confounding variables (P < .037). No significant associations were observed between the polymorphism with other risk factors for CVD in PW. CONCLUSION: In postmenopausal women, the ATG16L1 (T300A) polymorphism is significantly associated with increased carotid IMT (marker of atherosclerotic disease) after adjustments of the confounding variables (P < .037). Thus, identifying the ATG16L1 polymorphism is an important strategy for screening asymptomatic PW who are more predisposed to developing CVD.

Isolated vitamin D supplementation improves the immune-inflammatory biomarkers in younger postmenopausal women: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: The aim of this study was to evaluate the effect of vitamin D (VitD) supplementation on immune-inflammatory biomarkers in younger postmenopausal women. METHODS: In this double-blind, placebo-controlled trial, 160 postmenopausal women aged 50 to 65 years with amenorrhea ≥12 months were randomized into two groups: VitD group, oral supplementation with 1000 IU VitD3/day (n = 80) or placebo group (n = 80). The intervention time was 9 months, and the women were assessed at baseline and endpoint. Serum levels of interleukins (ILs)-1ß, IL-5, IL-6, IL-10, IL-12ρ70, IL-17α, tumor necrosis factor-alpha, and interferon-gamma were determined by immunoassay. Plasma concentrations of 25-hydroxyvitamin D [25(OH)D] were measured by high-performance liquid chromatography. Per-protocol analysis was adopted as the statistical method using a gamma distribution and repeated measures design, followed by Wald's multiple comparisons test. RESULTS: The two groups were similar at baseline in terms of clinical and laboratory parameters. After 9 months, there was a significant increase of 25(OH)D levels in the VitD group (+45.4%, P < 0.001) and a decrease (-18.5%, P = 0.049) in the placebo group. A significant decrease in IL-5, IL-12p70, IL-17α, tumor necrosis factor-alpha, and interferon-gamma levels was observed in the VitD group (P < 0.05). IL-5 and IL-6 levels were significantly lower in the VitD group compared to the placebo group (P < 0.05). There were no significant intervention effects on serum IL-1ß or IL-10 levels in either group (P > 0.05). CONCLUSIONS: In younger postmenopausal women, isolated supplementation with 1000 IU of VitD3 for 9 months was associated with a reduction in proinflammatory biomarkers.

Vitamin D deficiency is associated with metabolic syndrome in postmenopausal women.

OBJECTIVE: To evaluate the association between vitamin D (VD) deficiency and risk factors for metabolic syndrome (MetS) in postmenopausal women. STUDY DESIGN: Observational, cross-sectional cohort study. MAIN OUTCOME MEASURES: In this study, 463 women, aged 45-75 years, with amenorrhea >12months, without VD supplementation or established cardiovascular disease were included. Clinical and anthropometric data were collected. Biochemical parameters, including total cholesterol (TC), HDL, LDL, triglycerides, glucose, insulin and 25-hydroxyvitamin-D [25(OH)D] were measured. Women meeting three or more of the following criteria were diagnosed with MetS: waist circumference >88cm, triglycerides ≥150mg/dL, HDL <50mg/dL, blood pressure ≥130/85mmHg and glucose ≥100mg/dL. Serum 25(OH)D levels were classified as sufficient (≥30ng/mL), insufficient (20-29ng/mL) or deficient (<20ng/mL). ANOVA, chi-square test and logistic regression (odds ratio, OR) were used for statistical analysis. RESULTS: Serum 25(OH)D levels were sufficient in 148 women (32.0%), insufficient in 151 (32.6%) and deficient in 164 (35.4%). Women with low 25(OH)D levels had higher TC, triglycerides, insulin and HOMA-IR levels (p<0.05). MetS was detected in 57.8% (182/315) of women with hypovitaminosis D (insufficient and deficient) and in 39.8% (59/148) of those with sufficient VD​​ (p=0.003). In a multivariate logistic regression analysis, a low 25(OH)D level (<30ng/mL) was significantly associated with MetS (OR1.90, 95%CI=1.26-2.85), high triglyceride levels (OR1.55, 95%CI=1.13-2.35), and low HDL levels (OR1.60, 95%CI=1.19-2.40) (p<0.05) compared with women with sufficient 25(OH)D levels, after adjusting for age, time since menopause, body mass index, smoking and physical exercise. The mean concentration of 25(OH)D decreased with increasing numbers of MetS components (p=0.016). CONCLUSIONS: VD deficiency in postmenopausal women was associated with a higher prevalence of MetS. Women with VD deficiency had a higher risk of MetS, hypertriglyceridemia and low HDL than those with adequate levels.

Adding Soy Protein to Milk Enhances the Effect of Resistance Training on Muscle Strength in Postmenopausal Women.

Resistance training (RT) and high-quality protein ingestion improves muscle mass (MM) and strength (MS). However, no study has evaluated the effect of ingesting milk plus soy protein (SOY) on MM and MS in postmenopausal women (PW). Thus, the aim of this study was to evaluate the effects of adding SOY to milk on MM and MS after 16 weeks of RT. Thirty-two PW were randomized and allocated into two groups: placebo and RT (PL+RT, n = 16) and SOY and RT (SOY+RT, n = 16). The SOY+RT received 25 g of SOY while the PL+RT received 25 g of maltodextrin (placebo). All supplements were given in the form of a chocolate-flavored powder added to 200 mL of milk. The RT protocol consisted of eight total body exercises at 70% of one repetition maximum (1RM), three sets of 8-12 repetitions, 2-3 times/week. No differences were found in the baseline measures between groups (age, menopause status, anthropometric and nutrition patterns), except for protein intake, which was higher in the SOY+RT. Both groups increased the MM (bioimpedance) showing no difference between groups (PL+RT = 1.5 kg; SOY+RT = 1.1 kg). For MS, the SOY+RT showed a larger (p < .05) increase in 1RM of bench press (PL+RT = 6.7 kg; SOY+RT = 12.5 kg), knee extension (PL+RT = 3.7 kg; SOY+RT = 6.7 kg), total load (PL+RT = 15.1 kg; SOY+RT = 24.2 kg), and the total load exercises/MM (PL+RT = 0.3 kg; SOY+RT = 0.9 kg). These results suggest that adding SOY to milk combined with 16 weeks of RT resulted in more significant increases in MS in PW.

Vitamin D deficiency is associated with poor breast cancer prognostic features in postmenopausal women.

This study aimed to evaluate the association between pretreatment vitamin D (VD) deficiency with breast cancer prognostic features in Brazilian postmenopausal women. An analytical cross sectional study was conducted with 192 women, aged 45-75 years, attended at University Hospital. Women with recent diagnosis of breast cancer, in amenorrhea >12months and age ≥45 years, without medication use or clinical conditions that interfere with VD values were included. Clinical and anthropometric data were collected. Serum level of 25 hydroxyvitamin D [25(OH)D] was measured in all patients until 20days after breast cancer diagnosis, and was classified as normal (≥30ng/mL), insufficiency (20-29ng/mL) and deficiency (<20ng/mL). Data on breast cancer (histopathological type, grade, tumor stage, lymph node status), hormone status (estrogen receptor, ER, progesterone receptor, PR), human epidermal growth factor receptor type 2 (HER2) and epithelial proliferative activity (Ki-67) were collected. For statistical analysis, the t-student test, the Gamma Distribution (asymmetric variables), the chi-square test and the logistic regression (OR-odds ratio) were used. The median 25(OH)D level was 25.8ng/mL (range 12.0-59.2ng/mL). Sufficient vitamin D levels were detected in 65 patients (33.9%), whereas insufficient levels in 92 patients (47.9%), and deficient levels in 35 patients (18.2%). Participants with insufficient and deficient 25(OH)D levels had a higher proportion of tumors with a high grade and locally advanced and metastatic disease, more positive lymph node, a lower proportion of ER, PR positives tumors and higher Ki-67(p<0.05). Patients with normal vitamin D had a higher frequency of luminal A (47.7%) and luminal B (32.2%) tumors when compared to patients with vitamin D insufficiency or deficiency. Furthermore, all cases of triple negative were detected in women with low VD levels. Multivariate analysis, after adjusting for age, time since menopause and BMI, showed that insufficient and deficient level of vitamin D were significantly associated with negative estrogen receptor (OR 3.77 CI 95% 1.76-8.09 and OR 3.99 CI 95% 1.83-8.68), high Ki-67 (OR 2.50, CI 95% 1.35-4.63, and OR 2.62, CI 95% 1.40-4.98), and positive axillary lymph node status (OR 1.59, CI 95% 1.03-2.33, and OR 1.58, CI 95% 1.02-2.92) respectively. In Brazilian postmenopausal women with breast cancer, there was an association between vitamin D insufficiency or deficiency and tumors with worse prognostic features. Low vitamin D levels were shown to be a risk factor for ER negative tumors, with positive axilla and a higher rate of cell proliferation.

Physical Activity Level of Post-menopausal Women with Low Bone Mineral Density.

Introduction Proper physical activity is related to the prevention and the treatment of osteoporosis. Purpose To assess the level of physical activity (PA) in post-menopausal women with low bone mineral density (BMD). Methods This cross-sectional clinical study included 123 post-menopausal women. The inclusion criteria were: age of ≥ 45 years with last menses at least 12 months prior to the initiation of the study, and bone density scan (BDS) values measured over the preceding 12 months. Women with severe osteoarthritis were excluded. Women were allocated into three groups, according to BMD measured by BDS [osteoporosis (OP; 54 women), osteopenia (35 women), and normal bone density (NBD; 35 women)], and compared for general, clinical, and anthropometric data, and for PA level. The latter was assessed using the International Physical Activity Questionnaire (IPAQ), in metabolic equivalent of task (MET) units. Participants were classified as sedentary, active or very active. Quantitative variables were compared using ANOVA followed by Tukey's test. Associations between qualitative variables were tested by Chi-square (χ2) or Fisher's exact test. In order to check for differences among groups and IPAQ domains, a generalized linear model with Gamma distribution was adjusted for values in METs. Results The OP group differed from the NBD group regarding age (61.8 ± 10.1 and 52.9 ± 5.4 years), percentage of participants with self-declared white ethnicity (43.9 and 28.0%), body mass index (BMI - 25.7 ± 5.4 and 30.9 ± 5.1 kg/m(2)), and time since menopause (15.5 ± 7.5 and 5.8 ± 4.5 years). Smoking rates were higher in the OP (55.6%) and NBD groups (33.3%) than in the osteopenia group (11.1%). Within the OP group, the rate of subjects with sedentary lifestyles was higher (42.6%), and time spent sitting was greater (344.3 ± 204.8 METs) than in the groups with osteopenia (20.0% and 300.9 ± 230.6 METs) and NBD (17.7% and 303.2 ± 187.9 METs). Conclusions The rate of sedentary lifestyles was higher in post-menopausal women with OP than in those with either osteopenia or NBD. In order to change this physical inactivity profile, strategies should be created to address this group of patients.

Physical Activity Level of Post-menopausal Women with Low Bone Mineral Density / Nível de atividade física de mulheres menopausadas com baixa densidade mineral óssea

Abstract Introduction Proper physical activity is related to the prevention and the treatment of osteoporosis. Purpose To assess the level of physical activity (PA) in post-menopausal women with low bone mineral density ( BMD ). Methods This cross-sectional clinical study included 123 post-menopausal women. The inclusion criteria were: age of 45 years with last menses at least 12 months prior to the initiation of the study, and bone density scan (BDS) values measured over the preceding 12 months. Women with severe osteoarthritis were excluded. Women were allocated into three groups, according to BMD measured by BDS [osteoporosis (OP; 54 women), osteopenia (35 women), and normal bone density (NBD; 35 women)], and compared for general, clinical, and anthropometric data, and for PA level. The latter was assessed using the International Physical Activity Questionnaire (IPAQ), in metabolic equivalent of task (MET) units. Participants were classified as sedentary, active or very active. Quantitative variables were compared using ANOVA followed by Tukey's test. Associations between qualitative variables were tested by Chi-square (χ2) or Fisher's exact test. In order to check for differences among groups and IPAQ domains, a generalized linear model with Gamma distribution was adjusted for values in METs. Results The OP group differed from the NBD group regarding age (61.8 10.1 and 52.9 5.4 years), percentage of participants with self-declared white ethnicity (43.9 and 28.0%), body mass index (BMI - 25.7 5.4 and 30.9 5.1 kg/m2), and time since menopause (15.5 7.5 and 5.8 4.5 years). Smoking rates were higher in the OP (55.6%) and NBD groups (33.3%) than in the osteopenia group (11.1%). Within the OP group, the rate of subjects with sedentary lifestyles was higher (42.6%), and time spent sitting was greater (344.3 204.8 METs) than in the groups with osteopenia (20.0 % and 300.9 230.6 METs) and NBD (17.7% and 303.2 187.9 METs). Conclusions The rate of sedentary lifestyles was higher in post-menopausal women with OP than in those with either osteopenia or NBD. In order to change this physical inactivity profile, strategies should be created to address this group of patients.

Resumo Introdução Atividade física adequada está relacionada com a prevenção e o tratamento da osteoporose. Objetivo Avaliar o nível de atividade física em mulheres na pós-menopausa com baixa densidade mineral óssea ( DMO ). Métodos Este estudo clínico transversal incluiu 123 mulheres na pós-menopausa. Os critérios de inclusão foram idade 45 anos, com última menstruação pelo menos 12 meses antes do início do estudo, e DMO medida nos últimos 12 meses. Foram excluídas mulheres com osteoartrite grave. As mulheres foram divididas em três grupos, de acordo com DMO medida por densitometria óssea [osteoporose (OP; 54 mulheres), osteopenia (35 mulheres) e DMO normal (NBD; 35 mulheres)], e comparadas com dados gerais, clínicos e antropométricos, e quanto ao nível de atividade física. Este último foi avaliado pelo International Physical Activity Questionnaire (IPAQ), em unidades de metabolic equivalent of task (METs). As participantes foram classificadas como sedentárias, ativas ou muito ativas. As variáveis quantitativas foram comparadas por ANOVA seguida pelo teste de Tukey. As associações entre as variáveis qualitativas foram testadas por Qui-quadrado (χ2) ou exato de Fisher. Para verificar diferenças entre os grupos e domínios do IPAQ, um modelo linear generalizado com distribuição Gama foi ajustado para os valores em METs. Resultados O grupo OP diferiu do NBD quanto à idade (61,8 10,1 e 52,9 5 , 4 anos), porcentagem de etnia autorrelatada branca (43,9 e 28,0%), índice de massa corporal (25,7 5,4 e 30,9 5,1 kg/m2) e tempo da menopausa (15,5 7,5 e 5,8 4,5 anos). As taxas de tabagismo foram maiores nos grupos com OP (55,6 % ) e NBD (33,3%) do que no com osteopenia (11,1%). No grupo com OP, sedentarismo (42,6%) e tempo gasto sentado foram maiores (344,3 204.8 METs) do que nos com osteopenia (20,0% e 300,9 230,6 METs) e NBD (17,7% e 303,2 187,9 METs). Conclusões O sedentarismo foi maior em mulheres na pós-menopausa com osteoporose do que naquelas com osteopenia ou NBD. Estratégias devem ser criadas para alterar este perfil de inatividade física neste grupo de pacientes.

Metabolic syndrome as a predictor of endometrial polyps in postmenopausal women.

OBJECTIVE: The aim of the study was to evaluate clinical predictive factors for endometrial polyps in postmenopausal women compared with postmenopausal women without polyps. METHODS: In this cross-sectional study, 132 Brazilian women with a histopathological diagnosis of endometrial polyps were compared with 264 women without endometrial alterations (control). The study group included women aged at least 45 years with amenorrhea for at least 12 months, who underwent hysteroscopic polypectomy. The control group consisted of women aged at least 45 years with amenorrhea for at least 12 months, without postmenopausal bleeding and endometrial thickness less than 5 mm by transvaginal ultrasonography. Clinical, anthropometric (body mass index and waist circumference), laboratory, and ultrasonographic data were collected to evaluate predictive factors for endometrial polyps. The Student's t test, χ test, and logistic regression (odds ratio [OR]) were used for statistical analysis. RESULTS: A higher percentage of women with polyps were obese (72%) when compared with control (39%) (P < 0.0001). Waist circumference was greater among women with polyps (P = 0.0001). The incidence of diabetes, hypertension, and dyslipidemia was higher among women with endometrial polyps (P < 0.0001). According to the diagnostic criteria of the US National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III), 48.5% of the women with polyps and 33.3% of the controls were classified as having metabolic syndrome (MetS) (P = 0.004). The risk of endometrial polyps was higher in women with body mass index at least 25 kg/m (OR = 4.66; 95% CI 2.16-10.05); glucose at least 100 mg/dL (OR = 2.83; 95% CI 1.36-5.90); dyslipidemia (OR = 7.02; 95% CI 3.70-13.32); diabetes (OR = 2.58; 95% CI 1.05-6.32); and MetS (OR = 2.76; 95% CI 1.18-6.46) when compared with control, adjusted for age, and time since menopause. CONCLUSIONS: In postmenopausal women, obesity, dyslipidemia, hyperglycemia, and the presence of MetS were predictive factors for endometrial polyps.

Effect of isolated vitamin D supplementation on the rate of falls and postural balance in postmenopausal women fallers: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To evaluate the effect of isolated vitamin D supplementation (VITD) on the rate of falls and postural balance in postmenopausal women fallers. METHODS: In this double-blind, placebo-controlled trial, 160 Brazilian younger postmenopausal women were randomized into two groups: VITD group, vitamin D3 supplementation 1,000 IU/day/orally (n = 80) and placebo group (n = 80). Women with amenorrhea at least 12 months, age 50 to 65 years, and a history of falls (previous 12 months) were included. Those with neurological or musculoskeletal disorders, vestibulopathies, drugs use that could affect balance and osteoporosis were excluded. The intervention time was 9 months. Postural balance was assessed by stabilometry (computerized force platform) and investigation on the occurrence/recurrence of falls was performed by interviews. The plasma concentration of 25-hydroxyvitamin D [25(OH)D] was measured by high-performance liquid chromatography. Statistical analysis was achieved by intention-to-treat, using analysis of variance, Student's t test, Tukey test, chi-square, and logistic regression. RESULTS: After 9 months, mean values of 25(OH)D increased from 15.0 ±â€Š7.5 ng/mL to 27.5 ±â€Š10.4 ng/mL (+45.4%) in the VITD group, and decreased from 16.9 ±â€Š6.7 ng/mL to 13.8 ±â€Š6.0 ng/mL (-18.5%) in the placebo group (P < 0.001). The occurrence of falls was higher in the placebo group (+46.3%) with an adjusted risk of 1.95 (95% confidence interval [CI] 1.23-3.08) times more likely to fall and 2.80 (95% CI 1.43-5.50) times higher for recurrent falls compared to the VITD group (P < 0.001). There was reduction in body sway by stabilometry, with lower amplitude of antero-posterior (-35.5%) and latero-lateral (-37.0%) oscillation, only in the VITD group (P < 0.001). CONCLUSIONS: In Brazilian postmenopausal women fallers, isolated vitamin D supplementation for 9 months resulted in a lower incidence of falls and improvement in postural balance.

[Prevalence of low bone mineral density in postmenopausal breast cancer survivors]. / Prevalência da baixa densidade mineral óssea em mulheres na pós-menopausa tratadas de câncer de mama.

PURPOSE: To evaluate the prevalence of low bone mineral density (BMD) in postmenopausal breast cancer survivors. METHODS: In this cross-sectional study, 115 breast cancer survivors, seeking healthcare at a University Hospital in Brazil, were evaluated. Eligibility criteria included women with amenorrhea ≥ 12 months and age ≥ 45 years, treated for breast cancer and metastasis-free for at least five years. BMD was measured by DEXA at the lumbar spine (L1-L4) and femoral neck. Low BMD was considered when total-spine and/or femoral-neck T-score values were <-1.0 Delphi Score (DP) (osteopenia and osteoporosis). The risk factors for low BMD were assessed by interview. Data were analyzed statistically by the χ(2) test and Fisher's exact test. RESULTS: The mean age of breast cancer survivors was 61.6 ± 10.1 years and time since menopause was 14.2 ± 5.6 years, with a mean follow-up of 10.1 ± 3.9 years. Considering spine and femoral neck, 60% of breast cancer survivors had low BMD. By evaluating the risk factors for low BMD, a significant difference was found in the percent distribution for age (higher % of women >50 years with low BMD), personal history of previous fracture (11.6% with low BMD versus 0% with normal BMD) and BMI. A higher frequency of obesity was observed among women with normal BMD (63%) compared to those with low BMD (26.1%) (p<0.05). CONCLUSION: Postmenopausal breast cancer survivors had a high prevalence of osteopenia and osteoporosis.

Prevalência da baixa densidade mineral óssea em mulheres na pós-menopausa tratadas de câncer de mama / Prevalence of low bone mineral density in postmenopausal breast cancer survivors

OBJETIVO: Avaliar a prevalência da baixa densidade mineral óssea (DMO) em mulheres na pós-menopausa tratadas de câncer de mama. MÉTODOS: Estudo de corte transversal que incluiu 115 mulheres tratadas de câncer de mama atendidas em Hospital Universitário do Sudeste do Brasil. Foram incluídas mulheres com amenorreia há 12 meses ou mais e 45 anos ou mais de idade, tratadas de câncer de mama e livres de doença há pelo menos 5 anos. A DMO foi mensurada pelos raios-X de dupla energia em coluna lombar (L1 a L4) e colo de fêmur. Considerou-se baixa DMO quando valores de T-score de coluna total e/ou colo de fêmur <-1,0 Score de Delphi (DP) (osteopenia e osteoporose). Por meio de entrevista, foram avaliados fatores de risco para baixa DMO. Na análise estatística, empregaram-se os testes do χ2 ou Exato de Fisher. RESULTADOS: A média de idade das pacientes foi 61,6±10,1 anos e o tempo de menopausa, 14,2±5,6 anos, com tempo médio de seguimento de 10,1±3,9 anos. Considerando coluna e colo de fêmur, 60% das mulheres tratadas de câncer de mama apresentavam baixa DMO. Avaliando os fatores de risco para baixa DMO, foi encontrada diferença significativa na distribuição percentual quanto à idade (maior porcentagem de mulheres com mais de 50 anos e baixa DMO), história pessoal de fratura prévia (11,6% com baixa DMO e nenhuma com DMO normal) e índice de massa corpórea. Maior frequência de obesidade foi observada entre mulheres com DMO normal (63%) quando comparadas àquelas com baixa DMO (26,1%; p<0,05). CONCLUSÃO: Mulheres na pós-menopausa tratadas de câncer de mama apresentaram elevada prevalência de baixa DMO (osteopenia e/ou osteoporose). .

PURPOSE: To evaluate the prevalence of low bone mineral density (BMD) in postmenopausal breast cancer survivors. METHODS: In this cross-sectional study, 115 breast cancer survivors, seeking healthcare at a University Hospital in Brazil, were evaluated. Eligibility criteria included women with amenorrhea ≥12 months and age ≥45 years, treated for breast cancer and metastasis-free for at least five years. BMD was measured by DEXA at the lumbar spine (L1-L4) and femoral neck. Low BMD was considered when total-spine and/or femoral-neck T-score values were <-1.0 Delphi Score (DP) (osteopenia and osteoporosis). The risk factors for low BMD were assessed by interview. Data were analyzed statistically by the χ2 test and Fisher's exact test. RESULTS: The mean age of breast cancer survivors was 61.6±10.1 years and time since menopause was 14.2±5.6 years, with a mean follow-up of 10.1±3.9 years. Considering spine and femoral neck, 60% of breast cancer survivors had low BMD. By evaluating the risk factors for low BMD, a significant difference was found in the percent distribution for age (higher % of women >50 years with low BMD), personal history of previous fracture (11.6% with low BMD versus 0% with normal BMD) and BMI. A higher frequency of obesity was observed among women with normal BMD (63%) compared to those with low BMD (26.1%) (p<0.05). CONCLUSION: Postmenopausal breast cancer survivors had a high prevalence of osteopenia and osteoporosis. .

[Predictive factors for occurrence of endometrial polyps in postmenopausal women.] / Fatores preditivos para a ocorrência de pólipos endometriais em mulheres na pós-menopausa.

PURPOSE: To evaluate the predictive clinical factors for the development of endometrial polyps in postmenopausal women. METHODS: Observational cohort study with postmenopausal women who had been at a public university hospital. Clinical, anthropometrical, laboratorial, and ultrasonographic data of 132 patients with a histopathological diagnosis of endometrial polyps and 264 women without endometrial alterations (control) were compared in order to evaluate the predictive factors of endometrial polyps. Women with amenorrhea ≥12 months and ≥45 years of age were included in the study at a proportion of 1 case for 2 controls. The Student's t, χ2, and logistic regression tests were used for statistical analysis - odds ratio (OR). RESULTS: Patients with endometrial polyps were older and had been in menopause for a longer time compared to control (p<0.0001). The percentage of obese women with polyps (72.0%) was higher compared to the Control Group (39%; p<0.0001). The measurement of waist circumference was superior among patients with polyps (p=0.0001). We observed a higher incidence of diabetes, hypertension and dyslipidemia in patients with endometrial polyps (p<0.0001). According to the US National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) criteria, 48.5% of women with polyps and 33.3% of the Control Group were classified as having metabolic syndrome (p=0.004). Analysis of risk for endometrial polyps formation showed higher chances of occurrence of the disorder in patients with: BMI≥25 kg/m2 (OR=4.6; 95%CI 2.1-10.0); glucose ≥100 mg/dL (OR=2.8; 95%CI 1.3-5.9); dyslipidemia (OR=7.0; 95%CI 3.7-13.3); diabetes (OR=2.5; 95%CI 1.0-6.3), and metabolic syndrome (OR=2.7; 95%CI 1.1-6.4) compared to the Control Group. CONCLUSION: In postmenopausal women, obesity, dyslipidemia, hyperglycemia and presence of metabolic syndrome were predictive factors for the development of endometrial polyps.

Clinical and psychological repercussions of videolaparoscopic tubal ligation: observational, single cohort, retrospective study / Repercussões clínicas e psíquicas da ligadura tubária videolaparoscópica: estudo observacional de coorte única, retrospectivo

CONTEXT AND OBJECTIVE: Tubal ligation is one of the most commonly used contraceptive methods worldwide. Since the controversy over the potential effects of tubal sterilization still continues, this study aimed to evaluate the clinical and psychological repercussions of videolaparoscopic tubal ligation. DESIGN AND SETTING: Observational, single cohort, retrospective study, conducted in a tertiary public hospital. METHODS: A questionnaire was applied to 130 women aged 21-46 years who underwent videolaparoscopic tubal ligation by means of tubal ring insertion or bipolar electrocoagulation and sectioning, between January 1999 and December 2007. Menstrual cycle interval, intensity and duration of bleeding, premenstrual symptoms, dysmenorrhea, dyspareunia, noncyclic pelvic pain and degree of sexual satisfaction were assessed in this questionnaire. Each woman served as her own control, and comparisons were made between before and after the surgical procedure and between the two techniques used. RESULTS: The clinical and psychological repercussions were significant, with increases in bleeding (P = 0.001), premenstrual symptoms (P < 0.001), dysmenorrhea (P = 0.019) and noncyclic pelvic pain (P = 0.001); and reductions in the number of sexual intercourse occurrences per week (P = 0.001) and in libido (P = 0.001). Women aged ≤ 35 years at the time of sterilization were more likely to develop menstrual abnormalities. The bipolar electrocoagulation method showed greater clinical and psychological repercussions. CONCLUSION: Regardless of the technique used, videolaparoscopic tubal ligation had repercussions consisting of increased menstrual flow and premenstrual symptoms, especially in women aged ≤ 35 years, and also had a negative influence on sexual activity. .

CONTEXTO E OBJETIVO: A ligadura tubária é um dos métodos contraceptivos mais utilizados em todo o mundo. Como a controvérsia sobre seus possíveis efeitos ainda continua, o objetivo deste estudo foi avaliar as repercussões clínicas e psíquicas da laqueadura videolaparoscópica. TIPO DE ESTUDO E LOCAL: Estudo observacional de coorte único, retrospectivo, conduzido em hospital público terciário. MÉTODOS: Foi aplicado um questionário a 130 mulheres, entre 21-46 anos, submetidas à ligadura tubária videolaparoscópica, pelas técnicas de eletrocoagulação bipolar/secção ou inserção do anel tubário, entre janeiro de 1999 e dezembro de 2007. Nesse questionário avaliou-se: intervalo do ciclo menstrual, intensidade e duração do sangramento, sintomas pré-menstruais, dismenorreia, dispareunia, dor pélvica não cíclica e grau de satisfação sexual. Cada mulher serviu como seu próprio controle, foi realizada análise comparativa entre os períodos pré- e pós-cirúrgico e entre as duas técnicas utilizadas. RESULTADOS: As repercussões clínicas e psicológicas mostraram-se significativas, com aumento de sangramento (P = 0,001), de sintomas pré-menstruais (P < 0,001), dismenorreia (P = 0,019), dor pélvica não cíclica (P = 0,001), e redução no número de relações sexuais por semana (P = 0,001) e na libido (P = 0,001). Mulheres com idade ≤ 35 anos, no momento da laqueadura, mostraram-se mais propensas a desenvolverem alterações menstruais. A técnica de eletrocoagulação bipolar mostrou maiores repercussões clínicas e psíquicas. CONCLUSÃO: A ligadura tubária videolaparoscópica, independentemente da técnica, repercutiu com ...

Clinical and psychological repercussions of videolaparoscopic tubal ligation: observational, single cohort, retrospective study.

CONTEXT AND OBJECTIVE: Tubal ligation is one of the most commonly used contraceptive methods worldwide. Since the controversy over the potential effects of tubal sterilization still continues, this study aimed to evaluate the clinical and psychological repercussions of videolaparoscopic tubal ligation. DESIGN AND SETTING: Observational, single cohort, retrospective study, conducted in a tertiary public hospital. METHODS: A questionnaire was applied to 130 women aged 21-46 years who underwent videolaparoscopic tubal ligation by means of tubal ring insertion or bipolar electrocoagulation and sectioning, between January 1999 and December 2007. Menstrual cycle interval, intensity and duration of bleeding, premenstrual symptoms, dysmenorrhea, dyspareunia, noncyclic pelvic pain and degree of sexual satisfaction were assessed in this questionnaire. Each woman served as her own control, and comparisons were made between before and after the surgical procedure and between the two techniques used. RESULTS: The clinical and psychological repercussions were significant, with increases in bleeding (P = 0.001), premenstrual symptoms (P < 0.001), dysmenorrhea (P = 0.019) and noncyclic pelvic pain (P = 0.001); and reductions in the number of sexual intercourse occurrences per week (P = 0.001) and in libido (P = 0.001). Women aged ≤ 35 years at the time of sterilization were more likely to develop menstrual abnormalities. The bipolar electrocoagulation method showed greater clinical and psychological repercussions. CONCLUSION: Regardless of the technique used, videolaparoscopic tubal ligation had repercussions consisting of increased menstrual flow and premenstrual symptoms, especially in women aged ≤ 35 years, and also had a negative influence on sexual activity.