Maturitas

Editorial Board

2012-02-01

Natriuretic peptides, gender and cardiovascular risk: What is the link?

Rajalakshmi Santhanakrishnan, Carolyn S.P. Lam — 2011-12-05

Prominent sex differences in cardiovascular risk, where women appear to enjoy cardioprotection relative to men until menopause, have fuelled widespread interest in sex hormones as chief modulators of cardiovascular risk. Indeed, until this century it was widely believed that inter-gender differences in cardiovascular risk hinged on female sex hormones being the ‘good players’ in reducing risk. According to this concept, men were disadvantaged by their lack of estrogens, and women at menopause were thought to lose their protection through loss of estrogens, suggesting hormone replacement therapy (HRT) would provide cardiovascular protection. However, the Women's Health Initiative published in 2002 showed that HRT was not cardioprotective, but in fact potentially harmful, in post-menopausal women and the medical community was forced to re-examine these long-held beliefs.

News about Black cohosh

Wolfgang Wuttke, Dana Seidlova-Wuttke — 2011-12-16

Black cohosh preparations are not all the same. In the last decade sales of hormone therapy for the treatment of climacteric complaints and postmenopausal diseases such as osteoporosis have declined since publication of the results of the Women's Health Initiative and the Million Women Study. Demand for non hormonal options has increased such as preparations containing extracts from the rhizome of Actaea racemosa (synonyms: Cimicifuga racemosa, Black cohosh). These are used to improve climacteric complaints especially hot flushes. It is thought that endorphin concentrations in the hypothalamus decrease with declining estrogen production at the menopause, enhancing release of norepinephrine and serotonin. This lowers the set point in the thermoregulatory nucleus and leads to inappropriate heat-loss mechanisms experienced as hot flushes .

Chronic kidney disease and diabetes

Ronald Pyram, Abhishek Kansara, Mary Ann Banerji, Lisel Loney-Hutchinson — 2011-11-18

Abstract: Chronic kidney disease has a significant worldwide prevalence affecting 7.2% of the global adult population with the number dramatically increasing in the elderly. Although the causes are various, diabetes is the most common cause of CKD in the United States and an increasing cause of the same worldwide. Therefore, we chose to focus on diabetic chronic kidney disease in this review.The pathogenesis is multifactorial involving adaptive hyperfiltration, advanced glycosylated end-product synthesis (AGES), prorenin, cytokines, nephrin expression and impaired podocyte-specific insulin signaling. Treatments focus on lifestyle interventions including control of hyperglycemia, hypertension and hyperlipidemia as well treatment of complications and preparation for renal replacement therapy. This review examines the current literature on the epidemiology, pathogenesis, complications and treatment of CKD as well as possible areas of future disease intervention.

Rehabilitation after stroke in older people

Michaela M. Pinter, Michael Brainin — 2011-12-15

Abstract: Stroke is a leading cause of disability and therefore rehabilitation is a major part of patient care. Most interventions do not target aged patient but there is unequivocal evidence to promote rehabilitation in multidisciplinary stroke units or integrated care of a multidisciplinary team in the community. Most research has focused on the effect of interventions on recovery in different forms of impairment and disability. The most promising options for motor recovery of the arm include constraint-induced movement therapy and robotic-assisted strategies. Interventions to improve postural stability and gait include fitness training, high-intensity therapy, and repetitive-task training. However, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice are underway to test these interventions in the elderly, either alone or in combination with early mobilisation, cardiorespiratory fitness training and physical exercise.

Sarcopenia in the elderly: Diagnosis, physiopathology and treatment

Vincenzo Malafarina, Francisco Úriz-Otano, Raquel Iniesta, Lucía Gil-Guerrero — 2011-11-28

Abstract: Sarcopenia, defined as a syndrome rather than as a pathology, is the loss of muscle mass and function associated with age. Sarcopenia is an enigma for medicine, and despite the numerous publications available in the literature and the number of papers currently being published, there is no agreement about its definition, and even less about its root causes. One salient aspect that proves the lack of consensus is the fact that different working groups are still debating about the right name for this syndrome (which is associated with the loss of muscle mass and strength in the elderly).In hospitalized patients, sarcopenia has been shown to raise the risk of complications such as infections, pressure ulcers, loss of autonomy, institutionalization and poor quality of life, as well as to increase mortality.The factors that contribute to the development of sarcopenia in the elderly are: the state of chronic inflammation, atrophy of motoneurons, reduced protein intake (secondary among others to the condition defined as geriatric anorexia), and immobility. There is ongoing debate about the causes of sarcopenia, but the aspect that generates most interest today is the quest to achieve repeatable and clinically useful diagnostic criteria for its diagnosis, prevention and treatment.The aim of this narrative review is to summarise the abundant information available in the literature and to draw useful conclusions.

Age, weight and obesity

2011-12-19

Abstract: The western world is facing the consequences of higher standards of medical care and improved living conditions. While people are living longer the prevalence of overweight and obesity is escalating which increases the risk of developing non-communicable diseases. However it must be noted that there is a U shaped relationship between weight and mortality with both under and overweight increasing risk. This review examines possible contributory factors for overweight and obesity in older people: life style, depression, changes in body composition, endocrine alterations, sympathetic tone, oxidative stress and concomitant disease.

Depressive disorders and the menopause transition

2011-12-12

Abstract: Aim: Depressive disorders and symptoms are common among middle-aged women. The effects of hormones on depression remain unclear. This review aims to clarify the nature of depressive disorders during the menopause transition as well as their links with climacteric syndrome, sexuality, cardiovascular risk and cognitive function.Material and methods: The recent literature on depressive disorders and menopause is reviewed.Results and conclusions: Women are more vulnerable than men to depressive disorders. Endocrine influences have been postulated but differences in, for example, coping style and response to stress may also contribute to the gender difference in the prevalence of depressive disorders. Gender differences in socialization may lead to higher rates of depression in women. There are data top suggest that menopause and depression are associated, although there is not a common clear causative factor. Women with climacteric symptoms (hot flushes, night sweats, vaginal dryness and dyspareunia) are more likely to report anxiety and/or depressive symptoms. Bothersome vasomotor symptoms could be associated with sleep disturbances, which in turn can increase reports of anxiety and depressive symptoms. Biopsychosocial and partner factors have a significant influence on middle-aged women's sexuality and depressive disorders, and most antidepressants can have a negative effect on sexual response. Lastly, studies have consistently shown that women with high levels of depressive symptoms are at greater cardiovascular risk and have poorer cognitive function than non-depressed women. At present, a direct relationship between psychiatric symptoms and hormonal changes such as estrogen decrease has not been clearly found. Stress, educational level, ethnicity, socioeconomic factors and partner status may influence the prevalence and clinical course of both menopause symptoms and depressive disorders. Since in many cases depression is a lifelong condition, and is associated with severe comorbid conditions, further studies are needed to improve the early diagnosis of depression; it may be advisable to monitor a woman's mental health during the menopause transition to prevent a depressive disorder having long-term negative consequences.

A review of smoking cessation interventions for smokers aged 50 and older

2011-12-12

Abstract: Objectives: Cigarette smoking poses substantial health risks at any age, but is particularly dangerous for older smokers, who are already at heightened risk for various health conditions. Studies suggest that older smokers are motivated to quit and succeed, but few of these have been randomized controlled trials. There is a need to systematically evaluate the research on effective interventions in older smokers.Methods: We followed PRISMA guidelines in the development of this systematic review, which included randomized controlled trials of cessation interventions with smokers aged 50 or older.Results: We found 740 unique titles matching specified search criteria; 13 met final eligibility criteria. Nearly all the cessation treatments combined counseling with other strategies. Eight studies provided smoking cessation medications. None of the studies used newer forms of technology such as web- or text-based interventions. Nine of the 13 studies reported a significant intervention effect at one or more time points, with three studies reporting sustained treatment effects at 12mos or longer. In general, more intensive interventions and those with combined approaches including medications and follow-up counseling achieved the best outcomes.Conclusion: The quit rates from these studies and the relative effectiveness of different intervention approaches are consistent with the general smoking cessation literature. However, in most studies, treatment effects were of short duration, and absolute quit rates were low, leaving the vast majority of older smokers at high risk for smoking-related health conditions. This systematic review suggests a need for additional research to design and test future interventions specifically tailored for older smokers.

Association between depression and bone mineral density in community-dwelling older men and women in Korea

Sun Min Oh, Hyeon Chang Kim, Song Vogue Ahn, Yumie Rhee, Il Suh — 2011-11-22

Abstract: Objectives: Previous research suggested a significant correlation between depression and osteoporosis, but little is known for the elderly Asian population. We investigated an association between depression and bone mineral density (BMD) in the Korean elderly.Study design: Cross-sectional data analysis of a community-based study, Kangwha Island, South Korea.Main outcome measures: BMD, measured at the os calcis using a quantitative ultrasound device, was expressed as stiffness index and T-score. Depressive symptoms were evaluated by the Korean version of Beck Depression Inventory (K-BDI). Depression was defined as a K-BDI score of 16 or higher. Participants also completed a questionnaire, including demographic factors, metabolic abnormalities, and health-related lifestyle factors.Results: A total of 932 local residents (422 men and 510 women) aged 60–80 years completed the questionnaires and baseline BMD evaluation. Men with depression had a significantly lower stiffness index compared to those without depression in an age-adjusted (77.2±5.2 vs. 86.0±1.5, p=0.002) and a multivariate-adjusted model (78.5±5.2 vs. 85. 9±1.5, p=0.007). Correspondingly, men with depression had an increased probability of having an osteoporosis (T-score≤−2.5) compared to those without depression; the age-adjusted odds ratio was 2.86 (95% CI, 1.36–6.01) and the multivariate-adjusted odds ratio was 2.69 (95% CI, 1.26–5.76). However, no significant association was observed in older women.Conclusions: Depression was significantly associated with lower BMD in Korean older men, but not in women.

The selection of items for the preliminary version of the COURAGE in Europe built environment instrument

2011-12-05

Abstract: The built environment can increase or decrease disability through its impact on mobility or accessibility to infrastructures, and through its relation to social environment. There is a need for the development of a tool which allows to assess built environment in both objective and self-reported manner, contemplating also issues of accessibility and disability, and that allows data comparability across countries and populations.The present paper describes the preliminary process of the development of a new built environment instrument. It describes the process of the selection, creation and categorisation of a pool of items from the 31 instruments resulting from the UDHP Project.A pool of items was created and was used to produce two lists: the outdoor checklist, and the self-reported questionnaire. These two lists formed the basis of the COURAGE in Europe built environment instrument.The outcome of this selection and categorisation process was the creation of two lists of items, that are meant to measure the interaction between the built environment and aspects of health and disability in ageing.

Determinants of quality of life in Greek middle-age women: A population survey

2011-11-30

Abstract: Objectives: The aim of the present study was to evaluate how sociodemographic parameters, lifestyle indicators and intensity of climacteric symptoms affect the quality of life (QOL) of Greek community dwelling middle-aged women.Study design: This population survey included 1140 middle-aged women aged 45–65 who represented 1% of the whole female population of this age group in Greece, stratified by residential area.Main outcome measures: Participants were asked to complete a questionnaire concerning sociodemographic and anthropometric parameters, medical history, the Utian quality of life (QOL) scale and the Greene climacteric scale rating menopausal symptoms.Results: In the univariate analysis, normal body mass index, married status, higher education, employment, good financial status, physical exercise and a high calcium diet were associated with higher total QOL scores (p-value<0.001). Multivariate regression analysis showed that higher total QOL scores were predicted by being married (separated/divorced/widowed: beta=−3.17, p-value=0.008), by physical exercise (beta=4.84 and beta=4.57 for 1–3h and >3h per week respectively, p-value<0.001) and by a good financial status (beta=7.05, p-value<0.001), while a higher score in the Greene scale resulted in lower total QOL scores (beta=−0.77, p-value<0.001). Women with a better QOL were more health conscious and more probable to have utilized the public health preventive resources.Conclusions: Menopause as a life event has no effect on the QOL of Greek middle-aged women. On the contrary, the presence and intensity of climacteric symptoms have a negative impact on all aspects of QOL. Marital and financial status, as well as physical exercise, are also significant predictors of QOL.

Should risk of bone fragility restrict weight control for other health reasons in postmenopausal women? – A ten year prospective study

Joonas Sirola, Toni Rikkonen, Marjo Tuppurainen, Risto Honkanen, Heikki Kröger — 2011-12-12

Abstract: Background: The aim of the present study was to investigate the health risks of excess body weight in the light of its protective effects on bone fragility.Methods: Femoral neck and lumbar spine dual X-ray absorptiometry was performed for 1970 Finnish women with a mean baseline age of 58.8years (range 53.1–65.7years) in 1994 and 2004. Women were categorized according to baseline BMI into normal <25kg/m2, overweight 25–29.9kg/m2 and obese ≥30kg/m2. Weight change (kg) was categorized into tertiles. Co-morbidities, not allowed to be present at baseline, was based on self-reports. Osteoporosis was defined as femoral neck or spinal (L2–L4) T-score <−2.5 SD at 10-year follow-up or <−2.0 SD+low trauma energy follow-up fracture. Uni- and multivariate logistic regression models were used to estimate the 10-year risk of incident health disorders. Adjustment for age, number of diseases, alcohol intake and smoking was used in the multivariate models.Results: Obesity (Ob) and overweight (Ow) were related with higher 10-year risk of hypertension (OR=2.6 (Ob)/OR=1.7 (Ow), p<0.001), coronary artery disease (OR=1.6, p<0.05/OR=1.2, p=NS), diabetes (OR=11.7/OR=5.3, p<0.001), osteoarthritis (OR=1.4, p<0.05/OR=1.1, p=NS), chronic back pain (OR=1.6, p=0.007/OR=1.2, p=NS) and poor self-rated health (OR=2.4, p<0.05/OR=1.5, p=NS) and lower risk of osteoporosis (OR=0.13/OR=0.28, p<0.001). Weight change of less than +1kg was associated 1.8 and 2.6 times lower 10-year risk of having hypertension and breast cancer than weight change over 6.2kg. Among obese women the absolute risk increase of hypertension was 17%, of diabetes 12%, and absolute risk reduction of osteoporosis 14% in comparison to BMI <25kg/m2.Conclusions: Health related risks of high BMI outweigh its protective effects on bone. Weight gain increases the risk hypertension and breast cancer.

Serum Cathepsin K levels are not suitable to differentiate women with chronic bone disorders such as osteopenia and osteoporosis from healthy pre- and postmenopausal women

2011-12-15

Abstract: Objectives: Cathepsin K (CatK) is expressed in high levels in osteoplasts and therefore plays an important role in bone resorption. Thus CatK serum levels may be useful in the diagnosis of chronic bone disorders such as osteopenia and osteoporosis. Therefore we aimed at studying CatK levels in women putatively free of known skeletal disorders.Study design: In total, 121 voluntary women, 27 premenopausal women aged between 20 and 45 years, and 94 postmenopausal women aged 59–81 years, all free of known skeletal disorders were included. All women underwent bone density measurement, routine labor parameter and measurement of serum CatK levels.Main outcome measures: Based on WHO criteria, women were stratified in four groups (premenopausal: healthy; postmenopausal: healthy, osteopenia, osteoporosis), and their CatK levels were statistically analyzed.Results: Using WHO criteria 21 postmenopausal women had normal bone mineral density (BMD), 49 had osteopenia and 24 had osteoporosis. All 27 premenopausal women had normal BMD. There were no significant differences in CatK between these groups. ROC analysis resulted in poor diagnostic validity of CatK, where the area under curve was 0.544. There was no correlation neither between CatK and other biomarkers as C-telopeptide crosslaps (CTX) or bone-specific alkaline phosphatase (BAP) nor between CatK and age.Conclusions: Serum levels of CatK are not suitable to differentiate women with osteoporosis from healthy subjects.

The association of serum oestradiol level, age, and education with cognitive performance in peri- and late postmenopausal women

Hanna Tuomisto, Paula Salo, Reetta Saarinen, Nea Kalleinen, Päivi Polo-Kantola — 2011-12-16

Abstract: Objectives: To evaluate whether healthy women show cognitive changes after menopause and whether the possible changes are oestrogen-, age- or education-dependent.Methods: Forty-eight women, 21 perimenopausal (aged 43–51 years) and 27 late postmenopausal (aged 59–71 years), participated in the study. Verbal and visuomotor functions, visuoconstructive skills, visual and verbal episodic memory as well as attention were evaluated.Results: Perimenopausal women performed better than postmenopausal women. Serum oestradiol (E2) level was included in the model in perimenopausal women only given the lack of endogenous oestrogen in postmenopausal women who were also not using hormone therapy (HT). In perimenopausal women, lower E2 was associated with better visual episodic memory (p<.05), and older age was related to poorer verbal episodic memory (p<.05). In postmenopausal women, more education was associated with better performance in verbal and visuomotor functions, attention as well as verbal episodic memory (p<.05), older age was related to poorer performance in the visuoconstructive test and visual episodic memory (p<.05).Conclusions: Perimenopausal women had better cognitive performance compared to late postmenopausal women. In perimenopausal women the effect of E2 was minor. In both groups, age modified cognitive performance, but more so in postmenopausal women. Education did not have any effect on cognitive performance in perimenopausal women, whereas in postmenopausal women education exceeded age as a source of variation. Thus the relevance of education for better cognition was accentuated after menopause.

Testing GSTP1 genotypes and haplotypes interactions in Slovenian post-/pre-menopausal women: Novel involvement of glutathione S-transferases in bone remodeling process

Simona Jurkovic Mlakar, Janez Prezelj, Janja Marc — 2011-12-21

Abstract: Objectives: Osteoporosis (OP) is an age-related disease associated with increased production of reactive oxygen species (ROS) and a reduction in antioxidant defense system, such as low activity of glutathione S-transferase (GST) family. The enzyme activity of the member of GSTs, GSTP1, depends on gene polymorphisms such as: Ala114Val and Ile105Val. The aim of this study was to evaluate the association between genetic polymorphisms of the GSTP1 gene and BMD variation and biochemical bone remodeling markers in 523 Slovenian pre- and post-menopausal women.Study design: Observational pilot study in a representative cohort of Slovenian patients with adjustment for potential confounders (age, height, weight, years since menopause, smoking status and glucocorticoid use) using univariate one-way and two-way analyses.Main outcome measures: Ala114Val and Ile105Val polymorphisms genotypes of GSTP1 gene, bone mineral density (BMD) values of total hip (_th), femoral neck (_fn) and lumbar spine (_ls), plasma osteocalcin (OC), serum bone alkaline phosphatase (BALP), free soluble RANKL and serum osteoprotegerin (sOPG) concentrations were determined.Results: Our results show that the Ala114Val heterozygotes are (borderline) significantly associated with higher concentrations of pOC (p=0.052) and decreased BMD_fn values (p=0.053) and the same trend is shown for BMD_th and BMD_ls values in osteopenic postmenopausal women. Furthermore, significantly higher concentrations of pOC were determined among Val allele carriers of Ile105Val gene polymorphism (p=0.037) and in carriers with the absent 114Ala–105Ile haplotype combination, again in osteopenic post-menopausal women.In addition, in pre-menopausal women the significant associations between sOPG and Ala114Val genotypes subgroups and between sBALP and Ile105Val genotypes subgroups, alone or in combination with Ala114Val, were determined (0.032, 0.026 and 0.008, respectively).Conclusions: Since significant associations existed in Ala114Val genotype and 114Ala–105Ile haplotype subgroups, these variations can be useful for determining low BMD and high pOC risk in postmenopausal women.

Overactive bladder: Diagnosis and management

Dudley Robinson, Linda Cardozo — 2011-12-05

Abstract: Overactive bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. Whilst a number of women may be managed based on a clinical diagnosis alone urodynamic studies may be useful in those women with complex or refractory symptoms. In the first instance all women will benefit from a conservative approach using bladder retraining although a number will require antimuscarinic therapy. For those women with persistent symptoms following medical therapy alternative treatment modalities such as intravesical Botulinum Toxin, neuromodulation or reconstructive surgery may be considered.This review, whilst giving an overview of the syndrome, will focus on a practical clinical approach to managing women with symptoms of overactive bladder (OAB).

EMAS clinical guide: Selective estrogen receptor modulators for postmenopausal osteoporosis

2011-11-24

Abstract: Osteoporosis and the resulting fractures are major public health issues as the world population is ageing. Various therapies such as bisphosphonates, strontium ranelate and more recently denosumab are available. This clinical guide provides the evidence for the clinical use of selective estrogen modulators (SERMs) in the management of osteoporosis in postmenopausal women.