Dr. Juan Enrique Blümel. Departamento Medicina Sur. Universidad de Chile

BMJ. 2007 Jul 11; [Epub ahead of print
Main morbidities recorded in the women's international study of long duration oestrogen after menopause (WISDOM): a randomised controlled trial of hormone replacement therapy in postmenopausal women.
Vickers MR, Maclennan AH, Lawton B, Ford D, Martin J, Meredith SK, Destavola BL, Rose S, Dowell A, Wilkes HC, Darbyshire JH, Meade TW.
MRC General Practice Research Framework, Stephenson House, London NW1 2ND.
OBJECTIVE: To assess the long term risks and benefits of hormone replacement therapy (combined hormone therapy versus placebo, and oestrogen alone versus combined hormone therapy). DESIGN: Multicentre, randomised, placebo controlled, double blind trial. SETTING: General practices in UK (384), Australia (91), and New Zealand (24). PARTICIPANTS: Postmenopausal women aged 50-69 years at randomisation. At early closure of the trial, 56 583 had been screened, 8980 entered run-in, and 5692 (26% of target of 22 300) started treatment. INTERVENTIONS: Oestrogen only therapy (conjugated equine oestrogens 0.625 mg orally daily) or combined hormone therapy (conjugated equine oestrogens plus medroxyprogesterone acetate 2.5/5.0 mg orally daily). Ten years of treatment planned. MAIN OUTCOME MEASURES: Primary outcomes: major cardiovascular disease, osteoporotic fractures, and breast cancer. Secondary outcomes: other cancers, death from all causes, venous thromboembolism, cerebrovascular disease, dementia, and quality of life. RESULTS: The trial was prematurely closed during recruitment, after a median follow-up of 11.9 months (interquartile range 7.1-19.6, total 6498 women years) in those enrolled, after the publication of early results from the women's health initiative study. The mean age of randomised women was 62.8 (SD 4.8) years. When combined hormone therapy (n=2196) was compared with placebo (n=2189), there was a significant increase in the number of major cardiovascular events (7 v 0, P=0.016) and venous thromboembolisms (22 v 3, hazard ratio 7.36 (95% CI 2.20 to 24.60)). There were no statistically significant differences in numbers of breast or other cancers (22 v 25, hazard ratio 0.88 (0.49 to 1.56)), cerebrovascular events (14 v 19, 0.73 (0.37 to 1.46)), fractures (40 v 58, 0.69 (0.46 to 1.03)), and overall deaths (8 v 5, 1.60 (0.52 to 4.89)). Comparison of combined hormone therapy (n=815) versus oestrogen therapy (n=826) outcomes revealed no significant differences. CONCLUSIONS: Hormone replacement therapy increases cardiovascular and thromboembolic risk when started many years after the menopause. The results are consistent with the findings of the women's health initiative study and secondary prevention studies. Research is needed to assess the long term risks and benefits of starting hormone replacement therapy near the menopause, when the effect may be different.

J Sex Med. 2007 Jul;4(4i):1001-1008
Evaluation of the Clinical Relevance of Benefits Associated with Transdermal Testosterone Treatment in Postmenopausal Women with Hypoactive Sexual Desire Disorder.
Kingsberg S, Shifren J, Wekselman K, Rodenberg C, Koochaki P, Derogatis L.
University Hospitals of Cleveland, Cleveland, OH, USA.
Introduction. Postmenopausal women with hypoactive sexual desire disorder (HSDD) experienced statistically significant improvements in the frequency of satisfying sexual activity, sexual desire, and distress with testosterone treatment in phase III trials, but it was not known whether the magnitude of these effects was clinically meaningful. The clinical relevance study was designed to answer this question. Aim. To evaluate the clinical relevance of the treatment benefits. Methods. This study involved a representative sample of 132 surgically postmenopausal women with HSDD who were enrolled in two randomized, placebo-controlled trials (N = 1094) assessing the efficacy and safety of transdermal testosterone treatment (300 mcg/day) for 6 months. At the end of the studies, prior to unblinding, a sample of women (12%) was interviewed concerning their experiences with the treatment. Main Outcome Measures. Women were asked "Overall, would you say that you experienced a meaningful benefit from the study patches?" Changes in the efficacy end points in the double-blind studies were compared for the women who did and did not experience an overall meaningful benefit. Results. Overall, 33 of 64 women (52%) who received testosterone reported experiencing a meaningful treatment benefit, compared with 21 of 68 women (31%) who received placebo (P = 0.025). Among the women who identified themselves as experiencing a meaningful benefit, the mean (SE) change from baseline in 4-week frequency of satisfying sexual activity was 4.4 (0.76), in desire score was 21.0 (2.78), moving from "seldom" to "sometimes" feeling sexual desire, and in distress score was -36.5 (3.96), moving from "often" to "seldom" being distressed. Among the women who identified themselves as not experiencing a meaningful benefit, the mean (SE) change from baseline in 4-week frequency of satisfying sexual activity was 0.5 (0.31), in desire score was 2.9 (1.42), and in distress score was -8.8 (2.23). Conclusions. Surgically menopausal women with HSDD in these studies received clinically meaningful benefits, including improvements in satisfying sexual activity, sexual desire, and personal distress.

Introducción. Las mujeres posmenopáusicas experimentaron mejoras significativas relacionadas con el desorden del deseo (HSDD) en cuanto a la frecuencia de la actividad sexual, del deseo sexual, y del distress con el tratamiento de la testosterona en ensayos de la fase III, pero se desconoce si la magnitud de estos efectos era clínicamente significativa. El presente estudio la a fue diseñado para contestar a esta pregunta.

Objetivo. Evaluar la importancia clínica de las ventajas del tratamiento.
Métodos. Este estudio tomó una muestra representativa de 132 mujeres con posmenopausia quirúrgica con HSDD y fueron alistados en dos ensayos aleatorizados placebo-controlados (N = 1094) para determinar la eficacia y la seguridad del tratamiento transdérmico de la testosterona (300 mcg/día) por 6 meses. En el final de los estudios, una muestra de las mujeres (el 12%) fue entrevistada con referencia a sus experiencias con el tratamiento. Medidas principales del resultado. Pidieron las mujeres el " ¿Total, dirías que experimentaste una ventaja significativa de los remiendos del estudio? " Los cambios en los puntos del extremo de la eficacia en los estudios de doble anonimato fueron comparados para las mujeres que hicieron y no experimentaron una ventaja significativa total. Resultados. Totales, 33 de 64 mujeres (el 52%) que recibieron la testosterona divulgaron la experimentación de una ventaja significativa del tratamiento, comparada con 21 de 68 mujeres (el 31%) que recibieron placebo (P = 0.025). Entre las mujeres que se identificaron como experimentación de una ventaja significativa, el cambio malo (SE) de la línea de fondo en frecuencia de cuatro semanas de la actividad sexual satisfying era 4.4 (0.76), en cuenta del deseo era 21.0 (2.78), moviéndose desde " seldom" al " sometimes" el deseo sexual de sensación, y en cuenta de la señal de socorro era -36.5 (3.96), moviéndose desde " often" al " seldom" siendo apenado. Entre las mujeres que se identificaron como experimentación de una ventaja significativa, el cambio malo (SE) de la línea de fondo en frecuencia de cuatro semanas de la actividad sexual satisfying era 0.5 (0.31), en cuenta del deseo era 2.9 (1.42), y en señal de socorro la cuenta era -8.8 (2.23). Conclusiones. Las mujeres menopáusicas con HSDD en estos estudios recibieron quirúrgico clínico ventajas significativas, incluyendo mejoras en actividad sexual satisfying, deseo sexual, y señal de socorro personal.

J Sex Med. 2007 Jul;4(4i):1056-1069
The Burden of Testosterone Deficiency Syndrome in Adult Men: Economic and Quality-of-Life Impact.
Maggi M, Schulman C, Quinton R, Langham S, Uhl-Hochgraeber K.
Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
Introduction. Testosterone deficiency syndrome (TDS) causes a wide range of symptoms that can lead to significant morbidity. Preliminary evidence has also linked TDS with premature mortality and with a number of comorbid diseases including diabetes and metabolic syndrome. Such associations can lead to substantial economic and quality- of-life implications, the magnitude of which remains largely unknown. Aim. To review the economic and quality-of-life consequences of a largely untreated condition and to consider the likely health economic benefits of testosterone treatment. Methods. A systematic review of four main areas: epidemiological evidence of the magnitude of TDS, estimates of cost of illness, impact on quality-of-life, and cost-effectiveness of testosterone treatment. Main Outcome Measure. Review of peer-reviewed literature. Results. The lack of clear universally accepted diagnostic criteria and the uncertainty surrounding the link between TDS and some of its consequences complicate the estimation of the burden of illness of TDS. Consequences of TDS that potentially lead to increased economic burden include depression, sexual dysfunction, mild cognitive impairment, osteoporosis, cardiovascular disease, and mortality. However, although good evidence exists demonstrating an association between TDS and sexual dysfunction and cognitive impairment, evidence is less strong for depression, the incidence of fractures and mortality, and highly controversial for cardiovascular disease. The consequences that are likely to impact on patients' quality of life include sexual function, energy levels, body composition, mood, and cognitive function. Conclusion. Understanding the burden is only the first step decision makers need to take to decide whether to allocate scarce resources to treat the condition. To make informed decisions on when and who to treat information is also needed on the cost-effectiveness of available treatments. Such data would highlight the benefits of treatment of TDS to physicians, patients, and to society as a whole.

MED del sexo de J. El 2007 de julio; 4 (4i): 1056-1069
La carga del síndrome de la deficiencia de la testosterona en hombres adultos: Impacto económico y de la Calidad-de-Vida.
Maggi M, Schulman C, Quinton R, Langham S, Uhl-Hochgraeber K.
Unidad de la andrología, departamento de la fisiopatología clínica, universidad de Florencia, Florencia, Italia.
Introducción. El síndrome de la deficiencia de la testosterona (TDS) causa una amplia gama de los síntomas que pueden llevar a la morbosidad significativa. La evidencia preliminar también ha ligado el TDS a mortalidad prematura y a un número de enfermedades del comorbid incluyendo la diabetes y el síndrome metabólico. Tales asociaciones pueden llevar a las implicaciones económicas y de la calidad substanciales de la de-vida, la magnitud cuyo sigue siendo en gran parte desconocido. Puntería. Para repasar las consecuencias económicas y de la calidad-de-vida de una condición en gran parte no tratada y considerar la salud probable ventajas económicas del tratamiento de la testosterona. Métodos. Una revisión sistemática de cuatro áreas principales: evidencia epidemiológica de la magnitud de TDS, de estimaciones del coste de la enfermedad, del impacto el calidad-de-vida, y de la rentabilidad del tratamiento de la testosterona. Medida principal del resultado. Revisión de la literatura peer-reviewed. Resultados. La carencia del claro aceptó universal criterios de diagnóstico y la incertidumbre que rodea el acoplamiento entre el TDS y algo de sus consecuencias complica la valoración de la carga de la enfermedad del TDS. Las consecuencias del TDS que potencialmente llevan a la carga económica creciente incluyen la depresión, la disfunción sexual, la debilitación cognoscitiva suave, la osteoporosis, la enfermedad cardiovascular, y la mortalidad. Sin embargo, aunque exista la buena evidencia demostrando una asociación entre el TDS y la disfunción sexual y la debilitación cognoscitiva, la evidencia es menos fuerte para la depresión, el la incidencia de fracturas y de la mortalidad, y alto polémico para la enfermedad cardiovascular. Las consecuencias que son probables afectar la calidad de vida de los pacientes incluyen la función sexual, niveles de energía, la composición del cuerpo, el humor, y la función cognoscitiva. Conclusión. La comprensión de la carga es solamente los responsables del primer paso necesita tomar para decidir a si asignar recursos escasos para tratar la condición. Para tomar decisiones informadas en cuando y quién para tratar la información también se necesita en la rentabilidad de tratamientos disponibles. Tales datos destacarían las ventajas del tratamiento del TDS a los médicos, pacientes, y a la sociedad en conjunto.

Aust N Z J Obstet Gynaecol. 2007 Aug;47(4):329-34
A quantitative analysis of the menopause experience of Indian women living in Sydney.
Hafiz I, Liu J, Eden J.
School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
Aims: To examine the experience of menopause in Indian women (aged 45-65 years) in Sydney, and the relationship between sociodemographic factors and menopausal symptoms, and also to explore the cultural context. Methods: Two hundred and three women were interviewed about their menopausal experiences in the preceding week using the 29-item Menopause-Specific Quality of Life questionnaire. Results: The mean age of menopause for Indian women was found to be earlier than in other groups in the published literature, at 48.21 years. While there were higher scores for physical symptoms than for other symptoms, and there were significant differences between perimenopausal women and the others, it was found that the prevalence of classical menopausal symptoms was lower in Indian women than that found in Caucasians. However, physical and several psychological symptoms were found to be more prevalent than the usual vasomotor symptoms. Unemployed women and women with a tertiary level of education were found to experience a significantly higher score for all symptoms in our sample. Conclusions: Lower scores of menopause symptoms indicate that Indian women have fewer complaints of symptoms and a positive attitude towards menopause. Somatic symptoms are multifactorial in nature and could be because of health problems associated with ageing, midlife crises and cultural influences. Further detailed studies could examine the important relationship between cultural lifestyle factors and climacteric symptoms.

Aust N Z J Obstet Gynaecol. El 2007 de agosto; 47 (4): 329-34
Un análisis cuantitativo de la experiencia de la menopausia de las mujeres indias que viven en Sydney.
Hafiz I, Liu J, Eden J.
Escuela de la salud pública y medicina de comunidad, facultad de medicina, la universidad de Nuevo Gales del Sur, Sydney, Nuevo Gales del Sur, Australia.
Punterías: Para examinar la experiencia de la menopausia en las mujeres indias (envejecidas 45-65 años) en Sydney, y la relación entre los factores sociodemográficos y los síntomas menopáusicos, y también explorar el contexto cultural. Métodos: Doscientas y tres mujeres fueron entrevistadas con sobre sus experiencias menopáusicas en la semana precedente usar el cuestionario Menopausia-Específico de la calidad de vida de 29 artículos. Resultados: La edad media de la menopausia para las mujeres indias fue encontrada para ser anterior que en otros grupos en la literatura publicada, en 48.21 años. Mientras que había cuentas más altas para los síntomas físicos que para otros síntomas, y había diferencias significativas entre las mujeres perimenopausal y las otras, fue encontrado que el predominio de síntomas menopáusicos clásicos era más bajo en mujeres indias que lo encontrada en caucásicos. Sin embargo, la comprobación y varios síntomas psicologicos fueron encontrados para ser más frecuentes que los síntomas vasomotores generalmente. Encontraron a las mujeres paradas y a las mujeres con un nivel de educación terciario para experimentar una cuenta perceptiblemente más alta para todos los síntomas en nuestra muestra. Conclusiones: Cuentas más bajas de los síntomas de la menopausia indican que las mujeres indias tienen pocas quejas de síntomas y una actitud positiva hacia menopausia. Los síntomas somáticos son multifactoriales en naturaleza y podrían estar debido a los problemas de salud asociados al envejecimiento, a crisis de la media vida y a influencias culturales. Otros estudios detallados podían examinar la relación importante entre los factores culturales de la forma de vida y los síntomas climatéricos.

Menopause. 2007 Jul 6; [Epub ahead of print
Association of general and abdominal obesities and metabolic syndrome with subclinical atherosclerosis in asymptomatic Chinese postmenopausal women.
Yu RH, Ho SC, Ho SS, Woo JL, Ahuja AT.
From the 1Department of Community and Family Medicine, Chinese University of Hong Kong, School of Public Health; 2Department of Diagnostic Radiology and Organ Imaging, the Chinese University of Hong Kong, The Sir Yue-kong Pao Centre for Cancer, and the Lady Pao Children's Cancer Centre; and 3Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, SAR.
OBJECTIVE:: This study aimed to investigate the relationships between obesity, especially abdominal obesity, andmetabolic syndrome (MS) with carotid intima-media thickness (IMT) and plaque, markers of subclinical atherosclerosis, in asymptomatic Chinese postmenopausal women in Hong Kong. DESIGN:: A total of 518 postmenopausal women aged 50 to 64 years were recruited through random telephone dialing. Body mass index (BMI), waist circumference, waist-to-hip ratio, sociodemographic characteristics, blood pressures, medical, biochemical and lifestyle factors were obtained. MS was defined on the basis of the National Cholesterol and Education Program, Adult Treatment Panel III criteria. Subclinical atherosclerosis was determined by measuring IMT and plaque using high-resolution B-mode ultrasonography. RESULTS:: Women with a BMI of 25 kg/mor greater, a waist circumference of 80 cm or greater, a waist-to-hip ratio of 0.85 or greater, or MS were observed to have higher IMT values and prevalence of plaque. Multivariate analyses revealed that waist circumference was significantly associated with IMT independent of age, hormone therapy, lifestyle and sociodemographic factors, and BMI (P < 0.05), whereas a waist-to-hip ratio of 0.85 or greater was significantly associated with plaque (odds ratio = 1.7; 95% CI: 1.0-2.8) after controlling for age, hormone therapy, lifestyle and sociodemographic factors, BMI, and the traditional cardiovascular risk factors. MS was also associated with IMT after adjustment for age, hormone therapy, lifestyle and sociodemographic factors, and BMI (P < 0.05), whereas its association with plaque was also significant (odds ratio = 1.7; 95% CI: 1.0-2.6) after controlling for age. CONCLUSIONS:: Abdominal obesity and MS are independent of general obesity markers of subclinical atherosclerosis in Chinese postmenopausal women.

J Musculoskelet Neuronal Interact. 2007 Apr-Jun;7(2):144-8.
Common musculoskeletal adverse effects of oral treatment with once weekly alendronate and risedronate in patients with osteoporosis and ways for their prevention.
Bock O, Boerst H, Thomasius FE, Degner C, Stephan-Oelkers M, Valentine SM, Felsenberg D.
Centre for Muscle and Bone Research, Charite - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
Objective: To examine in a major cohort of patients whether or not musculoskeletal adverse effects (MAEs), similar to those seen in intravenous bisphosphonates (BP), might occur also in high dosage oral treatment regimens with alendronate (ALN) and risedronate (RSN). Patients and methods: 612 consecutive patients treated in the osteoporosis outpatient clinic at Charite, Campus Benjamin Franklin, between July 2002 and October 2003 with oral ALN or RSN (mean age 68.2+/-9.7 years; 527 females, 85 males), were examined and followed up for MAEs. Results: The overall frequency of any severe MAEs in our patients was low (5.6%). All severe MAEs occurred in primarily once weekly treated patients: 27 in ALN 70 mg once weekly (27/134=20.1%) and 7 in RSN 35 mg once weekly (7/28=25.0%), with no significant difference between those groups. The most frequently reported MAE was acute arthralgia in 12.6%, followed by acute back pain in 9.1% of all primarily once weekly treated cases. None of the 302 patients initially treated with daily BP reported any MAEs when later switching to once weekly administration (218 patients to ALN 70 mg once weekly and 84 patients to RSN 35 mg once weekly). With reference to recently published data, the phenomenon is probably related to dose dependent gammadelta T cell activation by accumulation of isopentenyl pyrophosphate (IPP) due to inhibition of the mevalonate pathway by nitrogen containing bisphosphonates (nBP). Conclusions: MAEs in oral BP are, in general, less common and severe than in intravenous BP. They are observed exclusively in patients starting ALN or RSN treatment with once weekly dosage regimens. In order to avoid this phenomenon, it is suggested to start ALN or RSN treatment with the lower daily dosages of ALN 10 mg daily or RSN 5 mg daily for about two weeks before switching to the overall, more convenient, once weekly dose regimen.

J Musculoskelet neuronal obra recíprocamente. El 2007 deJunio; 7 (2): 144-8.
Efectos nocivos musculoesqueléticos comunes del tratamiento oral con el alendronate una vez semanal y del risedronate en pacientes con osteoporosis y maneras para su prevención.
Bock O, Boerst H, FE de Thomasius, Degner C, Stephan-Oelkers M, tarjeta del día de San Valentín SM, Felsenberg D.
Centro para la investigación del músculo y del hueso, Charite - medicina Berlín, campus Benjamin Franklin, Berlín, Alemania de la universidad.
Objetivo: Para examinar en una cohorte importante de pacientes independientemente de si los efectos nocivos musculoesqueléticos (MAEs), similares a ésos considerados en los bisphosphonates intravenosos (BP), pudieron ocurrir también en altos regímenes de tratamiento oral de la dosificación con el alendronate (ALN) y el risedronate (RSN). Pacientes y métodos: 612 pacientes consecutivos tratados en la clínica de paciente no internado de la osteoporosis en Charite, campus Benjamin Franklin, entre el julio de 2002 y octubre de 2003 con ALN oral o RSN (edad media 68.2+/-9.7 años; examinaron y fueron seguidos a 527 hembras, a 85 varones), para MAEs. Resultados: La frecuencia total de cualquier MAEs severo en nuestros pacientes era baja (5.6%). Todo el MAEs severo ocurrió adentro sobre todo una vez que los pacientes tratados semanales: 27 en el magnesio de ALN 70 una vez semanalmente (el 27/134=20.1%) y 7 en el magnesio de RSN 35 una vez semanalmente (el 7/28=25.0%), sin diferencia significativa entre esos grupos. Lo más frecuentemente El MAE divulgado era artralgia aguda en 12.6%, seguido por dolor de espalda agudo en 9.1% de todos sobre todo una vez que las cajas tratadas semanales. Ningunos de los 302 pacientes trataron inicialmente con BP diario divulgaron cualquier MAEs cuando conmutación posterior a la administración una vez semanal (218 pacientes de ALN 70 del magnesio al semanario una vez y 84 pacientes al magnesio de RSN 35 una vez semanalmente). Referente a datos recientemente publicados, el fenómeno es relacionado probablemente con la activación dependiente de la célula de T del gammadelta de la dosis por la acumulación del pirofosfato del isopentenyl (IPP) debido a la inhibición del camino del mevalonate por los bisphosphonates con nitrógeno (nBP). Conclusiones: MAEs en BP oral es, generalmente menos común y severo que en BP intravenoso. Se observan exclusivamente en los pacientes que comienzan el tratamiento de ALN o de RSN con regímenes de dosificación una vez semanales. Para evitar este fenómeno, se sugiere para comenzar el tratamiento de ALN o de RSN con las dosificaciones diarias más bajas del diario del diario del magnesio de ALN 10 o del magnesio de RSN 5 por cerca de dos semanas antes de cambiar al guardapolvo, más conveniente, régimen una vez semanal de la dosis.

Cancer Epidemiol Biomarkers Prev. 2007 Jul;16(7):1443-8. Epub 2007 Jul
Dietary patterns and breast cancer risk in the shanghai breast cancer study.
Cui X, Dai Q, Tseng M, Shu XO, Gao YT, Zheng W.
Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111. m_tseng@fccc.edu.
The association of breast cancer with dietary patterns such as a western diet has not been studied in Asian women. We examined this among Shanghai Breast Cancer Study participants. Cases were of ages 25 to 64 years, diagnosed 08/1996-03/1998, and identified through a rapid case ascertainment system supplemented by the Shanghai Cancer Registry. Controls, selected from the general population of urban Shanghai, were frequency matched to cases by 5-year age group. Participants provided information on diet, lifestyle, and reproductive factors. In principal component analysis among 1,556 controls, two patterns emerged: a "vegetable-soy" pattern (tofu, cauliflower, beans, bean sprouts, green leafy vegetables) and a "meat-sweet" pattern (shrimp, chicken, beef, pork, candy, desserts). In adjusted unconditional logistic regression analyses including 1,446 cases and 1,549 controls with complete covariate data, risk was not associated with the vegetable-soy pattern. It was associated with the meat-sweet pattern (4th versus 1st quartile: odds ratio, 1.3; 95% confidence interval, 1.0-1.7; P(trend) = 0.03), but only in postmenopausal women, specifically among those with estrogen receptor-positive tumors (4th versus 1st quartile: odds ratio, 1.9; 95% confidence interval, 1.1-3.3; P(trend) = 0.03). Our findings indicate that a western diet increases breast cancer risk in postmenopausal Chinese women. They also suggest the value of quantifying aggregate risk for common combinations of foods.

BMC Public Health. 2007 Jul 9;7(1):150 [Epub ahead of print
Changes in body mass index in Canadians over a five-year period: Results of a prospective, population-based study.
Hopman WM, Leroux C, Berger C, Joseph L, Barr SI, Prior JC, Harrison M, Poliquin S, Towheed T, Anastassiades T, Goltzman D, Research Group C.
ABSTRACT: Background The initiation of the Canadian Multicentre Osteoporosis Study in 1996, and subsequent follow-up of the cohort 5 years later, provided longitudinal body mass index (BMI) data for a random sample of Canadians. Methods Height and weight were measured at baseline and 5 years and used to calculate BMI and assign one of six weight categories. Multiple imputation was used to adjust for missing weight at year 5. Data were stratified by age and gender. The proportion of participants moving between categories was generated, and multivariable linear regression was used to identify factors associated with weight change. Results Baseline data were available for 8548 participants, year 5 data for 6721, and year 5 weight was imputed for 1827 (17.6%). Mean BMI for every age and gender group exceeded healthy weight guidelines. Most remained within their BMI classification over 5 years, but when change occurred, BMI category was more likely to increase than decrease. Several sociodemographic, lifestyle and clinical characteristics were associated with change. Conclusions Mean baseline BMI tended to be higher than recommended. Moreover, on average, men under age 45 and women under age 55 were gaining approximately 0.45 kilograms (one pound) per year, which leveled off with increased age and reversed in the oldest age groups. These findings underscore the need for public health efforts aimed at combating obesity.

BMC Public Health. 2007 Jul 7;7(1):149 [Epub ahead of print
Early menopause, association with tobacco smoking, coffee consumption and other lifestyle factors: a cross-sectional study.
Mikkelsen TF, Graff-Iversen S, Sundby J, Bjertness E.
ABSTRACT: BACKGROUND: Early onset of menopause is a risk factor for several health problems. The objective was primarily to investigate the association between early menopause and current, past active and passive smoking. A second aim was to investigate the association between coffee and alcohol consumption and early menopause. METHODS: The present population-based cross-sectional study included a sub-sample of 2123 postmenopausal women born in 1940-41 who participated in the Oslo Health Study. Early menopause was defined as menopause occurring at an age of less than 45 years. We applied logistic regression analyses (crude and adjusted odds ratio (OR)) to examine the association between early menopause and selected lifestyle factors. RESULTS: Current smoking was significantly associated with early menopause (adj. OR, 1.59; 95% CI, 1.11-2.28). Stopping smoking more than 10 years before menopause considerably reduced the risk of early menopause (adj. OR, 0.13; 95% CI, 0.05-0.33). Total exposure to smoking (the product of number of cigarettes per day and time as a smoker) was positively related to early menopause and, at the highest doses, nearly doubled the odds (adj. OR, 1.93; 95% CI, 1.12-3.30). These data suggest a possible dose-response relationship between total exposure to smoking and early menopause, but no dose-response relationship was detected for the other variables examined. We found no significant association of coffee or alcohol consumption with early menopause. Of the lifestyle factors tested, high educational level (adj. OR, 0.50; 95% CI, 0.34-0.72) and high social participation (adj. OR, 0.60, 95% CI, 0.39-0.98) were negatively associated with early menopause. CONCLUSIONS: This cross-sectional study shows an association between current smoking and early menopause. The data also suggest that the earlier a woman stops smoking the more protected she is from early menopause. Early menopause was not significantly associated with passive smoking, or alcohol or coffee consumption.

J Sex Med. 2007 Jul;4(4i):859-866
Management of Female Sexual Dysfunction in Postmenopausal Women by Testosterone Administration: Safety Issues and Controversies.
Braunstein GD.
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Introduction. A Food and Drug Administration advisory group has questioned the long-term safety of testosterone administration to postmenopausal women. Although only short-term data exist on safety from the double-blind, placebo-controlled trials, testosterone has been used for more than 50 years. Therefore, some data concerning the long-term safety issues must exist in the literature. Aim. To review the published data concerning the safety of administration of testosterone to women. Methods. Review of published articles identified by a search of the Ovid databases and bibliographies from articles identified as dealing with the topics of testosterone or androgen treatment of women. Results. The major adverse reactions to exogenous androgens are the expected androgenic side effects of hirsutism and acne. High-density lipoprotein levels may be decreased with oral androgens. There are insufficient long-term safety data regarding breast, endometrium, or heart safety to draw strong conclusions, although the data available to date are reassuring. Conclusions. Testosterone administration to postmenopausal women that result in physiological to slightly supraphysiological serum-free testosterone levels is safe for at least 2 years.
MED del sexo de J. El 2007 de julio; 4 (4i): 859-866
Gerencia de la disfunción sexual femenina en mujeres posmenopáusicas de Testosterone la Administration: Ediciones de seguridad y controversias.
Braunstein GD.
Departamento de medicina, centro médico de Cedro-Sinaí, Los Ángeles, CA, los E.E.U.U.
Introducción. Un grupo consultivo de la Agencia de Medicamentos y Alimentos ha preguntado la seguridad de largo plazo de la administración de la testosterona a las mujeres posmenopáusicas. Aunque solamente los datos a corto plazo existan en seguridad de los ensayos de doble anonimato, placebo-controlados, la testosterona se ha utilizado por más de 50 años. Por lo tanto, un ciertos datos referentes a las ediciones de seguridad de largo plazo deben existir en la literatura. Puntería. Para repasar los datos publicados referentes a la seguridad de la administración de la testosterona a las mujeres. Métodos. Revisión de los artículos publicados identificados por una búsqueda de las bases de datos y de las bibliografías de Ovid de los artículos identificados como ocupándose de los asuntos del tratamiento de la testosterona o del andrógeno de mujeres. Resultados. Las reacciones adversas principales a los andrógenos exógenos son los efectos secundarios androgénicos previstos del hirsutismo y del acné. Los niveles de la lipoproteína de alta densidad se pueden disminuir con los andrógenos orales. Hay datos de largo plazo escasos de la seguridad con respecto el pecho, el endometrio, o a la seguridad del corazón para extraer conclusiones fuertes, aunque los datos disponibles hasta la fecha estén tranquilizando. Conclusiones. La administración de la testosterona a las mujeres posmenopáusicas que dan lugar a fisiológico a los niveles sin suero levemente supraphysiological de la testosterona es por lo menos 2 años seguros.