ABSTRACT
This study was designed to evaluate the role of postmenopausal estrogen deficiency on vaginal microflora, detect its relation with level of bone resorbing cytokines and to evaluate their role in postmenopausal osteoporosis. One hundred and twenty females were investigated. They were divided into two groups, Group I included 60 women in postmenopausal period, Group II [control group] included 60 women in premenopausal period. All of them were subjected to bacteriological examination: vaginal swabs were used for making direct Gram-stained smears but only 100 specimens [50 from each group] were cultured on suitable culture media to isolate different vaginal microorganisms and compare the isolates of the two tested groups. Eighty females [40 from each group] were subjected to serological studies including estimation of serum level of interleukin-6, interleukin- 1 beta, and tumor necrosis factor-alpha] using enzyme immunoassay [EIA] technique, estradiol and osteocalcin levels were measured by radioimmunoassay [RIA] technique. The study revealed that vaginal flora in postmenopausal females, according to Nugent Scoring System, showed normal pattern [82%] Intermediate [15%] and bacterial vaginosis [3%] compared with 72%, 23% and 5% respectively in premenopausal females with no statistically significant difference between the two groups [P>0.05]. There was a lower isolation rate of facultative Lactobacilli, Gardnerella vaginalis, C and ida albicans and Mobiluncus in postmenopausal females than in premenopausal females. Catalase +ve Lactobacilli was found to be predominant over catalase -ve in both post- and premenopausal females although their rate of isolation was lower in premenopausal females. In most of the cases, which showed bacterial vaginosis, G. vaginalis were isolated in high percentage associated with catalase-ve Lactobacilli. There was higher level of estradiol in sera of premenopausal than in postmenopausal females with statistically significant difference between them [P<0.001]. Serum level of osteocalcin was elevated in post- than in premenopausal females with no statistically significant difference between them [P>0.05]. There was also no statistically significant correlation between osteocalcin and age, parity, body mass index and estradiol level. A higher serum level of IL-6 and TNF-alpha was found in post- than in premenopausal females with statistically significant difference between them [P 0.05]. These factors showed no statistically significant correlation with serum level of both estradiol and osteocalcin [P>0.05]. Estrogen replacement therapy is recommended for postmenopausal females with more attention must be paid to personal hygienic measures for protection against colonization of vagina with potentially pathogenic microorganisms. Moreover, detection of bone resorbing cytokines level in bone microenvironment together with their estimation in serum are more important tool to evaluate the role of postmenopausal estrogen deficiency on bone resorption