Factores de riesgo de artrosis de rodilla, cadera o ambas en mujeres chilenas de mediana edad: un estudio de cohorte de tres décadas / Risk factors for the development of osteoarthritis in middle-aged women

BACKGROUND: Osteoarthritis (OA) is a health problem affecting millions of individuals worldwide. Aim: To evaluate risk factors for hip and knee osteoarthritis (OA) in women aged 40 to 59 years. MATERIAL AND METHODS: Analysis of a prospective cohort of 1159 women attending preventive health care programs and followed during 28 years. They underwent a clinical and laboratory evaluation from 1990 to 1993. The diagnosis of OA was retrieved from registries of a special program for osteoarthritis in 2020. RESULTS: Twenty four percent of participants developed osteoarthritis during the follow-up. At the beginning of the study and compared with women without OA, they were older (median [interquartile range or IQR]: 49.6 [8.5] and 47.2 [8.2] years respectively), had a higher body mass index (26.3 [5.3] and 25.1 [5.3] respectively), and a higher frequency of jobs with low qualification (76 and 62% respectively). The presence of type 2 diabetes mellitus, chronic hypertension, a previous history of alcohol or cigarette consumption, postmenopausal status and lipid and glucose blood levels did not differ between women with or without OA. Cox regression showed a final model that incorporates body mass index (hazard ratio (HR): 1.04; 95% confidence intervals (CI): 1.01-1.07), age (HR: 1.05; 95% CI: 1.03-1.08) and having an unqualified job (HR: 1.88; 95% CI: 1.43-2.47) as risk factors for OA. CONCLUSIONS: Obesity and the type of job are the most relevant risk factors found for OD: both may be modified with proper care.

Prevalencia de disfunción sexual en mujeres climatéricas / Prevalence of sexual dysfunction among climacteric women

Background: The Female Sexual Function index (FSFI), is a scale designed to evaluate sexuality and diagnose the presence of sexual dysfunction in women. Aim: To apply the FSFI to climacteric women. Patients and methods: The FSFI was applied to 370 healthy women aged between 40 and 59years old (49 ± 6years) that accompanied patients to public health services in Santiago. Results: Fifty six percent of women were married, 44 percent were postmenopausal, 6 percent used hormone replacement therapy, 67 percent were sexually active, and sexual dysfunction was present in 57 percent of them. Thirty two percent of women aged between 40 and 44 years and 65 percent of women aged between 55 and 59 years, had sexual dysfunction (p <0.01). In a logistic regression model, the risk of sexual dysfunction increased among women that perceive having health problems (Odds ratio (OR) 3-9; 95 percento confidence intervals (95 percent CI): 1.1-13-8), women older than 48 years (OR 1.9; 95 percent CI: 1.1-3-4) and women that gave birth to two or more children (OR 1.8; 95 percent CI: 1.0-3-1). Conclusions: Climateric women have high prevalence of sexual dysfunction. Age is its main risk factor.

Analisis general y peculiaridades metabolicas del acetato de medroxiprogesterona: Papel de los gestagenos en el estudio WHI / General analysis of medroxiprogesterona acetate

Los gestágenos son sustancias químicas que inducen una transformación secretora del endometrio. De la testosterona derivaron fármacos con propiedades progestácionales, los 19- norderivados (levonorgestrel, noretisterona, dexogestrel, etc). De la progesterona se obtuvieron los pregnanos (medroxiprogesterona, megestrol, ciproterona, etc). En los últimos años se ha logrado producir progesterona natural oral. La medroxiprogesterona se ha usado ampliamente en anticoncepción y terapia de reemplazo hormonal (TRH). El estudio WHI ha sugerido que la medroxiprogesterona podría ser responsable de algunos efectos negativos de la TRH. Algunas investigaciones sugieren que la medroxiprogesterona de depósito aumenta ligeramente el riesgo de cáncer de mama; su uso en postmenopáusicas se asocia a mayor densidad mamográfica, un conocido factor de riesgo, y en cultivos celulares tiene un efecto proliferativo; además, se ha descrito un mayor riesgo en hormonoterapia que incluye gestágenos. Desde el punto de vista cardiovascular, aunque en dosis bajas la medroxiprogesterona no modifica sustancialmente el perfil lipídico, sí altera la función endotelial, no afecta la coagulación, pero puede aumentar los receptores de trombina. No hay estudios claros que permitan identificar con seguridad si la medroxiprogesterona tiene efectos deletéreos. Sin embargo, algunas observaciones sugieren cautela en pacientes con riesgo elevado de cáncer de mama o de enfermedad cardiovascular

La transicion menopausica fisiopatologia, clinica y tratamiento / Menopausal transition, physiopathology, clinical and treatment

Menopausal transition is a period that begins four years before menopause as a result of follicular decline. The first hormonal change is a decrease in B inhibin levels, followed by a decrease in estradiol and an increase in FSH levels; abrupt plasmatic oscillations of these hormones can be observed. Climacteric symptomatology may appear before cycle disorders and provoke an impairment in quality of life. Bone loss equally precedes menopause. Some authors, but not all of them, accept that during perimenopause there is an increased risk of cardiovascular disease. We point out the need of beginning hormonal therapy when the first clinical signs of estrogenic deficiency arise, independent of menstrual cycle and hormonal levels. Women aged over 45 are suitable for the classical sequential therapy, adjusting it to the cycle while it still persists; younger patients may use transdermal estrogens for short periods of time. Whenever contraception is required or there is irregular bleeding we indicate low dose estrogenic contraceptives, if possible the 28 days of the cycle. It is necessary to correct potentially dangerous daily habits and treat concomitant diseases that may enhance cardiovascular risk. The patient's education is an indispensable goal for the success of the treatment.