Limited evidence for a protective effect of unopposed oestrogen therapy for osteoarthritis of the hip: a systematic review.

Above the age of 50 yrs, the incidence of OA rises steeply in women but less in men, suggesting an association with changes in female hormone levels in the menopause. This systematic review summarizes the evidence on the assumed association between exogenous hormone use and OA. Medline was searched up to March 2008 for articles assessing associations between OA of hand, hip or knee and menopause-related aspects. Methodological quality of the studies was assessed systematically. The results were summarized in a best-evidence synthesis. Nineteen studies on exogenous hormone use are included. Limited evidence was seen for a protective effect of unopposed oestrogen use for incidence of hip replacement/joint replacement, and a protective trend for incident radiological OA (ROA) of the knee. In prevalence studies, conflicting evidence was observed for hormone replacement therapy (HRT) use with DIP ROA and 'any joint OA', and oestrogen use with clinical knee OA. We found limited evidence for a significantly increased risk by using HRT for clinical hip OA and a significant protective effect of long-term unopposed oestrogen use for hip ROA. For all other relations studied no associations were found. Heterogeneity between the hormones used and outcome measurements made statistical data pooling impossible. The assumed relationship between the exogenous hormone use and OA was not clearly observed in this review. The relationship is perhaps too complex, or other aspects, yet to be determined, play a role in the increased incidence in women aged over 50 yrs. However, there is some evidence of a protective effect of unopposed oestrogen use for hip OA.

Validity of digital rectal examination and serum prostate specific antigen in the estimation of prostate volume in community-based men aged 50 to 78 years: the Krimpen Study.

BACKGROUND: In men with symptoms suggestive of BPH, an accurate estimation of the degree of prostate volume enlargement is important for the choice of treatment, and for prediction of treatment effect, the risk of acute urinary retention and the need for surgery. In a community-based population of men, the performance of digital rectal examination (DRE) and serum prostate specific antigen (PSA) is compared to planimetric transrectal ultrasonometry (planimetric TRUS) of the prostate. In this way we search for a practical, reliable, and reproducible alternative to TRUS that can be applied in a primary care setting and in the initial evaluation of men with lower urinary tract symptoms. METHODS: Data were collected from 1688 men aged 50 to 78 years recruited in a population-based study. Measurements included serum PSA, DRE, and planimetric TRUS for the estimation of prostate volume. RESULTS: The AUC values of the receiver-operating curves (ROC) curves for serum PSA as a method for the discrimination of prostate volumes above or below 30, 40 and 50 cc are 0.79, 0.86 and 0.92, respectively. DRE has limited value in the estimation of prostate volume and is only good in identifying very large prostates (>50 cc). CONCLUSIONS: In the general male population serum PSA performs reasonably well compared with planimetric TRUS, and better than DRE, in estimating whether prostate volume is greater or smaller than 30, 40 or 50 cc. Serum PSA is an acceptable alternative method to estimate the degree of prostatic enlargement in clinical settings where TRUS is not available and when prostate cancer has been excluded.

[Summary of the Dutch College of General Practitioners practice guideline 'The menopause']. / Samenvatting van de standaard 'De overgang' van het Nederlands Huisartsen Genootschap.

In the Dutch College of General Practitioners' practice guideline 'The menopause', the menopause is viewed as a physiological phase of life with its associated discomforts, which sometimes require treatment. The GP should inform women with menopausal symptoms about the extent to which oestrogens can diminish vasomotor symptoms and about the benefits and risks of hormonal therapy on various organ systems. Oestrogens can be used when vasomotor symptoms cause serious limitations in daily life. First choice is a sequential combination of oestrogen and progestagen hormones, in which progestagens are given at least ten days per month. When urogenital complaints need to be treated, vaginally applied oestrogens can be prescribed. Depressive symptoms, fatigue, myalgia or arthralgia should not be treated with hormonal therapy. Nor are oestrogens recommended for the prevention of osteoporosis and cardiovascular diseases.