[Low bone mineral density in children with Crohn's disease]. / Déminéralisation osseuse au cours de la maladie de Chron de l'enfant.

UNLABELLED: Recent studies have reported low bone mineral density in children with Crohn's disease. The aims of this retrospective study were to quantify its frequency and to search for risk factors. POPULATION AND METHODS: Bone mineral density of 29 children with Crohn's disease was measured by dual-energy X-ray absorptiometry. All the children were taking calcium and vitamin D, during all the follow-up. RESULTS: Osteoporosis (Z-score < or = -2.5 S.D.) was found in 38% of the children, and osteopenia in 38% (Z-score between -1 and -2.5 S.D.). Low bone mineral density was correlated with age, suggesting it begins with puberty. Daily corticosteroid exposure was significantly higher for patients with osteoporosis. Disease severity measured with Harvey-Bradshaw index and exposure to immunosuppressive drugs were almost statistically significant. Sex, height, duration and site of disease, nutritional assistance exposure were not associated with low bone mineral density. CONCLUSION: This study confirms the high frequency of low bone mineral density in children with Crohn's disease, mainly during puberty. Corticosteroid exposure is a risk factor, and the disease severity, a probable one (non significant). New treatment strategy has to be defined to prevent and to treat this complication.

[Vascular risk and menopause: role of hormone replacement therapy]. / Risque vasculaire de la ménopause: intérêt du traitement hormonal substitutif.

RATIONALE: Menopause dramatically increases cardiovascular risk in women who lack the protecting effects of estrogens. This emphasizes the importance of hormone replacement therapy (HRT) which, until recently, was considered beneficial in spite of the heterogeneous nature of clinical studies. Such a benefit was supposed to result from the favorable effects of estrogens, including lipid lowering and a complex vasodilating action including the improvement of vascular endothelial function. RATIONALE REVISITED: The results of the HERS study have however questioned these affirmations because of the lack of clinical benefit due to HRT in secondary prevention of coronary artery disease in postmenopausal women, with an increased vascular risk during the first year of treatment. In clinical practice, it is not recommended to start HRT after a cardiac attack. PRACTICAL ATTITUDE: In fact, the HERS study used a conjugated equine estrogen and progestin (with possible deleterious effects) and cannot be compared to French prescription habits which are based on the use of natural hormones. However, it remains to be demonstrated that some HRT regimens, in particular those using progesterone, may provide a real benefit in terms of lower cardiovascular morbidity-mortality.