Influence of weight and body fat distribution on bone density in postmenopausal women.

OBJECTIVE: To determine whether obesity or body fat distribution induces a greater modification on bone remodeling biochemistry (BRB) and bone density in postmenopausal women. METHODS: One hundred and thirteen postmenopausal patients were studied. They were initially divided according to body mass index (BMI), and afterwards by waist-hip ratio (WHR) as well as combinations of the two factors. Hormone measurements and assessments of BRB were also done. Dual-emission X-ray absorptiometry from the lumbar column and hip was performed with Lunar DPXL equipment, and the standard deviation in relation to young adult (T) and age-matched subjects (Z) was calculated. Statistical analysis was done by the Mann-Whitney U test. The relation of BMI and WHR with the variables was calculated by simple regression analysis. RESULTS: When divided according to BMI, there was greater bone density in the femoral neck in those with normal weight. After dividing according to WHR, the Z scores had a trend to a lesser decrease in those with upper level body fat distribution. Divided according to BMI and WHR, obese patients with upper-level body fat distribution had greater bone density in the lumbar column than those with normal weight and lower-level body fat distribution. With the same WHR, those with normal weight had greater bone density than those who were obese. CONCLUSIONS: A beneficial effect of upper-level body fat distribution on bone density was found. It is greater than that from obesity alone, and obesity and upper-level body fat distribution have an additive effect on bone density.

[Determination of the sensitivity and specificity of an osteoporosis risk factor questionnaire]. / Determinación de la sensibilidad y especificidad de un cuestionario de factores de riesgo de osteoporosis.

OBJECTIVE: To determine de sensitivity and specificity of a questionnaire of osteoporosis risk factors. MATERIAL AND METHODS: In 1,088 files of postmenopausal women, osteoporosis risk factors such as age, time since menopause, former hormone replacement therapy (HRT) use, current use of HRT, former and current HRT use, fractures after 45 years age, actual weight, corticosteroid use and hyperthyroidism were analyzed, giving them different punctuation. Every punctuation was added in each patient. In all of them a dual emission X ray (DEXA) absorptiometry was done from lumbar column and hip (femoral neck, trochanter and Ward's triangle). Odds ratio, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for every one of the variables and DEXA T score as well as Spearman correlation coefficient. RESULTS: Odds ratio increased as the punctuation of the questionnaire increased. With four points in the questionnaire the PPV was 41%, the NPV 86%, the sensitivity 16% and the specificity 96%. A significant negative correlation was found between age, time since menopause, current use of HRT, former and current use of HRT and column and hip T scores, and with the punctuation for all the regions. A positive correlation was found between former fracture and column and femoral neck T scores, and with actual weight in all regions. CONCLUSIONS: This study showed that the questionnaire can be a useful instrument to identify patients at high risk of osteoporosis.

[Epidemiologic variables in postmenopausal women]. / Variables epidemiológicas en la mujer posmenopáusica.

The objective was to know the characteristics of presentation, its clinical aspects and the modification in the diagnostic tools in a selected population of Mexican women with spontaneous menopause. The age at menarche, age at menopause, marital status, age at marriage, number of pregnancies and occupation of 1,099 women with spontaneous menopause were studied. In 619 women which were not receiving nor had received hormone replacement therapy the clinical, laboratory such as glucose, lipids, hormones, bone remodeling biochemistry; and X ray studies such as densitometry and mammography were analyzed. The age average of menarche presentation was at 13 years, and that of spontaneous menopause at 48.1 years 78% were married, with an age at marriage of 23 years, 66% had home duties. The screening tests showed that 30% of patients required cardiovascular evaluation, 40% showed alterations on lipids levels and at least 40% had some alteration on bone remodeling biochemistry or in densitometry. The mammography was normal in 81%. This study showed that most of the data in these group of women were similar to those of other populations, and many of them need intensive surveillance and adequate therapeutic prescriptions to diminish risk factors.

Changes in symptoms, blood pressure, glucose, hormones, and lipid levels according to weight and body fat distribution in climacteric women.

OBJECTIVE: To evaluate how symptoms, blood pressure, glucose, hormones and lipid levels are modified in climacteric women according to obesity and body fat distribution. METHODS: One hundred and thirteen women were studied and divided initially according to body mass index (BMI), and afterward to waist-hip ratio (WHR). Climacteric symptoms, blood pressure, fasting and post-breakfast glucose, hormone and lipid levels were analyzed. Statistical analysis was done by the chi square and Mann-Whitney U tests, and the relation of BMI and WHR with several variables was assessed by linear regression analysis. RESULTS: When dividing patients according to BMI, the only differences were found in age, number of diabetic and hypertensive patients, and values of systolic and diastolic blood pressure, which were greater in the obese group. When dividing according to WHR it was found that high-density lipoproteins were lower in those with upper segment body fat distribution. Subgroup analysis showed that chronic diseases are frequently found in obese women, while android body fat distribution has an additive effect on obesity in some of these variables. CONCLUSION: Chronic diseases are more frequently found in obese women, but most of the metabolic alterations are modified by body fat distribution in the upper segment.

Influence of previous bilateral partial tubal resection on symptoms, hormones, lipids, and bone density in postmenopausal women.

The late effect of bilateral partial tubal resection (BPTR) on symptoms, hormone and lipid levels, and bone density in postmenopausal women was analyzed. Thirty-six postmenopausal women in whom BPTR was accomplished were studied; they were matched by age with a group without BPTR. They were subdivided according to time since BPTR into two groups: < or = 15 years > 15 years since the procedure. In both groups, the patients' general data were analyzed as well as the frequency of climacteric symptoms; serum levels of follicule-stimulating hormone (FSH), estradiol, total cholesterol, HDL-C, LDL-C, and triglycerides; and bone density in lumbar spine, femoral neck, Ward's triangle, and trochanter. The statistical analysis was done for the symptoms with chi-squared and for the rest of variables with Student's t-test. When comparing the groups, no differences were found in analyzed parameters; only hot flashes and sweating associated with hot flashes were frequently found in the BPTR group when the analysis was done in the group without any division. With the groups subdivided, hot flashes were found more frequently in the group for whom it had been more than 15 years since the BPTR procedure. The BPTR did not influence hormone and lipid levels or bone density.

Changes in symptomatology, hormones, lipids, and bone density after hysterectomy.

OBJECTIVE: To evaluate the differences in symptoms, hormone and lipid levels, and bone density in two groups of women. METHODS: Two hundred eighty-five women who attended for climacteric study with previous simple hysterectomy were studied. Three groups were formed according to time since surgery (group I < 10 years, group II > or = 10 and < 20 years, and group III > or = 20 years). They were paired by age with a group without hysterectomy (control group) that also attended for climacteric study. None of them were receiving nor had received hormone replacement therapy. Age, body mass index, gestations, deliveries, and climacteric symptoms were analyzed for all subjects. Follicle-stimulating hormone (FSH), estradiol, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglyceride levels were determined, and atherogenic index was calculated. Bone density was measured with a Lunar DPXL appliance. Statistical analysis was done by the chi-square test, Student's t test, and linear regression analysis. RESULTS: There were no differences among groups in body mass index, gestations, or deliveries. Depression was more frequent in the hysterectomy group, who also had lower levels of total cholesterol, HDL cholesterol, and FSH than controls. CONCLUSIONS: It was observed that hysterectomy does not have a deleterious effect on hormone or lipid levels, nor on bone density, but depression was a frequent finding in hysterectomized women.