Preoperative plasma osteopontin level as a biomarker complementary to carbohydrate antigen 125 in predicting ovarian cancer.

AIM: New biomarkers other than carbohydrate antigen (CA) 125 are needed for the detection of ovarian cancer. Osteopontin (OPN) is one of the candidates identified by high-throughput complementary DNA microarray techniques. We evaluated the preoperative plasma OPN level as a diagnostic biomarker for ovarian cancer in comparison with CA125. METHODS: Preoperative plasma OPN and CA125 levels were measured and compared in 32 patients with ovarian cancer, 34 patients with benign ovarian tumor, 30 patients with other gynecologic cancers and 31 healthy women. Preoperative plasma OPN levels were also assessed according to tumor stage, the volume of ascites and histological types. The sensitivity and specificity for predicting ovarian cancer was compared between OPN and CA125. RESULTS: Preoperative plasma OPN levels were significantly higher in patients with ovarian cancer than in those with benign ovarian tumor, in other gynecologic patients or in healthy women. Stage IV ovarian cancer patients and ovarian cancer patients with ascites had higher plasma OPN levels than those without ascites and in a lower stage. There was no relation between OPN and the histological type. The sensitivity of preoperative plasma OPN in detecting ovarian cancer was 81.3% and almost reached that of CA125. The specificity was moderate. Sensitivity increased to 93.8% with the combination of CA125, compared to 84.4% with CA125 alone. CONCLUSION: Preoperative OPN is a useful biomarker for predicting ovarian cancer. It is especially useful when used complementary to CA125. Larger studies of patients with ovarian cancer showing a low CA125 level or in early stages of ovarian cancer are needed.

Body fat patterning in polycystic ovary syndrome women as a predictor of the response to clomiphene.

BACKGROUND: To investigate the difference in the response to clomiphene citrate (CC) based on body fat distribution in women with polycystic ovary syndrome (PCOS). METHODS: Ninety anovulatory PCOS women were divided into two subgroups based on treatment response: women who ovulated with CC (CC responders, n = 49) and those who did not ovulate with CC (CC nonresponders, n = 41). Baseline characteristics included age, age at menarche, height, weight and body mass index [BMI; weight/(height)2]. Percentage of body fat, body fat mass and the ratio of trunk fat to leg fat mass amount (trunk-leg fat ratio) were measured by dual-energy X-ray absorptiometry (DEXA). RESULTS: Age, age at menarche and height did not differ between the two groups. However, trunk-leg fat ratio in CC responders (0.9 +/- 0.4) was significantly lower than that in CC nonresponders (1.3 +/- 0.4) (p < 0.001). Percentage of body fat, body fat mass and BMI were also lower in CC responders (p < 0.01). On multiple regression analysis, however, trunk-leg fat ratio proved to be a superior predictor of CC responder to percentage of body fat, BMI or body fat mass (standardized regression coefficient > or = 0.510; t-values > or = 3.432; p < 0.001). CONCLUSIONS: Response to CC in anovulatory PCOS women differs with body fat distribution.

Age-related change in the strength of correlation of lumbar spine bone mineral density with other regions.

OBJECTIVES: To investigate whether the strength of correlation of lumbar spine bone mineral density (BMD) with other regions differs with age. METHODS: Subjects were 336 premenopausal women aged 20-49 years and 218 postmenopausal women aged 50-69 years with right-side dominance. Age, height, weight, and years since menopause (YSM) were recorded. Subjects were classified into five subgroups at 10-year increments. BMD of the arms, lumbar spine (L2-4), pelvis, legs, and total body were measured by dual-energy X-ray absorptiometry (DEXA). RESULTS: Regional and total body BMD did not differ among women aged in their 20s, 30s, and 40s. However, in women aged over 50, regional and total body BMD gradually decreased with age. The strength of correlation of lumbar spine BMD with the left arm, right arm, left leg, right leg, and total body BMD gradually increased with advancing age (r=0.422-0.715, 0.376-0.714, 0.476-0.721, 0.491-0.734, and 0.642-0.800, respectively). However, the strength of correlation of lumbar spine BMD with pelvis BMD remained unchanged (r=0.512-0.622). CONCLUSIONS: Correlation of lumbar spine BMD with extremities BMD gradually strengthens with advancing age, while higher correlation of lumbar spine BMD with pelvis BMD remains unchanged. When lumbar spine BMD is predicted using values at sites such as forearm BMD, we should consider the patient's age.

Precedence of bone loss over changes in body composition and body fat distribution within a few years after menopause.

OBJECTIVE: The present study investigated the sequence of certain phenomena with a few years after menopause: bone mineral loss, decrease in lean body mass, increase in body fat mass, or the shift toward upper body fat distribution. METHODS: Subjects were 64 postmenopausal women aged 50-53 years with right side dominance (mean age+/-S.D., 51.4+/-1.1 years), and 59 age-matched regularly menstruating premenopausal women (51.7+/-1.2 years) serving as controls. Height, weight, body mass index (BMI, wt./ht.(2)), age at menopause (in postmenopausal women), and years since menopause (YSM) were recorded. Anthropometries, bone mineral density (BMD), and body fat distribution were assessed by dual-energy X-ray absorptiometry. RESULTS: Age at menopause and YSM in postmenopausal women were 51.7+/-1.2 and 2.3+/-1.7 years, respectively. Age, height, weight, BMI did not differ between the two groups. BMD of the bilateral arm, lumbar spine (L2-4), pelvis, and total body were significantly lower in postmenopausal women. However, leg BMD, trunk-leg fat ratio, body fat mass, and the lean body mass did not differ between the two groups. CONCLUSION: Within a few years after menopause, bone mineral loss precedes lean mass loss, increase in body fat mass, and a shift toward upper body fat distribution. We can say that bone tissue is more sensitive to hypogonadism than lean and fat tissues are.

Relationship of upper body fat distribution to higher regional lean mass and bone mineral density.

We investigated the relationship of upper body fat distribution to regional bone mineral density (BMD). Subjects were 361 regularly menstruating premenopausal women with right-side dominance. Age, height, and weight were recorded. Regional (arms, L2-L4 of the lumbar spine, and legs) BMD, regional (arms, trunk, and legs) lean mass, and the ratio of trunk fat mass to leg fat mass amount (trunk-leg fat ratio) were measured by dual-energy X-ray absorptiometry. Body fat distribution was assessed by trunk-leg fat ratio. Trunk-leg fat ratio was positively correlated with regional BMD ( r = 0.120-0.216; P < 0.05- P < 0.001) and regional lean mass ( r = 0.162-0.229; P < 0.01- P < 0.001). Regional lean mass was more positively correlated with regional BMD ( r = 0.319-0.475; P < 0.001). These relationships remained significant after adjusting for age and height. However, correlation of trunk-leg fat ratio with regional BMD disappeared after additionally adjusting for regional lean mass. In premenopausal women, upper body fat distribution is associated with higher regional BMD via greater regional lean mass irrespective of age and height.

Inverse relationship between the changes in trunk lean and fat mass during gonadotropin-releasing hormone agonist therapy.

OBJECTIVE: The aim of the present study was to investigate the relationship between the changes in lean and fat mass during gonadotropin-releasing hormone agonist (GnRH agonist) therapy. METHODS: Subjects were 24 premenopausal women (mean age, 39.5+/-9.4 years; range, 32-52 years) with uterine leiomyomas. They were given GnRH agonist (leuprorelin acetate, 3.75 mg) monthly for 4 months. Age and height were recorded. Body weight, regional and total body composition, and the ratio of trunk fat mass to leg fat mass (trunk-leg fat ratio) were assessed by whole body scanning with dual-energy X-ray absorptiometry. Changes in these variables were investigated. Relationships between the changes in regional lean and fat mass were investigated using Pearson's correlation test. RESULTS: Trunk fat mass significantly increased from 8616+/-3538 to 9265+/-3526 g (P<0.01) and trunk-leg fat ratio significantly increased (1.02+/-0.39 to 1.07+/-0.39, P<0.05). Trunk lean mass significantly decreased from 18,509+/-2602 to 17,916+/-2402 g (P<0.01). However, body weight, and lean and fat mass component in the extremities did not change. Change in trunk fat mass was inversely correlated with change in trunk lean mass (r=-0.439, P<0.05), but such relationships were not observed in arm and leg regions. CONCLUSION: Inverse relationship between the changes in trunk lean and fat mass is observed during GnRH agonist therapy.