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To identify patients at high risk of fracture using clinical risk factors could reduce health costs arising from the realization of a bone densitometry. The aim of this study was to compare the FRAX score without bone mineral density (BMD) with the criteria proposed by the Argentine Society of Osteoporosis (SAO) to consider starting antiresorptive treatment. We conducted an observational, cross-sectional study where 330 postmenopausal women between 40 and 90 years of age were included. The number of treatments given if the FRAX tool without BMD had been followed was compared with the number of treatments indicated using the SAO criteria. Using the SAO criteria, 85 (25.8%) patients would initiate antiresorptive treatment compared with 15 (4.5%) using the FRAX without BMD (p = 0.0019). Among the 67 patients with a diagnosis of osteoporosis by BMD determination, all of them (100%) would have received treatment by using the SAO criteria compared with 10 (15%) using the FRAX score (p = 0.011). The use of FRAX without BMD significantly underestimates the number of patients who should receive antiresorptive treatment. In patients diagnosed with osteoporosis by BMD, the FRAX score underestimates the number of patients to be treated.

Background and Objective: The aim of this study is to determine whether an educational intervention in perimenopausal women in rural environments achieves significant changes in risk behaviors related to osteoporosis., Material and Methods: Randomized clinical trials of parallel groups: 216 women (45-54 years old) of a rural Primary Healthcare service. Pre- and post- intervention were covered: body mass index (BMI), densitometry and blood test (calcium [Ca], parathormone [PTH]). Intervention group (n1=110): 2 interactive workshops on the prevention of osteoporosis. Control group (n2=106): information by post., Results: After the educational intervention, the intervention group maintained its BMI, increased its bone mineral density (BMD) (P<.001) and decreased the Ca (P ≤.048) and PTH (P<.001) levels. The control group increased its BMI (P<.001) and its BMD (P ≤.048), maintained its Ca levels and decreased the PTH values (P=.01)., Conclusions: The improvement in the objective parameters related to osteoporosis indicates the importance of health education as a preventive measure in this group of women. It would be interesting to analyze the repercussions of this improvement on a long-term basis in terms of reducing the incidence of osteoporosis and fractures., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Objective: [corrected] Estimate the percentage of excessive use of medicines (bisphosponates, strontium ranelate and raloxifene) in the prevention of fragility fractures in postmenopausal women., Material and Methods: A descriptive study conducted in an urban health centre in Vitoria-Gasteiz. The participants were women aged between 50 and 70, treated during 2010 with some of aforementioned medicines. Out of the 253 women included, three died, two moved, one did not want to sake part, and another one could not be found, leaving 246 participants. It was determinated if the treatment was or not indicated, as recommended in the ESCEO, NAMS and NOF clinical practice guides. A data search, including fragility fracture history, densitometry performed, densitometry diagnoses, prescribed medicines and prescribing doctor, was carried out by looking in the Osabide and Global Clinic digital clinic records. Interviews were carried out with 72 patients for a more complete information., Results: The mean patient age was 60.5 ± 4.9 years, and 91,5% of them (225) had undergone a densitometry. Three-quarters (75.1%, 169) had a diagnosis of osteoporosis and 4,4% (11) had previous history of fractures. More than a quarter (27.0%, 68) of treatments had no indication, and varied depending of the prescribing doctor (family doctors: 8.5%/ traumatologists: 58.5%) (p<0.001). The use of the medicine of choice, alendronate in 29.7% of cases, Was significantly higher (59.3%) in Primary Care than in other specialties., Conclusions: A high percentage of women are given excessive medication, exposing them to potentially severe secondary damages. Family doctors deal correctly with osteoporosis, with a high percentage of indicated treatments and a rational use of medicines, with alendronate as the first choice in the majority of cases., (Copyright © 2012 Elsevier España, S.L. y SEMERGEN. All rights reserved.)

The selective estrogen receptor modulators (SERMs) are substances with estrogenic/anti-estrogen effect that act differently depending on the tissue and composition. Since the discovery that tamoxifen and raloxifene (RLX) had a breast cancer preventive effect, the search for the perfect SERM has been the goal. The evidence that tamoxifen significantly increased the risk of endometrial cancer as compared to placebo made this tissue the center of interest in developing new SERMs. Thus, ospemifen, arzoxifene, lasofoxifene (LFX) and bazedoxifene (BZA) appeared as third-generation SERMs but only BZA reached the stage of clinical use. Both experimental and clinical data available on the effects of RLX or third-generation SERMs reaching clinical stage (LFX and BZA) show either neutrality or anti-estrogenic effects at endometrial level. BZA has shown to be equivalent to vehicle in several experimental conditions and acts as anti-estrogen in models were estrogens (conjugated equine estrogens [CEE] or E2) were co-administered. In a 7 years pivotal study the incidence of endometrial adenocarcinoma has been significantly lower in the BZA than in the placebo group. Moreover, in a clinical trial to evaluate the ability of a combination of BZA and CEE to prevent hot flushes in symptomatic postmenopausal women, doses of 20mg or higher of BZA have significantly decreased the risk of presenting endometrial hyperplasia when co-administered with either 0.650 or 0.450mg of CEE., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

The increase bone turnover is the most important fact at the physiopathology of postmenopausal osteoporosis. At the molecular level it is the increase of the RANK-L the principal mediator who allows the osteoclasts formation, survival and development of them. Multiple models have been in use in preclinical investigations for evaluating the effects of the inhibition of the RANKL, between which it is included on OPG's over-expression in mice and transgenic mouse and by means of other models that include the treatment with recombinant OPG. The results of these studies show that RANKL's inhibition improves the DMO as well as the geometry and resistance of the bone. Several references clinical trials have investigated the potential of denosumab as antiresorptive drug for the prevention and treatment of bone disease. It is a monoclonal antibody, the first fully human, which were recently published results of randomized clinical trials to eight years for increasing BMD in different locations and five years for the prevention of vertebral and hip fractures. We review the fundamentals of the mechanism of inhibition of RANK-L and the results of several clinical trials of Denosumab.

Background and Objective: To analyze the effects of nutritional intervention with a milk product enriched with soy isoflavones on quality of life and bone metabolism in postmenopausal Spanish women., Patients and Method: We performed a double-blind controlled randomized trial in ninety-nine postmenopausal women. Group S women (n=48) were randomized to consume milk product enriched with soy isoflavone (50 mg/day) while group C (n=51) consumed product control for 12 months. Parameters of quality of life (Cervantes scale), markers of bone metabolism and bone mass estimated by ultrasound of the calcaneus (QUS) were evaluated., Results: Overall, there was an improvement in the domains menopause (P=.015) and vasomotor symptoms (P<.001). S group emphasized the assessment of vasomotor symptoms (P=.001) and differed positively from group C in health (P=.019), sex (P=.021) and partner (P=.002). Serum levels TRAP (P<.001) and OPG (P=.007) decreased and concentrations of 25-OH-vitamin D increased (P<.001) without differences between groups. In the assessment of QUS, there was an increase in estimated bone mineral density in group S (P=.040), whereas in group C there were no significant differences., Conclusions: Daily consumption of these milk products increases levels of 25-OH-vitamin D and decreases bone metabolism markers. Additional supplementation with soy isoflavones seems to improve quality of life and bone mass in Spanish postmenopausal women., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Background: [corrected] On planning health promotion strategies for a disease or condition, one must know the current situation of the factors which have a bearing thereon. This study is aimed at analyzing, in the Basque Country, those living habits which interact to control the maximum bone density peak in postmenopausal women., Methods: This study was conducted in February-May 2003 on a sample of 555 women over 45 years of age selected at random in the Basque Country. A total of 82.8% thereof answered a living habit survey and a three-day recall diet survey. A descriptive core trend study was made for quantitative variable and frequencies for qualitative variables. A comparison was drawn between the prevalence among groups selected by way of the chi-square test and Student's t-test., Results: A total of 27.4% of the women studied were over 65 years of age (average age 58.51). Forty percent (40%) of the women were actively involved in physical exercise. A total of 4.1% of the women had sun exposure occasionally or exceptionally. The average calcium intake was 788.17 mg/day (SD=218.35). A total 0.3% had risk-level alcohol consumption and 14.7% moderate consumption. In relation to smoking, 12.6% of the women in the sample smoked less than a pack a day, and 3.5% more than one pack a day., Conclusions: The women studied showed as risk factors for having osteoporosis: a low level of active exercise, low calcium intake and in those women younger that 65 years of age and high degree of smoking.

Objective: To know the frequency and factors associated with the intake of calcium (Ca), vitamin D supplements and use of hormone replacement therapy (HRT) among postmenopausal (PM) health professionals women., Methods: During January to June 2004, health workers women of IMSS General Hospitals in Tijuana and Ensenada, Baja California, Mexico, were invited to participate. An interview and measurement of calcaneous bone mineral density (BMD) were performed. The following variables were assessed: sociodemographic, clinic and gynecologic features. We defined preventive osteoporosis (OP) treatment as the use of HRT, intake of Ca supplements (> or =1000 mg/ day) and supplements of vitamin D for a least six months., Results: Among 739 women interviewed, 312 were PM, and 31%, 25% and 31% have been taking Ca supplements, vitamin D, and HRT respectively. Calcium, vitamin D supplements intake and use of HTR was similar during the menopause evolution. The variables significantly associated with the use of preventive OP treatment were older age, low weight, previous ooferectomy and use of corticosteroids. In the multivariate analysis, age and underweight were significantly associated with a low bone mass density, independently of the use of preventive OP treatment, Conclusions: The frequency and length of time of Ca, vitamin D supplements intake and use of HRT was low, and 50% of PM health professional women are not under preventive OP therapy.

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.

In this article, the authors analyze the pathological alterations which women suffer in which menopause is assumed to be a risk factor leading to the outbreak of these pathologies. Taken together, all of these alterations present some clear nutritional considerations; therefore, adequate dietetical care, followed by women during this phase, could help in their prevention and control. These alterations are: osteoporosis, obesity, arterial hypertension, arteriosclerosis and cardiovascular diseases.

Objective: To define the standard knowledge women should have about the menopause in order to confront this stage successfully., Design: Use of the Delphi technique to reach consensus with experts at a national level., Participants: 43 professionals were chosen from the biological, psychological and social health fields, who had professional experience in women's problems at this stage of their lives, and/or authors of books, articles, doctoral theses and other documents on the menopause., Measurements and Main Results: Through three mailings, we obtained the views of 37 (86.04%) of the experts about the knowledge a woman should have of the menopause and the importance attached to each facet of this knowledge. Combining both criteria enabled us to classify the 266 Conceptual Elements (CE) that were expressed into three categories according to their relevance to women's knowledge., Conclusion: The Conceptual Framework on the Menopause is made up of a total of 173 CE, structured in 4 dimensions: biological aspects (23.12%), psychological and social aspects (24.8%), health risks (10.98%), and care, prevention and health promotion activities concerning the menopause (41.4%). This last dimension contained the highest percentage of specially relevant material (47.88% Level I CE).

During the year 1994, 318 women suffered from hip fractures in the Republic of Panama. Of these, 310 fractures occurred in post-menopausal women (97.5%). The rate of hip fractures in post-menopausal women is 191.76 by 100,000 women of fifty or more years of age. Both public health and other civic entities should organize a nationwide campaign to prevent osteoporosis and fractures in general.

Menopause is the physiologic state that is a consequence of the cessation of ovarian function. A large number of vasomotor, psychological and gynecological symptoms have been associated with menopause. Hormonal replacement therapy is effective in treating these conditions. The use of estrogens and progestins including dosages, routes of administration and their advantages and disadvantages are reviewed in this article. In addition, hormonal replacement therapy may reduce the risk of atherosclerosis and prevent the osteoporosis of climateric women. Hormonal therapy is associated with side effects but they do not contraindicate its use.

Estrogen treatment prevents early postmenopausal bone loss. The aim of this study was to evaluate the effects of estrogen-progestogen therapy on bone mass in elderly osteopenic postmenopausal women. Fifteen women with a mean age of 58 +/- 6 (mean +/- SD) years and 12 +/- 7 (5-31) years from menopause were evaluated. Bone mineral density (BMD) was assessed by dual X-ray absoptiometry (DXA) with 1.7% variation coefficient at lumbar spine (L2-4) and 1.9% at femur neck. Measurements were done at both sites before and after a 12 month treatment. At the beginning of the study lumbar spine BMD (LS BMD) was low: < 0.9 grs/cm2; z-score: -1.4 +/- 0.17 (mean +/- SEM). Treatment consisted in transdermal 17 beta estradiol (50 micrograms/day) (n = 10) or an equivalent natural estrogen oral dose (n = 5). Variable doses of medroxiprogesterone acetate were added on an individualized basis to women with an intact uterus (n = 12). Calcium intake was increased up to a median of 1200 mg/day (800-1600). After a one year treatment LS BMD was increased by 8.4 +/- 1.1% (mean +/- SEM) (95% CI: 6-10.8), from 0.748 +/- 0.02 to 0.810 +/- 0.02 gr/cm2 (p < 0.0001). A less marked gain in femur neck bone mineral density (FN BMD) was also noticed: 3.9 +/- 1.5% (95% CI: 0.6-7.2); 0.671 +/- 0.02 vs 0.697 +/- 0.02 gr/cm2 (p < 0.05). Patients treated with transdermal and oral routes showed similar results. Percentage variations in LS BMD and FN BMD were positively correlated (r: 0.53; p < 0.05). Six patients were treated for 2 years; LS BMD continued to rise, the additional gain being 5.1 +/- 2.2% (p < 0.05), while a non significant increase in FN BMD was observed (7.5 +/- 3.5%; p = 0.06). In the early postmenopausal period, hormonal replacement therapy (HRT) produces either a stabilization or a slight increase (2-4%) in BMD. In contrast, a significant augmentation of bone mass (especially at the spine) seems to occur in osteopenic women when THR is administered in the late postmenopausal period. This suggests that HRT could be used for the prevention as well as for the treatment of postmenopausal osteoporosis. Further studies should be done to evaluate whether HRT reduces the incidence of osteoporotic fractures in elderly osteopenic women.

Osteoporosis is a serious health problem for women over 45 years of age. It is divided in type I, affecting mainly cancellous bone and type II, affecting cancellous and cortical bone. Type I osteoporosis is related mainly with menopause, meanwhile, type II osteoporosis is related with ageing in both sexes. Osteoporosis has a major impact in the quality of life and the independence of the individuals, being the best treatment its prevention. All women at the beginning of the menopause should receive hormonal replacement treatment and calcium, in order to avoid type I osteoporosis, since treatment for women with established osteoporosis is aimed to halt the process of bone loss. Bone density may be measured in a reliable way by different techniques, allowing to the practitioner an accurate and reproducible measurement in different segments of the body. The main indications for bone densitometry suggested by the NOF are commented, as well as, the variability that may occur in different populations and the concept of normal values of bone density.

Bilateral oophorectomy is an essential part in the treatment of gynecologic cancer, and is often performed at the time of hysterectomy to prevent ovarian or/and breast cancer premenopausic women. In our study, we analyzed results from previous reports to determine the influence of estrogen on coronary heart disease, osteoporotic fracture and life expectancy in young patients with medical records of ovarian or breast cancer.

Menopause is the physiologic state that is consequence of ovarian function cessation and everyday more women reach it. In this article is reviewed the pathophysiology of menopause and treatment of osteoporosis.

A review of general aspects of osteoporosis and of the post-menopausal type specially; clinical appearance and hormonal mechanisms are briefly reviewed. Special emphasis is made upon sexual hormonal events. Demographic, socio-economic and epidemiological changes in México, are analyzed; explaining their causes, present status of the problem and its possible future projection. Finally, several propositions are made in order to face the problem, as follows: 1) Promotion for more research studies as to incidence, risk factors, determination of population standards for bone mass, 2) Health education programs, and 3) Prevention and treatment programs.