Search

We agree with Lega and colleagues (1) that menopausal hormone therapy (MHT) has been shown in randomized controlled trials (RCTs) to be effective and safe for treating problematic vasomotor symptoms [...]

We appreciated the recent CMAJ article about adolescent contraception. (1) We especially support the statement that long-acting reversible contraceptive agents, such as implants and intrauterine devices, are ideally first-line methods [...]

Background: A set of nomograms based on the Dubbo Osteoporosis Epidemiology Study predicts the five- and ten-year absolute risk of fracture using age, bone mineral density and history of falls and low-trauma fracture. We assessed the discrimination and calibration of these nomograms among participants in the Canadian Multicentre Osteoporosis Study. Methods: We included participants aged 5595 years for whom bone mineral density measurement data and at least one year of follow-up data were available. Self-reported incident fractures were identified by yearly postal questionnaire or interview (years 3, 5 and 10). We included low-trauma fractures before year 10, except those of the skull, face, hands, ankles and feet. We used a Cox proportional hazards model. Results: Among 4152 women, there were 583 fractures, with a mean follow-up time of 8.6 years. Among 1606 men, there were 116 fractures, with a mean follow-up time of 8.3 years. Increasing age, lower bone mineral density, prior fracture and prior falls were associated with increased risk of fracture. For low-trauma fractures, the concordance between predicted risk and fracture events (Harrell C) was 0.69 among women and 0.70 among men. For hip fractures, the concordance was 0.80 among women and 0.85 among men. The observed fracture risk was similar to the predicted risk in all quintiles of risk except the highest quintile of women, where it was lower. The net reclassification index (19.2%, 95% confidence interval [CI] 6.3% to 32.2%), favours the Dubbo nomogram over the current Canadian guidelines for men. Interpretation: The published nomograms provide good fracture-risk discrimination in a representative sample of the Canadian population., Current recommendations for the treatment of osteoporosis are in transition. The T-score-based definition of osteoporosis and osteopenia by the expert committee of the World Health Organization on bone mineral density [...]

A study shows that young women who keep themselves on a restricted diet may reduce the bone mass benefits of regular exercise.

Research shows a positive correlation between spinal cancellous bone, ovulation and running. Studies using premenopausal women found that those who ran regularly for exercise, coupled with regular menstrual cycles, produced beneficial effects on spinal cancellous bone mineral density. Exercise and luteal length were also found to produce bone density benefits independently of each other.

We compared energy and macronutrient intakes across the menstrual cycle in participants (n = 42) in a study that assessed the frequency of ovulatory disturbances in regularly cycling vegetarians and nonvegetarians. Women kept daily basal body temperature records for six consecutive menstrual cycles and provided 3-d diet records near the beginning, middle, and end of different cycles. On completion of the study, temperature records were quantitatively analyzed to determine whether cycles were ovulatory, and if so, the date the luteal phase began. Diet records kept near the beginning and end of cycles were matched with temperature analysis results, and women were grouped according to whether the end-of-cycle record was kept during the luteal phase of an ovulatory cycle (group 1, n = 29), or during an anovulatory cycle or before luteal phase onset of a short luteal phase cycle (group 2, n = 13). Group 1 had higher energy intakes during the luteal than during the follicular phase (9.27 [+ or -] 2.69 vs 8.01 [+ or -] 2.36 MJ/d, P < 0.0001), whereas intakes of group 2 did not differ across the cycle (7.91 [+ or -] 2.18 vs 8.20 [+ or -] 1.48 MJ/d, NS). Both groups' macronutrient intakes were similar in records kept near the beginning and end of cycles. Documentation of ovulation is necessary in studies assessing premenopausal women's energy intakes.

Ovulatory function was prospectively assessed over 6 mo in 23 vegetarians and 22 nonvegetarians with clinically normal menstrual cycles. Subjects were 20-40 y of age, of stable weight (body mass index, in kg/m2 of 18-25), on current diets for [greater than or equal to] 2 y, and not using oral contraceptives. Quantitative analysis of basal body temperature records classified cycles as normally ovulatory, short luteal phase (< 10d), or anovulatory. Subjects completed the Three-factor Eating Questionnaire (subscales for restraint, hunger, and disinhibition) and kept three 3-d food records. Vegetarians had lower BMIs (21.1 [+ or -] 2.3 vs 22.7 [+ or -] 1.9, P < 0.05), percentage body fat (24.0 [+ or -] 5.5% vs 27.4 [+ or -] 5.1%, P < 0.05), and restraint scores (6.4 [+ or -] 4.4 vs 9.5 [+ or -] P < 0.05). Mean cycle lengths were similar, but vegetarians had longer luteal phase lengths (11.2 [+ or -] 2.6 vs 9.1 [+ or -] 3.8d, P < 0.05). Cycle types also differed ([x.sup.2 = 9.64, P < 0.01): vegetarians had fewer anovulatory cycles (4.6% vs 15% of cycles). Compared with those with restraint scores below the median, highly restrained women had fewer ovulatory cycles (3.6 [+ or -] 2.3 vs 5.0 [+ or -] 1.4, P < 0.05) and shorter mean luteal phase lengths (7.4 [+ or -] 4.1 vs 10.7 [+ or -] 3.1d, P < 0.05). We conclude that ovulatory disturbances and restrained eating are less common among vegetarians, and that restraint influences ovulatory function.

OBJECTIVE.: Bone loss occurs in young women who experience amenorrhea or ovulatory disturbances. The purpose of this study was to determine whether bone loss could be prevented by simulating a more normal hormonal pattern, using treatment with cyclic medroxyprogesterone, with or without calcium supplementation, in physically active women with disturbed menstruation. DESIGN: This study was a 1-year randomized, double-blind, placebo-controlled trial. Women who were stratified by menstrual cycle disturbance were randomized into four groups. The outcome variable was the change in spinal bone density measured by dual energy techniques. SETTING: A large metropolitan area. PARTICIPANTS: Sixty-one healthy, normal-weight physically active premenopausal women aged 21 to 45 years who experienced amenorrhea, oligomenorrhea, anovulation, or short luteal phase cycles completed the study. INTERVENTION: Therapies were cyclic medroxyprogesterone (10 mg/day for 10 days per month) and calcium carbonate (1,000 mg/day of calcium) in four groups: (A) (n = 16) cyclic medroxyprogesterone plus calcium carbonate; (B) (n = 16) cyclic medroxyprogesterone with calcium placebo; (C) (n = 15) placebo medroxyprogesterone with active calcium; or (D) (n = 14) both medroxyprogesterone and calcium placebos. RESULTS: The initial bone density (mean = 1.12 g/[cm.sup.2]) did not differ by group (P = 0.85). The 1-year bone density change was strongly related to treatment with medroxyprogesterone (P = 0.0001) and weakly to calcium (P = 0.072) treatment. Bone density increased significantly (+1.7% [+ or -] 0.5%, [+ or -] SEM, P = 0.004) in the medroxyprogesterone-treated groups (A and B), did not change in the calcium-treated group (C) (-0.7% [+ or -] 0.6%, P = 0.28), and decreased on both placebos (D) (-2.0% [+ or -] 0.6%, P = 0.005). CONCLUSIONS: Cyclic medroxyprogesterone increased spinal bone density in physically active women experiencing amenorrhea or ovulatory disturbances. POTENTIAL CLINICAL SIGNIFICANCE: Amenorrhea, oligomenorrhea, anovulation, and short luteal phase cycles are common in premenopausal women and associated with spinal bone loss occurring at a stage of life when bone density would normally be stable or increasing. This controlled trial shows a significant gain in bone in women in the cyclic medroxyprogesterone intervention group, whereas those subjects in the placebo group lost bone. Calcium supplementation appeared to be helpful but did not reach statistical significance. The implications of these findings for the prevention of osteoporosis warrant further investigation.

We assessed the relationship between dietary restraint and menstrual cycle characteristics in 27 ovulatory women, previous participants in a longitudinal study of spinal cancellous bone mineral density (BMD). Subjects completed the restraint scale of the Three Factor Eating Questionnaire, recorded basal temperature and exercise for at least three menstrual cycles, and completed a 3-d food record. Cycle lengths of women in the upper and lower tertiles of scores for restraint were similar [27.8 [+ or -] (x[bar] [+ or -] SE) vs 27.6 [+ or -] 0.8 d], but luteal phase length was shorter in the former group (8.6 [+ or -] 0.9 vs 10.8 [+ or -] 0.5 d, P < 0.05). Age, body mass index, percent body fat, waist-hip ratio, reported energy intake, and activity were similar between groups. Because the previous longitudinal study found associations between ovulatory disturbances and bone loss, we assessed spinal BMD using dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT). BMD of women in upper and lower restraint tertiles, respectively, did not differ: DXA, 1.15 [+ or -] 0.05 vs 1.20 [+ or -] 0.06 g/[cm.sup.2] and QCT, 140 [+ or -] 7 vs 133 [+ or -] 7 mg/[cm.sup.3]. Additional prospective studies, however, appear warranted. In conclusion, this study's results provide evidence that high dietary restraint is associated with a shortened luteal phase length.

Background: Cognitive dietary restraint, assessed by the Three-Factor Eating Questionnaire restraint subscale, is associated with subclinical menstrual cycle disturbances. This association may be mediated by stress-activated cortisol release. Objective: We assessed whether 24-h urinary cortisol excretion differs between women with high and low restraint scores. Design: Participants (aged 21.6 [+ or -] 2.5 y; n = 62) with normal-length menstrual cycles and high (n = 33) or low (n = 29) restraint scores completed a questionnaire describing weight history, dietary practices, and exercise. Cortisol, calcium, and creatinine were measured in urine collected over 24 h on a day when all food and beverages were provided and measured. Previously, 3-d food records and anthropometric measurements were obtained. Results: Age, height, weight, body mass index, and length of menstrual cycle were similar between groups. The reported amount of exercise was higher (3.4 [+ or -] 1.7 compared with 2.2 [+ or -] 1.8 h/wk; P [is less than] 0.05) and energy intakes (assessed from 3-d and 24-h food records) were lower in the high- than in the low-restraint group. Ratios of urinary cortisol (nmol) to creatinine (mmol) were higher in the high-restraint than in the low-restraint group (42.9 [+ or -] 12.9 compared with 36.3 [+ or -] 8.9; P [is less than] 0.05), whereas ratios of urinary calcium (mmol) to creatinine were lower (0.3 [+ or -] 0.1 compared with 0.4 [+ or -] 0.2; P [is less than] 0.05) in the high-restraint group. Urinary cortisol was not associated with exercise, nutrient intakes, or anthropometric measurements. Conclusions: High dietary restraint scores are associated with urinary cortisol, a biological marker of stress, and high cortisol excretion may affect bone health. Our results suggest that further research is warranted to clarify these associations and to determine whether they persist over time. Am J Clin Nutr 2001;73:7-12. KEY WORDS Dietary restraint, urinary cortisol, premenopause, women, Three-Factor Eating Questionnaire