Biomedical subjects

Jean-Michel Pouillès

Publications and source records attributed to Jean-Michel Pouillès.

5 recordsLinked to original sources

PubMed2005

Osteoporosis in otherwise healthy perimenopausal and early postmenopausal women: physical and biochemical characteristics.

Population studies have shown that about 3-5% of perimenopausal women already have osteoporosis according to the WHO definition of osteoporosis for postmenopausal women ( t -score<or=-2.5). In general, this bone loss arises from well-characterized diseases or conditions that affect acquisition of peak bone mass and/or the rate of bone loss after peak bone mass has been attained. However, there often remains a subset of these women, with no identifiable cause of bone loss. This group has so far been little studied. We prospectively evaluated a group of 60 perimenopausal and early postmenopausal women (mean age 52.2+/-2.5 years) who were found to have apparently unexplained low bone mass, and we compared them to 120 controls matched for age and menopausal status. These women were extensively investigated, including by detailed questionnaire and laboratory testing. Of the 60 women with osteoporosis, only three were found to have previously undiagnosed disorders (two with subclinical hyperthyroidism and one with elevated serum PTH levels) that might have contributed to their low bone mass. On the other hand, osteoporotic patients were characterized by a significantly lower body weight, higher prevalence of personal and parental histories of fractures and a higher level of bone turnover as assessed by increased serum osteocalcin and bone alkaline phosphatase levels and urinary type I collagen C-telopeptide (CTX) excretion, as compared to controls. These findings support theories of a genetic contribution to osteoporosis and underline the predictive value of a previous history of personal and familial fracture in the identification of osteoporosis in early postmenopausal women.

Alkaline Phosphatase↗

PubMed2005

[Management of postmenopausal osteoporosis].

Current management of postmenopausal osteoporosis has benefited from several advances both in the screening or those women with the highest risk of fracture and the development of efficient drugs to reduce the occurrence of fracture. At the individual level, assessment of the risk of fracture must associate the level of bone mineral density which represents the major determinant of fracture and several clinical risk factors. Measurements of biochemical markers of bone turnover are sometimes useful to improving this risk evaluation. However, the 5- to 10-year absolute risk or fracture still needs to be determined as well as the threshold above which a therapeutical intervention should be warranted. Besides hormone replacement therapy, which indications are now more limited than before, the different therapeutical options include several anti-osteoclastic drugs and more recently new anabolic compounds. It should be now possible to anticipate a long term strategy for the prevention of osteoporosis based on an early screening of the women at higher risk of fracture as well as the optimal choice of treatment taking into account the age and underlying clinical conditions of each woman.

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PubMed2002

[Screening techniques].

WOMEN "AT RISK": Assessment of the risk of osteoporosis in a woman approaching the menopause relies essentially on the evaluation of her bone mass and the study of a certain number of clinical criteria. The principle osteoporosis risk markers are age, past personal and family history of fractures due to bone fragility, low body weight, past history of early menopause and all the affections corresponding classically to "secondary" osteoporosis. OSTEODENSITOMETRY: Densitometric measurement is the corner stone of this assessment, since any decrease of 1 in the standard deviation of bone density corresponds to a two-fold greater risk of fracture. This relationship has led to a new densitometric definition of osteoporosis, based on a decrease of more than 2.5 standard deviations compared with the median value of a young adult (t-score < -2.5). THE INTEREST OF BIOCHEMICAL MARKERS: The interest of bone remodeling biochemical markers has not been clearly defined. Combined with densitometric measurements, they may permit the assessment of the level of bone remodeling and hence estimate bone loss, which is one of the determinant factors of fracture risk.

Absorptiometry, Photon↗

PubMed2002

[Current therapeutic means].

UNLABELLED: VARIOUS THERAPEUTIC POSSIBILITIES: Treatment of osteoporosis has greatly progressed over the past few years and, in parallel with hormone replacement therapy (HRT), new drugs (2nd and 3rd generation bisphosphonates and raloxifen) are now available, not only for primary prevention but also for secondary prevention of fractures. WHAT INDICATIONS?: The anti-fracture efficacy that has been demonstrated in large clinical trials, conducted according to the requirements of modern methodology, only appear patent in women at "high risk" for osteoporosis, i.e., those presenting a t-score < -2.5 and a prevalent fracture (particularly vertebral crushing), situation which is relatively rare at the onset of the menopause. IN PRACTICE: The initiation of such treatment in a women approaching the menopause should only be considered after prior measurement of her bone density, using a validated technique, measurement that is not always officially recognized by our Health Authorities. This problem, together with the varying conditions of prescription and reimbursement, explain some of the problems encountered in the use of these new therapeutics, notably in women at high risk of osteoporosis, who have not yet presented a fracture due to their bone fragility.

Bone Density↗

PubMedDate not supplied

Association of cardiovascular risk factors with intima-media thickness of the carotid arteries in early postmenopausal women.

OBJECTIVE: The aim of this study was to examine the association between carotid intima-media thickness (IMT) and coronary heart diseases (CHD) risk factors in a large population of peri- and postmenopausal women. DESIGN: Participants in this study were 906 healthy peri- and postmenopausal women from southwestern France, 45 to 65 years old with no history of cardiovascular disease and no utilization of estrogen/hormone therapy. Women were classified either as perimenopausal (n = 240) or post-menopausal (n = 666) according both to the regularity of menses and to serum follicle-stimulating hormone and estradiol values. All women answered a questionnaire, which included 72 questions, related to the identification of familial and personal cardiovascular risk factors. Biological measurements were performed to evaluate their lipid-lipoprotein profiles and fasting glucose levels, ultrasonography was used to measure IMT and total body scanners by DXA were performed to determine the percentage of body fat. RESULTS: Multiple regression analyses were used to examine the ability of each variable to explain IMT values. Mean IMT of the right carotid artery was 0.520 (+/- 0.07) mm. Of the 906 women, 9% were currently taking lipid-lowering drugs, 12.8% and less than 2% were being treated for hypertension and diabetes, respectively. Additionally, 124 women were found to have current hypertension, 10% had a familial history of CHD, and 18% were regular smokers. In multiple regression analyses, only increasing age (P < 0.001) and systolic and diastolic blood pressure (P < 0.001) were independently and significantly associated with IMT. CONCLUSIONS: These results show that only a few risk factors were associated with IMT in this population of healthy peri- and postmenopausal women. These results might be related to the fact that this study was conducted in an area of France well known for having the lowest rates of CHD in women, which is further supported by the thinner IMT found in this population as compared with a higher-risk population. Therefore, these results might not be relevant for CHD in older or high-risk women.

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