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M Dören

Publications and source records attributed to M Dören.

48 records · Page 3Linked to original sources
PubMed1992

[Postmenopausal osteoporosis from the viewpoint of the gynecologist].

Prophylaxis of postmenopausal osteoporosis is of major importance if estrogen replacement therapy is considered. Assessment of clinical symptoms, (standardized) x-ray analysis, and bone densitometry contribute to the final diagnosis. Incidence of osteoporotic fractures is rising due to alterations in life style and dietary habits. One out of three to four women eventually suffer from osteoporosis in the European countries, United States and Japan. Prevention of postmenopausal osteoporosis is achieved by adequate estrogen replacement therapy carried out for years, maintaining peripheral estradiol concentrations of 220 pmol/l. Doses of 2 mg estradiol or 0.625 mg of conjugated estrogen or 50-100 micrograms percutaneous estradiol/day are equally effective for prevention. The additional administration of a progestogen may be of specific value to increase the antiresorptive effect of estrogens. We distinguish between estrogen replacement in a cyclic or continuous way combined with a sequential or continuous progestogen in women with intact uterus.

Bone Density↗
PubMed1992

Identification and treatment of postmenopausal women at risk for the development of osteoporosis.

One in the three women develops osteoporosis--low bone mass and structural deterioration leading to fractures. Pre- and postmenopausal deficiency states are main causes. Estrogens prevent bone loss: Oral doses of 2 mg estradiol or 0.625 conjugated estrogens/day or 50-100 micrograms transdermal estradiol/day substantially reduce vertebral, forearm, and hip fractures. Certain progestins may enhance this effect. Calcium as a prerequisite for attainment of peak bone mass will not substitute for estrogen replacement. Selection of patients actually being at risk for postmenopausal osteoporosis needs to be improved substantially; there is no sensitive single test or testing system for osteoporosis. As individual history and physical exam or biochemical markers of bone resorption and formation rarely provide the early diagnosis of osteoporosis, prophylactic estrogen replacement therapy has to be considered in the majority of postmenopausal women to achieve prevention of postmenopausal osteoporosis. Compliance of replacement therapy in the European countries is poor, only 5-25% of postmenopausal women use estrogen replacement therapy for more than one year. Major compliance problems are alleged weight gain, resumption of withdrawal bleeding and fear to develop breast or endometrial cancer.

Aged↗
PubMed1992

[Osteoporosis from the gynecologic viewpoint].

Osteoporosis is a disease of the elderly characterized by a loss of bone mass causing fractures in presence of an inadequate trauma. Osteoporosis has to be considered as a significant ailment in our population. This review outlines epidemiology, pathogenesis and risk factors of primary osteoporosis. The physiological role of sex hormones, especially of estradiol, for the development and maintenance of skeletal bone mass is explained. Principles of preventive estrogen(-progesterone) application for the prophylaxis of postmenopausal osteoporosis are specified by several estrogen replacement studies in postmenopausal women. Individual replacement therapy for the compensation of a long-lasting estrogen deficit in the reproductive age group, in pre- and postmenopausal women is the assignment of the gynecologist in order to protect the skeletal system.

Adult↗
PubMed1988

[Postmenopausal osteoporosis. Early diagnosis as an indication for preventive hormone therapy].

Idiopathic osteoporosis mainly affects postmenopausal women. The normal trabecular volume of the lumbar vertebrae in a sample of healthy perimenopausal women was established by monoenergetic computed tomography. Early diagnosis of diminished bone mass is crucial for the identification of women at risk for involuntary osteoporosis following climacteric estrogen depletion. Body weight, endogenous levels of sex steroids, renal calcium and hydroxyproline excretions are not related to individual bone mass in the lumbar spine.

Aged↗
PubMed1988

[Mineral content of the spongiosa of the lumbar spine determined by computer tomography. Normal values for healthy perimenopausal women and their relation to mechanical stress of the vertebral column].

Healthy perimenopausal women (152) were examined by QCT to quantify the mineral content of the axial skeleton. The density was measured in the spongiosa of the L2-4, using single energy technique and the Cann-Genant calibration phantom. The women, aged 37 to 64, had no history of pathological fractures, ovariectomy, metabolic disease, or hormone therapy. The age-related mean values were 25 mg K2HP04/cm3 lower than the normal values reported by Genant et al. for 203 healthy American women. The 95% confidence interval was distinctly narrower (+/- 40 mg/cm3) than the American confidence interval (+/- 60 mg/cm3). To evaluate the relationship of the BMC to mechanical stress, the BMC was compared with body weight, body mass index (weight/height2), and the lumbar muscle mass estimated from cross sections of the paravertebral muscles in the CT images. The assumption that higher mechanical stress results in higher bone mineralization could not be confirmed.

Adult↗
PubMed1986

Effect of continuous intrauterine administration of prostaglandin F2 alpha and indomethacin on fertilization of rabbits.

The effect of continuous intrauterine administration of prostaglandin F2 alpha (PGF2 alpha) or indomethacin or indomethacin together with PGF2 alpha and PGE2 or vehicle on fertilization of rabbits was studied. These substances and vehicle were delivered into the cornua of the uterus via an Alzet minipump for 11 days. The animals were inseminated vaginally. Compared with controls (104 eggs of which 88.5% were fertilized) a reduction of the fertilization rate was observed with indomethacin (74 eggs of which 70% were fertilized). Exogenously added PGF2 alpha did not change the fertilization rate. The administration of indomethacin together with PGE2 raised the fertilization rate to 86% (63 eggs of which 54 were fertilized). The application of PGF2 alpha together with indomethacin showed a fertilization rate of 85% (59 eggs of which 50 were fertilized). The indomethacin application was associated with a reduction of prostaglandin production in several tissues from the female genital tract, showing that indomethacin is taken up by the endometrium of the rabbit. The ovary, oviduct, cervix and vagina were mainly affected by this treatment. The route of transport of this drug is not known, however. The reduction of the total number of eggs together with the decrease of the fertilization rate after indomethacin administration point towards multiregional sites of interference of prostaglandins in reproductive functions. PGF2 alpha seems to be the more important factor since PGE2 may be converted to PGF2 alpha in reproductive tissues.

Animals↗
PubMedDate not supplied

Prevention of postmenopausal osteoporosis with oestrogen replacement therapy and associated compounds: update on clinical trials since 1995.

Hormonal replacement therapy (HRT) is generally regarded as first choice for pharmacological prevention of osteoporosis in women. We reviewed recent studies of HRT regimens and selective oestrogen receptor modulators (SERMs), including controlled trials of at least one-year duration published since 1995 until February 2000 providing data on bone mineral density (BMD) or fractures. Natural and synthetic oestrogens exert a continuum of positive effects on BMD in a dose-dependent, though non-proportional, fashion independent of age and mode of administration. Bone loss may be largely prevented by 25 microg transdermal patch oestradiol, 0.3 mg conjugated equine or 0.3 mg esterified oestrogens. Progestogens neither attenuate nor augment the effect of oestrogens; sole use of tibolone prevents bone loss. Both the SERMs, tamoxifen and raloxifene, slightly increase BMD. There are no adequately powered fracture trials for any HRT regimen. Raloxifene 60 mg daily decreases the relative risk of vertebral fractures by at least 30%, as demonstrated by one 3-year fracture study of osteoporotic women. In conclusion, the recommendation to use oestrogen for postmenopausal osteoporosis, given both the lack of fracture trials and the rare trials on long-term use of HRT in (late) postmenopausal women, is not well supported. Fracture trials could overcome shortcomings of the current level of evidence.

Aged↗
PubMedDate not supplied

The impact of different HRT regimens on compliance.

Epidemiological data strongly suggest a substantial improvement of quality of life for post-menopausal women using hormonal replacement therapy (HRT). Nevertheless, reluctance of women to choose HRT is high. Various attempts to develop regimens with substantially better acceptance are being investigated. Sequential and continuous combined regimens, oral and transdermal routes of administration are available; however, no regimen nor any mode of administration has proven superior with regard to patients' compliance. Research on the specific problems of compliance in HRT has not yet offered solutions to the medical community about optimal conditions concerning long-term hormonal therapy. Unless metabolic profiles of the various modes of treatment are defined in long-term trials, general recommendations are difficult to justify. As long as the occurrence of uterine bleeding is associated with any concept of HRT in non-hysterectomized women, adherence has been reported to be very low. Persisting endometrial atrophy has not been achieved by any type of HRT. New regimens not stimulating endometrial growth are essential, since women in most cultures do not accept uterine bleeding after cessation of ovarian function. Educational programs should be developed to inform women about the physiology of menopause in general and the rationale of HRT. The occurrence of uterine bleeding due to the present types of HRT needs to be specifically addressed. Risk-benefit assessments are to be explained to patients to reach an informed decision on HRT, and fears of women about actual or alleged negative metabolic impacts of HRT need to be discussed.

Aged↗