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PubMed2001

Increase in circulating levels of cardiac natriuretic peptides after hormone replacement therapy in postmenopausal women.

The mechanisms that mediate the cardioprotective action of steroid hormones in postmenopausal women are poorly understood. To study the inter-relationship between female steroid hormones and cardiac natriuretic peptides, plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured in postmenopausal women, both before and after oestrogen replacement therapy. A total of 22 healthy postmenopausal women (mean age 51.9+/-4.6 years) were enrolled in the study; all had been postmenopausal for at least 1 year and all reported climacteric symptoms accompanied by increased levels of follicle-stimulating hormone (>30 m-i.u./ml) and luteinizing hormone (>20 m-i.u./ml), and a reduction in oestradiol (<25 pg/ml). All women were given hormone replacement therapy with transdermal oestradiol, either patch (50 microg/24 h) or gel (1 mg/day), cyclically combined with oral dihydrogesterone (10 mg/day for 12 days/month, on days 19-30 of the month). ANP and BNP were measured directly in plasma samples with specific and sensitive immunoradiometric assays before and after hormone replacement therapy (transdermal oestradiol combined with oral dihydrogesterone). Body weight, arterial blood pressure and echocardiographic examination values did not change after hormone replacement therapy. As expected, serum oestradiol increased significantly and gonadotropins decreased as an effect of the hormone replacement therapy. On average, both ANP and BNP had increased significantly after 3 months of hormone replacement therapy [ANP: before treatment, 17.6+/-9.6 pg/ml; after, 23.6+/-5.6 pg/ml (P=0.0173); BNP: before treatment, 12.6+/-10.2 pg/ml; after, 19.8+/-14.0 pg/ml (P<0.0001)]. Our study indicates that hormone replacement therapy for a period of 3 months induces a rise in the circulating levels of cardiac natriuretic hormones in postmenopausal women. Our data also suggest the working hypothesis that cardiac natriuretic peptides may play an important role in mediating the cardioprotective effects of female steroid sex hormones in women throughout life.

20-alpha-Dihydroprogesterone↗

PubMed2001

Cigarette smoking and the degree of maturation of the vaginal squamous epithelium in postmenopausal women.

To determine the effects of cigarette smoking on vaginal squamous epithelium in postmenopausal women, we studied the vaginal smear patterns of 199 healthy postmenopausal non-smokers and 41 healthy postmenopausal smokers, with a mean age of 56 years. A statistically significant difference to the hazard of smokers was found in the percentage of smears manifesting absence of maturation of vaginal squamous cells. A high incidence of atrophic-type vaginal smears in the group of smokers was also found independent of postmenopausal age. In the group of non-smokers, there was a statistically significant difference between the cytologic patterns of smears of women who were in the early postmenopausal age (<10 years) and those many years after (> or =10 years). Finally our data suggest that smokers had an earlier menopause, on average 2.4 years sooner than non-smokers. Cigarette smoking has an effect on vaginal squamous epithelium, but pathophysiology still remains unclarified.

Atrophy↗

PubMed2001

Circadian serum levels of dehydroepiandrosterone sulphate in postmenopausal asthmatic women before and after long-term hormone replacement.

OBJECTIVE: To assess mean 24-h serum concentrations of dehydroepianrosterone (DHEAS) in postmenopausal women with asthma before and after hormone replacement therapy (HRT). METHODS: Studies were performed in 55 asthmatic and 20 healthy postmenopausal women aged 48-60 before HRT and after 6 months of transdermal 17b-estradiol (E2) and medroxyprogesterone acetate treatment (cyclical method). Serum DHEAS concentrations were assessed with the use of RIA method. RESULTS: In the group of postmenopausal asthmatic women treated with glucocorticoids the mean 24 h DHEAS serum levels were lower than in a similar group not treated with glucocorticoids and a control group of healthy postmenopausal women. However, in both groups of asthmatic women (e.g. glucocorticoid treated and untreated) a significant increase of mean daily DHEAS levels after 6 months of HRT was observed. The hormone concentrations did not change in control group. CONCLUSIONS: Postmenopausal asthmatic women show diminished circadian dehydroepiandrosterone sulphate serum concentrations irrespective whether they were treated with glucocorticoids or not. However, after 6 months of hormonal replacement therapy in these groups increased levels of DHEA were found.

Administration, Cutaneous↗

PubMed2001

A study of the effect of tamoxifen on serum lipoprotein profiles in premenopausal and postmenopausal women with breast carcinoma and associated risk of cardiovascular disease.

To examine the effect of tamoxifen on serum lipoprotein profiles of premenopausal and postmenopausal patients of breast carcinoma (without and with cardiovascular disease) we performed a short term evaluation of serum lipoprotein profiles of 38 pre and 42 post menopausal subjects of breast carcinoma (without and with cardiovascular disease) at baseline and after 3 and 6 months of tamoxifen therapy. The serum lipoprotein profiles of premenopausal patients of breast carcinoma, both without and with cardiovascular disease, showed no significant variation, after 3 and 6 months of tamoxifen treatment than the corresponding baseline values of premenopausal subjects. However, in postmenopausal subjects of breast carcinoma (both without and with cardiovascular disease), serum TC, Apo-B, and Lp (a) were significantly decreased and serum TG, HDL and Apo A1 were significantly elevated, after 3 and 6 months of tamoxifen treatment, than the corresponding baseline values of postmenopausal subjects. Also, the comparison of the results of the present study for pre and postmenopausal patients of breast cancer revealed that the administration of tamoxifen, as an adjuvant therapy for breast cancer, is estrogenic and beneficial for postmenopausal patients of breast carcinoma (both without and with the risk of cardiovascular disease) as the drug minimises the risk of cardivascular disease by bringing significant improvement in serum lipoprotein profiles of the patients. But the drug fails to bring any significant beneficial effect on serum lipoproteins of hyperiipoproteinemic patients of breast cancer.

Adult↗

PubMed2002

Assessment of four biochemical markers of bone metabolism in postmenopausal osteoporosis.

In order to sudy the specificity and sensitivity of markers of bone metabolism in postmenopausal osteoporosis we investigated bone alkaline phosphatase, osteocalcin and carboxyl-terminal propeptide of procollagen type I in sera as markers of bone formation, and deoxypyridinoline in urine as a marker of bone resorption. The investigated parameters were determined in 53 women with confirmed osteoporosis and in a control group consisting of 45 healthy postmenopausal women without bone changes who were 40 to 79 years old. All biochemical markers were determined by monoclonal competitive enzyme immunoassay tests obtained by Metra Biosystems. The activity of bone alkaline phosphatase and the concentration of osteocalcin, procollagen type IVC-terminal propeptide (PICP), and deoxypyridinoline were grouped according to age of postmenopausal healthy and osteoporotic women. The values of all bone markers gradually increased with age, but significantly higher values were obtained in groups of postmenopausal osteoporotic women. By using receiver operator characteristic curve analysis, a very high specificity and sensitivity of the investigated biochemical markers in the diagnosis of postmenopausal osteoporosis were proven. The areas under the PICP curve and the osteocalcin curve were significantly higher than the area under the deoxypyridinoline curve, demonstrating a higher discriminating power of PICP and osteocalcin than deoxypyridinoline (p < 0.05).

Adult↗

PubMed2001

Serum bone specific alkaline phosphatase and urinary deoxypyridinoline in postmenopausal osteoporosis.

The objectives of this study were to: (i) evaluate the diagnostic sensitivity and specificity of the biochemical bone markers: serum total alkaline phosphatase (TALP), bone specific alkaline phosphatase (BSALP) and urinary deoxypyridinoline (Dpyr) in postmenopausal osteoporosis, (ii) compare the bone turnover of postmenopausal osteoporotic patients without and with hormone replacement therapy (HRT) against controls and (iii) identify the correlation between these bone markers and bone mineral density (BMD). We examined 42 postmenopausal women with BMD proven osteoporosis and 35 control subjects. Serum TALP, BSALP and urinary Dpyr were measured. All three biochemical bone markers showed comparable moderate diagnostic sensitivity but Dpyr had the highest diagnostic specificity. There were significantly higher serum TALP, BSALP and urinary Dpyr levels in non-HRT treated patients compared to controls (p<0.005, <0.0001 and <0.005 respectively). There were no significant differences in the levels of all three bone markers between HRT treated patients and control subjects. There was no significant correlation between TALP, BSALP or Dpyr and BMD in both controls and patients. In conclusion, the biochemical bone markers are not useful in diagnosis of postmenopausal osteoporosis but may have a role in monitoring progress and response to treatment. HRT treatment reduces bone turnover of postmenopausal osteoporosis.

Alkaline Phosphatase↗

PubMed2002

Body mass index, height, and the risk of ovarian cancer mortality in a prospective cohort of postmenopausal women.

Endogenous hormones may play a role in ovarian carcinogenesis. Postmenopausal obesity, although associated with higher circulating levels of estrogen and androgens, has not been linked consistently to ovarian cancer. The present study examined the relationship between body mass index (BMI), height, and ovarian cancer mortality among postmenopausal women in a large prospective mortality study of 300,537 women who were cancer free at enrollment in 1982 and had no history of hysterectomy or ovarian surgery. During 16 years of follow-up, 1,511 deaths occurred from ovarian cancer. Cox proportional hazard modeling was used to compute rate ratios (RRs) and to adjust for confounders. Ovarian cancer mortality rates were higher among overweight [BMI >/=25;RR, 1.16; 95% confidence interval (CI), 1.04-1.30] and obese women (BMI >/=30; RR, 1.26; 95% CI, 1.07-1.48) compared with women with BMI <25. Use of postmenopausal estrogens modified the association between BMI and ovarian cancer mortality (P = 0.05). The increased risk associated with obesity (BMI >/=30) was limited to women who never used postmenopausal estrogens (RR, 1.36; 95% CI, 1.12-1.66) and was not seen among ever users (RR, 0.93; 95% CI, 0.62-1.41). Height was positively associated with ovarian cancer mortality. Compared with women 152-156 cm tall, ovarian cancer mortality rates were lowest for the shortest women (RR, 0.72; 95% CI, 0.47-1.10 for women <152 cm) and highest for the tallest (RR, 1.41; 95% CI, 0.95-2.09 for women >/=177 cm). In this study, obesity and height appear to be independently associated with ovarian cancer mortality. The 36% increase in risk associated with obesity among women who had never used postmenopausal estrogens may have important public health implications because obesity is a growing problem in the United States.

Adult↗

PubMed2002

[What can we expect of raloxifene in the treatment of postmenopausal osteoporosis--views of a gynecologist].

OBJECTIVE: Evaluation of positive properties and side effects of raloxifene treatment with respect to its potential use as agent to improve women's health and quality of life in postmenopausal years. DESIGN: A review article. SETTING: Obstetrics and Gynaecology Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. SUBJECT: Estrogen use may protect against osteoporosis and cardiovascular disease, but may increase the risk of breast cancer in long-term treated women and also may increase the risk of irregular uterine bleeding (in combination with gestagen in non-hysterectomized women) in perimenopause and postmenopause. Drugs with tissue-specific estrogenic effects are termed selective estrogen receptor modulators (SERM). Tamoxifen is the first SERM successfully used in the prevention and treatment of breast cancer. Another SERM raloxifene is widely used in the prevention and treatment of postmenopausal osteoporosis, especially in women without climacteric complaints. Therapy with raloxifene increases bone mineral density, lowers serum concentrations of total and low-density lipoprotein cholesterol, and does not stimulate endometrium and breast. Evaluation of another potential positive effects (reducing size of uterine leiomyomas, etc.) warrants further investigation. CONCLUSION: Raloxifene can be used in postmenopausal women free of climacteric symptoms for the prevention and treatment of postmenopausal osteoporosis with no increased risk of thrombosis and with the advantage of positive side effects during the treatment.

Estrogen Replacement Therapy↗

PubMed2002

Influence of NaMFP therapy on plasma leptin concentration in postmenopausal women.

OBJECTIVE: To investigate the effect of a low dose of fluoride on the plasma leptin concentration in postmenopausal women. STUDY DESIGN: One hundred one healthy, postmenopausal women participated in this comparative study. To evaluate the influence of NaMFP treatment and body mass index (BMI) on leptin concentrations, patients were allocated to one of four groups: postmenopausal women (1) on NaMFP with BMI < 25 (n = 29), (2) on NaMFP with BMI > or = 25 (n = 26), (3) not on NaMFP with BMI > or = 25 (n = 24) and (4) not on NaMFP with BMI < 25 (n = 22). Plasma leptin levels were measured before and 12 months after the initiation of NaMFP or, in groups 3 and 4, after the start of the study. Ninety-eight women completed the study. RESULTS: There were significant differences in leptin concentrations at baseline and 12 months between NaMFP users with BMI > or = 25 and BMI < 25 and between women not taking NaMFP with BMI > or = 25 and BMI < 25 (group 2 versus 1 and 3 versus 4). After controlling for BMI, the use of NaMFP was not found to be related to the leptin value (group 1 versus 4 and group 2 versus 3). Although plasma leptin concentrations tended to be decreased slightly at 12 months in NaMFP users, this decrease was not statistically significant (P = .065). CONCLUSION: Leptin concentrations are significantly higher in obese, postmenopausal women than in nonobese, postmenopausal women. Plasma leptin concentrations are slightly but nonsignificantly influenced by long-term, low-dose fluoride treatment. Further studies are needed to elucidate the role of NaMFP on plasma leptin concentrations.

Body Mass Index↗

PubMed2002

Differing effects of low-dose estrogen-progestin therapy and pravastatin in postmenopausal hypercholesterolemic women.

BACKGROUND: Most studies examining the potential cardioprotective effects of postmenopausal estrogen have been undertaken in healthy women, with doses that may not be appropriate for long-term intervention. New low-dose estrogen-progestin regimens alleviate postmenopausal symptoms with a favorable side-effect profile; however, little is known of the impact of such regimens in women at increased risk of cardiovascular disease. Hence, we have evaluated the effects of low-dose oral estrogen-progestin therapy on serum lipoprotein lipids, brachial artery reactivity and fibrinogen in hypercholesterolemic postmenopausal women in direct comparison with the effects of pravastatin, a lipid-lowering agent known to reduce cardiovascular events in women. METHODS: In a randomized, double-blind, double-dummy, parallel trial, we studied the effects of continuous combined estrogen-progestin therapy (1 mg 17beta-estradiol with 500 micro g norethisterone acetate daily) or pravastatin (20 mg daily) in 72 postmenopausal women with fasting serum low-density lipoprotein (LDL) cholesterol levels greater than 124 mg/dl after an 8-week run-in diet, over a 24-week period. The primary end-point was percentage change in LDL cholesterol from baseline. RESULTS: The intention-to-treat population comprised 65 women, mean age 59 +/- 6.3 years, and 29 in each group completed the trial. Diet alone reduced LDL cholesterol significantly in both treatment groups, in association with a reduction in weight during this period. Compared with respective baseline values, pravastatin decreased LDL cholesterol and total cholesterol to a greater extent than hormone therapy (p = 0.0001 and 0.003 for difference between treatments, respectively). High-density lipoprotein (HDL) cholesterol levels decreased with hormone therapy, but did not change with pravastatin (p = 0.01). Lipoprotein(a) decreased significantly with hormone therapy only (-14%, 95% confidence interval (CI) -21 to -6%, p = 0.01 for difference between groups). Brachial artery flow-mediated dilatation (FMD) was impaired at baseline, and this increased with hormone therapy (absolute mean change in artery diameter as percentage units 2.07, 95% CI 0.57-3.57, p = 0.009) versus no change with pravastatin (0.19, 95% CI -1.1 to 1.5, p = 0.78), with a near-significant difference between the two groups (p = 0.058). A significant correlation between improved brachial artery FMD and reduction in LDL cholesterol was not observed. Fibrinogen decreased significantly in both treatment groups with no difference between treatments. CONCLUSIONS: In postmenopausal hypercholesterolemic women, pravastatin and hormone therapy exhibited divergent effects. The former lowered total and LDL cholesterol more effectively, whereas hormone therapy lowered lipoprotein(a) significantly and improved brachial artery endothelium-dependent dilatation, independent of the reduction in LDL cholesterol. The modest increase in brachial artery FMD seen is consistent with hypercholesterolemia compromising endothelial integrity, and suggests that the important effect of estrogen on the endothelial microenvironment may be attenuated in women with endothelial dysfunction.

Aged↗

PubMed2003

Acceptance of outpatient flexible hysteroscopy by premenopausal and postmenopausal women.

OBJECTIVE: To compare tolerance for and feasibility of outpatient flexible hysteroscopy in premenopausal and postmenopausal women. STUDY DESIGN: A comparative, prospective study including 475 premenopausal and 216 postmenopausal women who underwent outpatient hysteroscopy without analgesia. RESULTS: Mean pain score was higher in postmenopausal patients (1.55 +/- 0.56 vs. 1.27 +/- 0.38 [P < .0001]). Outpatient flexible hysteroscopy was feasible without analgesia in 471/475 premenopausal (99.2%) and 210/216 postmenopausal women (97.2%) (P = .07). CONCLUSION: Outpatient flexible hysteroscopy was feasible and well tolerated; local anesthesia should be reserved for postmenopausal women.

Adult↗

PubMed2003

Circulating levels of osteoclast activating cytokines, interleukin-11 and transforming growth factor-beta2, as valuable biomarkers for the assessment of bone turnover in postmenopausal osteoporosis.

The objective of this study was to evaluate the role of osteoclast activating cytokines, interleukin-11 (IL-11) and transforming growth factor-beta2 (TGF-beta2) in the assessment of bone turnover in postmenopausal osteoporosis (PO). Eighty postmenopausal osteoporotic women with lumbar spine bone mineral densities (BMD) as measured by DEXA that were more than 2.5 SD below the normal mean of healthy women (controls), participated in this study. Various therapeutic modalities (hormone replacement therapy, HRT, alendronate, calcitonin and 1alpha-hydroxyvitamin D (alfacalcidol) were administered for 12 months to 4 groups of postmenopausal osteoporotic patients. Fasting blood samples and two hour urine samples were collected from control subjects and from patients before and after treatment. Serum samples were assayed for IL-11, TGF-beta2, osteocalcin (OC) and bone alkaline phosphatase (B-ALP), whereas urine samples were assayed for N-telopeptide for type I collagen (NTX) and deoxypyridinoline (DPyr). The results demonstrated a significant increase of both IL-11 and TGF-beta2 in postmenopausal osteoporosis. Positive correlations exist between TGF-beta2 or IL-11 and markers of bone resorption (NTX and DPyr). Moreover, there was a significant positive correlation between TGF-beta2 and IL-11. Therapeutic modalities enhancing bone formation and/or with antiresorptive effect revealed a significant decrease in markers of bone resorption, formation and osteoclast activating cytokines, indicating a decrease in bone turnover. The decrease of IL-11 and TGF-beta2 may be attributed to a drug inhibitory effect of these cytokines on enhancing osteoblast mediated osteoid degradation. In conclusion, both serum IL-11 and TGF-beta2 determinations may be considered as biomarkers for the assessment of bone turnover and for monitoring antiresorptive therapy in postmenopausal osteoporosis.

Adult↗

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↗

PubMed2004

Basic research into the mechanisms responsible for postmenopausal hypertension.

Women typically experience increased cardiovascular disease (CVD) following menopause. Major risk factors for CVD include hypertension and, after menopause, blood pressure increases in women. The mechanism(s) responsible for this increase are not determined. Changes in oestrogen/androgen ratios, possible activation of the renin-angiotensin system, and increases in endothelin and oxidative stress, are hallmarks in postmenopausal women. Obesity, type 2 diabetes and activation of the sympathetic nervous system may also play important roles. However, progress in clarifying the mechanisms responsible for postmenopausal hypertension has been hampered by lack of a suitable animal model. We have recently characterised the ageing female spontaneously hypertensive rat (SHR) as a model of postmenopausal hypertension, since this strain exhibits many of the humoral characteristics of postmenopausal women. This review discusses some of the mechanisms that could play a role in postmenopausal hypertension, as well as the characteristics of the ageing female SHR as a model.

Androgens↗

PubMed2004

[Prevalence and related factors of urinary incontinence in postmenopausal women].

OBJECTIVE: To investigate the prevalence of urinary tract atrophy and related factors to urinary incontinence in postmenopausal women in the urban area of Beijing. METHODS: Subjects were selected from 4 central districts in Beijing with a multiple-stage randomly sampling procedure. A total of 1,257 postmenopausal women aged 60 years or over received interviews on lower urinary tract symptoms and physical examinations. The prevalences of different urinary tract symptoms were calculated. Logistic regression analysis was used to find the related factors of urinary incontinence. RESULTS: The prevalence of urinary incontinence of postmenopausal women was 61.0%. Stress urinary incontinence had the highest prevalence (64.5%). While the prevalence of nocturia was 66.8%. Logistic regression analysis indicated that stress urinary incontinence in postmenopausal women was associated with the following factors: obesity, long education years, long-time standing, and low ability of bending or squatting. High grip strength might reduce the risk of urinary stress incontinence. Urge incontinence was associated with obesity, while higher education and high grip strength might reduce the risk of urge incontinence. CONCLUSIONS: Incontinence is very common in postmenopausal women. The prevalence in this study is even higher than that in other reports. Obesity and muscle strength are related to the prevalence of urinary incontinence in subjects over 60 in Beijing.

Aged↗

PubMed2003

Circulating osteoprotegerin and leptin levels in postmenopausal women with and without osteoporosis.

Osteoprotegerin (OPG) is a recently identified citokine with an important role in bone remodeling, that acts as a decoy receptor for RANKL; OPG was shown to be an important inhibitor of osteoclast differentiation and activation. Leptin influences bone metabolism by acting on differentiated osteoblasts, having an anabolic effect on bone. The relationship between circulating OPG levels and osteoporosis in postmenopausal women is controversial. Thus, one of the aims of our study was to investigate the relationships between OPG levels and biochemical markers of bone turnover and bone density in women with and without osteoporosis. We have investigated 135 postmenopausal women, including a group with osteoporosis (n=76, mean age 59+/-8 years) and a group with severe osteoporosis (n=31, mean age 64+/-8 years), using healthy postmenopausal women (n=28, mean age 48+/-9 years) as controls. The serum concentrations of OPG were determinated by ELISA. Serum estradiol was measured by Enzyme Immunoassay (EIA). The markers of bone formation and resorption were measured by standard methods. Leptin was measured by ELISA. Bone mineral density at lumbar spine and femoral neck was measured by dual energy x-ray absorptiometry (DEXA). There was a significant positive association between serum OPG levels and age (r=0.27; p<0.001), both in the postmenopausal women as a whole and in the cohort with osteoporosis. Circulating OPG levels were significantly higher in both osteoporotic groups (p<0.005 and p<0.01, respectively) than in the control group. There were no significant associations between serum OPG levels and bone density, bone markers and serum estradiol. Serum leptin levels were significantly associated with age (r=0.18, p<0.03), estradiol (r=0.2, p<0.05) and BMD (r=0.25, p<0.008); there was no significant relationship between leptin and bone turnover markers. We conclude that serum OPG levels increase with age, both in healthy and osteoporotic postmenopausal women. This could represent a possible protective mechanism against bone loss. Serum leptin levels also increase with age and are positively associated with estradiol and BMD and not significantly associated with bone turnover markers.

Adult↗

PubMed2004

[Defining the role of raloxifene as a therapeutic agent for postmenopausal osteoporosis: focus on its pharmacological properties].

In this semiar, I propose to describe the pharmacological properties of raloxifene that provide a basis for its role in the treatment of postmenopausal osteoporosis. These pharmacological properties can be described as providing therapeutic benefits in the following three areas: 1) reduction in bone turnover, 2) increases in bone mineral density, and 3) risk reduction in fractures. While reloxifene shares these effects with conventional bisphosphonates that are in common use for postmenopausal osteoporosis, it exerts its antiresorptive effects through a different mechanism of action from those of the bisphosphonates. Furthermore, raloxifene exerts its stimulatory or inhibitory effects on estrogen in a tissue-specific fashion as a selective estrogen-receptor-modulator (SERM), thereby providing a wide range of clinical benefits that result from its ability to exert estrogen-like beneficial effects in tissues other than bone while at the same time inhibiting estrogen-like deleterious effects in other tissues. I therefore propose to define the role of raloxifene as a viable therapeutic option in the treatment of postmenopausal osteoporosis in light of these unique pharmacological features. Current data suggests that raloxifene can be positioned somewhere in between hormone replacement therapy (HRT) and bisphosphonates, and is highly likely to be suitable for use in patients between the ages of 55 and 70, while other agents may be indicated in special populations, such as premenopausal patients, postmenopausal patients with hot flushes, or elderly patients who may be placed at accelerated risk of developing femoral neck fractures. Thus, as a novel therapeutic option with unique clinical benefits, a far greater role may be expected for raloxifene in the treatment of postmenopausal osteoporosis than for other conventional therapeutic agents.

Biomarkers↗

PubMed2005

[Postmenopausal osteoporosis and blood stasis].

OBJECTIVE: To investigate whether blood stasis is one of the main causes in the pathogenesis of postmenopausal osteoporosis. METHODS: The clinical manifestation of blood stasis syndrome were comprehensively scored in sixty postmenopausal osteoporosis patients, their vascular endothelial function and platelet activating capacity were also detected, and compared with those in 30 healthy women as control. RESULTS: The molecular indexes as vascular endothelial function and platelet activating capacity, as well as comprehensive scores of clinical manifestation of blood stasis syndrome in postmenopausal osteoporosis patients were significantly different to those of healthy women (P < 0.05, P < 0.01). CONCLUSION: There is objective molecular pathologic change of blood stasis syndrome in postmenopausal osteoporosis. Blood stasis plays an important role in pathogenesis of postmenopausal osteoporosis.

Aged↗