scholarly journals Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Guideline Update

2020 ◽  
Vol 105 (3) ◽  
pp. 587-594 ◽  
Author(s):  
Dolores Shoback ◽  
Clifford J Rosen ◽  
Dennis M Black ◽  
Angela M Cheung ◽  
M Hassan Murad ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
Meta Analysis ◽  
Clinical Trial Data ◽  
Careful Consideration ◽  
Boxed Warning ◽  
Endocrine Society ◽  
Pharmacological Management ◽  
Individual Woman ◽  
The Individual ◽  
Very High

Abstract Objective The objective is to provide an update of the 2019 Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline for the pharmacological management of osteoporosis in postmenopausal women using romosozumab. Conclusions We reviewed findings from the meta-analysis and primary clinical trials assessing the efficacy of romosozumab, a monoclonal antibody targeting sclerostin, for the prevention of fractures and concluded that this agent can be considered a treatment option for postmenopausal women at very high risk for osteoporotic fracture. The romosozumab label has a boxed warning, recommending careful consideration by the treating clinician as to cardiovascular risk profile in the individual woman who might receive this agent, since clinical trial data from an active comparator study show an imbalance in serious cardiovascular adverse events between romosozumab and alendronate.

Hormone replacement therapy and the endometrium

2009 ◽  
Vol 15 (3) ◽  
pp. 134-138 ◽  
Author(s):  
S Daayana ◽  
C M Holland
Keyword(s):  
Quality Of Life ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Postmenopausal Women ◽  
Hormone Replacement ◽  
Symptom Relief ◽  
Careful Consideration ◽  
Age Group ◽  
Individual Woman

The life-expectancy for women has increased significantly in the 20th century, although the time of onset of menopause has not. Almost a third of a woman's life is now postmenopausal and therefore many postmenopausal women consider using hormone replacement therapy (HRT) to improve their quality of life. Most cases of endometrial carcinoma arise in postmenopausal women and this raises concern among patients and clinicians with regard to the safety of HRT in this age group. Whenever the use of HRT is considered, a careful consideration of the actual benefit in terms of symptom relief and quality of life must be balanced against the risks for each individual woman. This review discusses the effects of HRT on the endometrium and the evidence regarding HRT use and risk of endometrial cancer.

Contraception for women with medical diseases

2020 ◽  
pp. 2711-2718
Author(s):  
Aarthi R. Mohan
Keyword(s):  
High Risk ◽  
High Mortality ◽  
Contraceptive Method ◽  
Unplanned Pregnancy ◽  
Mortality Rates ◽  
Failure Rates ◽  
Medical Disorders ◽  
Individual Woman ◽  
The Individual ◽  
Very High

All women with underlying medical disorders should be given correct advice regarding adequate contraception so that they can make informed choices regarding potential future pregnancies. There are several important factors to consider when deciding upon the most appropriate form of contraception to use. These include the risk of pregnancy for the woman, the effect of the contraceptive method on the medical disease, the failure rates associated with the contraceptive method, the consequences of an unplanned pregnancy, and the compliance and preferences of the individual woman. There are a small number of very high-risk conditions where pregnancy is not recommended due to high mortality rates, and the most reliable contraceptive methods should be recommended for these women.

scholarly journals Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline

2019 ◽  
Vol 104 (5) ◽  
pp. 1595-1622 ◽  
Author(s):  
Richard Eastell ◽  
Clifford J Rosen ◽  
Dennis M Black ◽  
Angela M Cheung ◽  
M Hassan Murad ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Postmenopausal Women ◽  
Patient Preferences ◽  
Assessment Tools ◽  
Endocrine Society ◽  
Pharmacological Management ◽  
Provider Perspectives ◽  
Specific Assessment ◽  
Osteoporosis Patient ◽  
Pharmacologic Therapies

Abstract Objective The objective is to formulate clinical practice guidelines for the pharmacological management of osteoporosis in postmenopausal women. Conclusions Evidence from clinical trials and insights from clinical experience with pharmacologic therapies for osteoporosis were critically evaluated in formulating this guideline for the management of postmenopausal osteoporosis. Patient preferences, data on adherence and persistence, and risks and benefits from the patient and provider perspectives were also considered in writing committee deliberations. A consensus by the Writing Committee members was achieved for four management principles: (i) The risk of future fractures in postmenopausal women should be determined using country-specific assessment tools to guide decision-making. (ii) Patient preferences should be incorporated into treatment planning. (iii) Nutritional and lifestyle interventions and fall prevention should accompany all pharmacologic regimens to reduce fracture risk. (iv) Multiple pharmacologic therapies are capable of reducing fracture rates in postmenopausal women at risk with acceptable risk-benefit and safety profiles.

The Orchard Plot: Cultivating a Forest Plot for Use in Ecology, Evolution and Beyond

2019 ◽  
Author(s):  
Shinichi Nakagawa ◽  
Malgorzata Lagisz ◽  
Rose E O'Dea ◽  
Joanna Rutkowska ◽  
Yefeng Yang ◽  
...  
Keyword(s):  
Meta Analysis ◽  
R Package ◽  
Effect Sizes ◽  
Forest Plot ◽  
Point Estimates ◽  
Aggregate Effect ◽  
The Individual ◽  
Meta Analyses ◽  
Heterogeneous Effect ◽  
Intuitive Interpretation

‘Classic’ forest plots show the effect sizes from individual studies and the aggregate effect from a meta-analysis. However, in ecology and evolution meta-analyses routinely contain over 100 effect sizes, making the classic forest plot of limited use. We surveyed 102 meta-analyses in ecology and evolution, finding that only 11% use the classic forest plot. Instead, most used a ‘forest-like plot’, showing point estimates (with 95% confidence intervals; CIs) from a series of subgroups or categories in a meta-regression. We propose a modification of the forest-like plot, which we name the ‘orchard plot’. Orchard plots, in addition to showing overall mean effects and CIs from meta-analyses/regressions, also includes 95% prediction intervals (PIs), and the individual effect sizes scaled by their precision. The PI allows the user and reader to see the range in which an effect size from a future study may be expected to fall. The PI, therefore, provides an intuitive interpretation of any heterogeneity in the data. Supplementing the PI, the inclusion of underlying effect sizes also allows the user to see any influential or outlying effect sizes. We showcase the orchard plot with example datasets from ecology and evolution, using the R package, orchard, including several functions for visualizing meta-analytic data using forest-plot derivatives. We consider the orchard plot as a variant on the classic forest plot, cultivated to the needs of meta-analysts in ecology and evolution. Hopefully, the orchard plot will prove fruitful for visualizing large collections of heterogeneous effect sizes regardless of the field of study.

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