Ethnic characteristics of bone remodeling in female patients with type 2 diabetes mellitus

Background: Structural and metabolic disorders of bone tissue in women with T2DM have no clinical manifestations, but they are accompanied by the risk of fractures.Aim: To study the parameters of bone metabolism, BMD and microarchitectonics in female patients with T2DM in the Buryat population.Materials and methods: The observational single-center one-stage controlled study included 73 women with T2DM, which were divided into 2 groups depending on the functional state of the ovaries (reproductive and postmenopausal periods). In each group, subgroups of the Buryat and Russian populations were identified. The first group included 34 patients with T2DM of the reproductive period: 16 from the Buryat population and 18 from the Russian population. The second group consisted of 39 postmenopausal patients with T2DM: 17 from the Buryat population and 22 from the Russian population. The study of BMD in the lumbar spine (L1-L4), femoral neck (Neck), in the proximal femur (Total hip), trabecular bone score (TBS), serum osteocalcin (OC), N-terminal propeptide type 1 procollagen was carried out (P1NP), vitamin D 25 (OH), blood plasma type I collagen C-terminal telopeptide (β-Cross laps) and ionized calcium (iCa).Results: In female patients with T2DM of the reproductive age of the Buryat population, an increase in both markers of osteosynthesis P1NP (p=0.035), OC (p=0.047), and bone resorption β-Cross laps (p=0.040) was found relative to the similar group of the Russian population. In women with T2DM in the postmenopausal period of the Buryat population, there was also an increase in P1NP (p = 0.016), OC (p = 0.048), β-Cross laps (p = 0.020) compared with the group of postmenopausal women in the Russian population. Structural disorders, characterized by a decrease in TBS, were detected only in the postmenopausal period in female patients of the Buryat population compared to women in the Russian population (p = 0.029).Comparative analysis among women with T2DM of the Buryat population, depending on the functional state of the ovaries, showed that activation of bone remodeling with an increase in P1NP (p = 0.019), OC (p = 0.004) and β-Cross laps (p = 0.004) is characteristic of postmenopausal women accompanied by a decrease in BMD Neck (p = 0.006), BMD Total hip (p = 0.003), BMD L1-L4 (p = 0.049) and TBS (p = 0.020) relative to female patients with T2DM in the reproductive period.Conclusion: In women with T2DM in the Buryat population, both in the reproductive and postmenopausal periods, an increase in bone remodeling markers and BMD stability was found when compared with the corresponding groups of patients in the Russian population. The postmenopausal period was characterized by an additional decrease in TBS in patients with T2DM in the Buryat population relative to women in the Russian population.

739 Atypical presentation of Takotsubo syndrome early after pacemaker implantation

Aims Takotsubo syndrome (TTS) is an acute stress-induced cardiomyopathy showing left ventricular (LV) dysfunction without obstructive coronary arteries disease. A sudden massive surge of circulatory catecholamines from an intense physical or emotional stress may play a central role in the pathogenesis of TTS. We report the case of an 87 years-old woman who developed TTS with uncommon presentation after permanent pacemaker (PM) implantation. Methods and results The patient was referred to our hospital for PM implantation because of advanced atrio-ventricular block (3:1). She suffered by rheumatoid arthritis (RA), arterial hypertension, and chronic kidney disease. Echocardiogram, performed before PM implantation, showed normal LV kinesis and normal ejection fraction (EF 60%). She was initially administered with infusion of Isoprenaline 2 mcg/min. The subsequent day, she underwent permanent dual-chamber pacemaker implantation without any complications. After 3 days, the patient complained severe asthenia and fever, together with increase of white blood cells and C reactive protein. Blood cultures were negative. We started antibiotic therapy and, suspecting a reactivation of RA, steroid therapy with infusion of methylprednisolone 40 mg/die. Electrocardiogram showed normal sinus rhythm and paced ventricular rhythm. PM interrogation showed normal function. Surprisingly, echocardiogram showed LV dysfunction with apical and medium segments akinesia, and severe EF reduction (35%). Coronary angiography documented absence of coronary obstructive lesions, assessing diagnosis of TTS. The patient was discharged 1 week after admission in good clinical condition. One week later, an echocardiogram showed apical akinesia, partial recovery of medium segments motility, and slight increase of EF (40%). The excess of catecholamines could lead to decreased cardiac muscular function and to spasm of coronary arteries: these events can lead to acute heart failure and decrease of LVEF. Furthermore, about 90% of patients with TTS are women, especially in postmenopausal period. Peculiarities of this case were the atypical symptoms of TTS and the combination of different predisposing stressors factors: female sex in postmenopausal period, anamnesis of chronic inflammatory disease, use of stress-inducing drugs (methylprednisolone and isoprenaline, the last associated with TTS after PM-implantation), atrio-ventricular block itself, and PM implantation procedure. Our findings remark that even a low-risk procedure could be a possible cause of TTS in patient with such risk factors. In our opinion, in this subset of patients, conscious sedation could be useful to reduce the stress load, together with an early procedure and consequently the minimal use of exogenous stress drugs like Isoprenaline, even if the patient is in a good clinical condition. Conclusions This case highlights TTS as a potential complication after PM implantation, especially in post-menopausal women with high pre-existing stress load.

The association between sexual function and body image among postmenopausal women: a cross-sectional study

Background Postmenopause physiological changes may alter body image (BI) during the postmenopausal period of life. Body image dissatisfaction may have negative effects on the sexual function of women. The present study aims to assess the relationship between body image and sexual function during the postmenopausal period. Methods This cross-sectional study was performed on 231 postmenopausal women who were menopausal during the recent 5 years, aged > 40 years old, and referring to health centers in Tehran-Iran. The participants were recruited using a multi-stage sampling method. Data were collected using 3 questionnaires including socio-demographic, Fisher’s Body Image, and female sexual function index (FSFI). Data were analyzed using SPSS 24 and multiple regression, Mann–Whitey, Pearson, and Spearman correlation tests. Results Two hundred thirty-one postmenopausal women aged 52.53 ± 5.32 (mean ± SD) years old participated in the study. The mean and standard deviation of FSFI and BI of the women were respectively 19.59 ± 11.11(ranges 1.2–36) and 155.43 ± 37.09 (ranges from 46 to 230). According to FSFI, 62.8% of female sexual dysfunction (FSD) was reported. There were significant correlations between scores of total and all domains of FSFI with scores of total and all dimensions of BI. There was also a positive correlation between education and family income of the women and a negative correlation between age of husband and duration of menopause with their sexual function. Significant relationships were also shown between the women's and the husbands' jobs with the total score of women's sexual function. According to the multiple linear regression model, BI was a significant predictor of sexual function in postmenopausal women. Conclusion Body image is effective on the sexual function of postmenopausal women. Therefore, body image is necessary to be considered in future postmenopausal health promotion programs.

Hyperprolactinemia in the postmenopause: versions and contraversions

The prevalence of hyperprolactinemia in postmenopausal women is unknown and has been estimated as infrequent by many studies. Prolactinomas found after menopause are usually macroadenomas and remain unrecognized for a long time due to atypical clinical signs or their absence. The growth potential of prolactinomas persists after menopause, most of them are invasive and accompanied by high prolactin levels. Treatment with dopamine agonists is usually long-term, the goals of which are to reduce tumor size, normalize prolactin levels and the negative effects of hyperprolactinemia. Treatment with cabergoline makes it possible to achieve remission of the disease in the first years after discontinuation, however, the proportion of relapses in postmenopausal women increases 5 years after discontinuation of the drug. Remission of prolactinomas is not evident in postmenopausal women. The modern management of patients with prolactinoma and/or hyperprolactinemia does not have clear positions in the postmenopausal period. Controversial issues remain: an ambiguous relationship between prolactin levels and breast cancer, there are no convincing conclusions on the improvement of bone mineral density and/or a decrease in the risk of fractures with normalization of prolactin levels, there are no data on metabolic parameters after the end of treatment with dopamine agonists, conflicting information about the relationship of prolactin levels and the severity of the manifold manifestations of the climacteric syndrome. The use of estrogen-progestin drugs in women with hyperprolactinemia/prolactinomas is also not well understood. Thus, the problem of hyperprolactinemia in the perimenopausal and postmenopausal period is underestimated and requires additional research, as well as the development of diagnostic and therapeutic strategies for potential benefits in terms of weight loss, improving insulin sensitivity, reducing the risk of fractures, maintaining sexuality and psycho-emotional well-being.

HORMONE LEVEL CHANGES IN ENDOMETRIAL ABNORMALITIES IN THE POSTMENOPAUSAL PERIOD

Background. In recent decades, the increase in life expectancy has led to a significant increase in the duration of the postmenopausal period. Prolonged estrogen deficiency contributes to an increase in the incidence of chronic somatic diseases, including neurovegetative, metabolic-endocrine, and psycho-emotional disorders that define the menopausal syndrome. Aim. To study the prognostic and diagnostic significance of hormone parameters in endometrial abnormalities in the postmenopausal period. Material and methods. Forty-seven women with various clinical manifestations of endometrial pathology in the postmenopausal period were examined. The mean age of the examined women was (58,43±1,1) years. All the patients had luteinizing hormone, follicle-stimulating hormone, progesterone, testosterone, estradiol, dehydroepiandrosterone sulfate, and serum sex hormone-binding globulin measured by enzyme immunoassay. The results obtained were subjected to statistical processing using standard computer programs «Statgraph» designed for parametric and nonparametric methods of calculating mean values. We calculated mean and standard deviation (M±Se), as well as minimum-maximum values for the sample. Differences were considered significant at p<0,05. Results and discussion. As a result of the study the abnormality of the endometrium in the postmenopausal period was determined. Endometritis was observed in 4 (8,5%) of 47 patients, atrophic endometrium in 7 (14,9%) patients, diffuse endometrial hyperplasia in 3 (6,4%) cases, endometrial polyp in 29 (61,7%) cases, and endometrial carcinoma in 3 (6,4%) cases. A significant increase in follicle-stimulating hormone [(65,39±1,27) mmE/ mL], luteinizing hormone [(34,85±0,15] mmE/mL), estradiol [(88,73±2,1) pg/mL], and testosterone [(2,29±0,08) ng/mL] values was registered in the postmenopausal patients, which is an important prognostic and diagnostic criterion in this patient population. Conclusion. The study of hormone parameters in the postmenopausal period is one of the most important methods of early detection of various endometrial abnormalities, allowing timely implementation of appropriate therapeutic and preventive measures.

The incidence of osteoporosis and vertebral fracture in women with postmenopausal type 2 diabetes mellitus and predisposing factors of vertebral fractures

Background: Type 2 diabetes mellitus (DM) has an increased fracture risk due to loss of bone quality and tendency to falling. The aim of the study was to analyze the incidence of osteoporosis and vertebral fractures (VF) in postmenopausal women with type 2 DM and to define the risk factors of VF in terms of clinical, metabolic characteristics and diabetes related microvascular complications.Methods: The 42 postmenopausal patients with type 2 DM were included to the study in Haseki Training and Research Hospital outpatient clinics.Results: Osteoporosis with regard to lumbar spine (LS) and femur neck (FN) was 8.4%, 19.4%, respectively. Vertebral fracture ratio was 31%. There was no statistical significance between vertebral fracture and osteoporosis. In logistic regression analysis, longer postmenopausal period, higher postprandial blood glucose (PBG), presence of peripheral neuropathy was found associated with vertebral fracture (p=0.04, 0.04, and 0.05, respectively).Conclusions: In this study we suggest to consider the length of postmenopausal period, PBG and peripheral neuropathy for assessing the risk of VF.

Nutrition in Menopausal Women: A Narrative Review

Among the various aspects of health promotion and lifestyle adaptation to the postmenopausal period, nutritional habits are essential because they concern all women, can be modified, and impact both longevity and quality of life. In this narrative review, we discuss the current evidence on the association between dietary patterns and clinical endpoints in postmenopausal women, such as body composition, bone mass, and risk markers for cardiovascular disease. Current evidence suggests that low-fat, plant-based diets are associated with beneficial effects on body composition, but further studies are needed to confirm these results in postmenopausal women. The Mediterranean diet pattern along with other healthy habits may help the primary prevention of bone, metabolic, and cardiovascular diseases in the postmenopausal period. It consists on the use of healthy foods that have anti-inflammatory and antioxidant properties, and is associated with a small but significant decrease in blood pressure, reduction of fat mass, and improvement in cholesterol levels. These effects remain to be evaluated over a longer period of time, with the assessment of hard outcomes such as bone fractures, diabetes, and coronary ischemia.

Comparative Analysis of Anthropometric Parameters and Body Composition of Patients with Breast Cancer and Healthy Women in the Postmenopausal Period

According to a statistical review (2018) in Latvia, there are more than one thousand women (n = 1266) with the diagnosis of breast cancer. Assessments of anthropometrical parameters were made according to the World Health Organisation recommendations for morbidity risk analysis. The aim of the study was to determine the differences and changes of anthropometric parameters and indices in a control group and in a clinical group (initial oncological diagnosis without treatment intervention). We examined women in their postmenopausal period. The control group included apparently healthy women (n = 181) and the clinical group included women (n = 44) with initial oncological diagnosis (breast cancer 1st and 2nd stage). In order to assess body anthropometric characteristics we used the body mass index (BMI), waist circumference, waist/height ratio and skin fold thickness measurement. The study results were assessed using statistical analyses in the IBM SPSS Statistics for Windows, Version 22.0 software: Shapiro–Wilk and Mann–Whitney tests with a two-tailed p-value < 0.05). The analysis of statistical data showed that, despite the low number of patients in the clinical group, we found a significantly lower waist-to-hip ratio, skinfold thickness above m. biceps brachii, skinfold thickness above m. triceps brachii, and subscapular and suprailiac skin fold thickness in this group.

The effect of regular resistance exercise, vitamin D, and calcium supplements on the gastrocnemius muscle in rats in the post-menopausal period: An experimental study

Background: Menopause is the natural termination of menstruation which affects the quality and important aspects of women’s life. Objective: To evaluate the effect of regular resistance training (Ex) with vitamin D (Vit. D) and calcium (Ca) supplements in the postmenopausal period on muscle tissue in rats. Materials and Methods: In this experimental study, 72 female Wistar rats (8-10-wk old) were randomly divided into control, placebo, Vit. D, Ca, Ex, Ca + Vit. D, Ex + Ca, Ex + Vit. D, and Ex + Ca + Vit. D groups. Control and placebo groups were fed with a standard diet and sesame oil, respectively. Two months after the ovariectomy, Ex, Ca (35 mg/kg), and Vit. D (10000 IU) were administered in all groups except the control. The number of muscle and inflammatory cells, fiber diameter, endomysium thickness, and degenerative collagen fiber area were assessed through hematoxylin-eosin staining. Results: Muscle cell number was increased in the Ex + Vit. D + Ca, Vit. D + Ex, and Vit. D groups compared to the control group; also, inflammatory cell number showed significant increase in the Ex + Vit. D + Ca (12 ± 5.46), Vit. D + Ex (14 ± 3.25), Ex (13 ± 4.08), Vit. D (11 ± 3.26), Ca + Vit. D (10 ± 1.01), and Ca + Ex (9 ± 2.87) groups. Muscle fiber diameter in the Ex + Vit. D + Ca and Vit. D + Ex groups was higher than the other groups. Endomysium thickness was significantly decreased in the Ex + Vit. D + Ca and Vit. D + Ex groups compared to the control and placebo groups (p < 0.001). Degenerative collagen fiber area showed a significant increase in the Ex + Vit. D + Ca and Vit. D + Ex groups (p ≤ 0.001) comparison with the control group. Conclusion: Regular resistance exercise, Vit. D, and Ca supplements can improve muscle morphological features in the postmenopausal period. Key words: Menopause, Muscle, Vitamin D, Calcium, Exercise.

Сomparison of ultrasonic scanning and morphological data in patients with postmenopausal endometrial polypes

The article discusses the features of obstetric and gynecological anamnesis in patients with endometrial polyps in the postmenopausal period, compares the ultrasound protocols and data of morphological examination of the surgical material (n = 100). The results showed that endometrial polyps are detected with the same frequency in patients in the early and late postmenopausal period. It is noteworthy that every five patient with an endometrial polyp in the reproductive age had menstrual dysfunction and a high frequency of using intrauterine contraceptive. In order to verify the pathology of the uterine cavity, ultrasound infusion sonography was not used in the studied group of patients. There was a high frequency of the absence of visualization of endometrial polyps on TV ultrasound, besides, they were frequently verified as endometrial hyperplasia; overdiagnosis took place in more than 7.5 cases; morphological examination confirmed hyperplasia only in 8% of 60 % of patients. It is important to note that in case of malignant endometrial processes, TV ultrasound did not reveal even a suspicion of this. All of the above allows us to say that there is a need for further study of the tactics of managing patients with endometrial pathology in the postmenopausal period.