Dehydroepiandrosterone (DHEA) and the menopause: an update

Since we last reviewed this topic in 2001, considerably more information about dehydroepiandrosterone (DHEA) has accrued, but this has not necessarily left us any wiser about the use of this steroid in postmenopausal women. There is no further evidence that DHEA supplementation is likely to be useful in the prevention of cardiovascular disease or cognitive impairment, or in the promotion of wellbeing. Evidence has, however, accumulated for beneficial effects of DHEA on osteoporosis, both in postmenopausal women and in patients receiving long-term glucocorticoid therapy. What is also emerging is a link between low DHEA levels and cardiovascular risk, and between high DHEA levels and breast cancer risk. In fact, the benefits and adverse effects of DHEA administration in postmenopausal women increasingly resemble those of conventional hormone replacement therapy. Overall, we conclude that DHEA is not currently to be recommended for therapeutic use in the majority of postmenopausal women. However, DHEA supplementation may be of benefit in two specific groups of women: those with the lowest circulating levels of DHEA; and those for whom osteoporosis is a particular problem.     

Prevention of osteoporosis: one step forward, two steps back

For many years, hormone replacement therapy (HRT) was the mainstay for osteoporosis prevention in postmenopausal women until a large randomized clinical trial raised serious safety concerns. This resulted in a big drop in HRT use and its demotion by regulatory authorities to second-line treatment. Many clinicians now feel that HRT is not safe to use, and recommend various alternatives for the treatment of osteoporosis. But how effective are these alternative therapies, are they any safer than HRT, and how do their costs compare? This review questions the validity of the safety concerns about HRT, and highlights the safety concerns about alternative therapies. It concludes that HRT is as safe as the other treatment options, and its efficacy and low cost demand that it be restored as a first-line treatment for the prevention of postmenopausal osteoporosis. Other therapies are available for use in osteoporosis, and the bisphosphonates are particularly effective for the treatment of the established disease. However, they must be used selectively and with caution, and are best restricted to those patients who are elderly or have severe disease. New treatments are emerging, but again caution must be taken until any long-term adverse effects have been identified.     

Osteoporosis knowledge and attitudes: a cross-sectional study among college-age students

OBJECTIVE: The authors' purpose in this study was to investigate the influence of knowledge of osteoporosis, attitudes regarding osteoporosis, and knowledge of dietary calcium on dairy product intake in both male and female college-age students. PARTICIPANTS: The authors conducted this cross-sectional study on 911 men and women enrolled in 2 demographically similar universities. METHODS: A modified osteoporosis knowledge questionnaire assessed participant's general osteoporosis knowledge and perceived disease risk. RESULTS: The authors found that knowledge of osteoporosis and calcium did not significantly influence dairy product intake. Attitude regarding osteoporosis was a significant predictor of dairy product intake in men but was not significant for the women. CONCLUSIONS: The authors recommend development and implementation of educational programs designed to increase awareness of calcium-rich food sources as well as other risk factors of this crippling disease.     

Role of bisphosphonates in the management of postmenopausal osteoporosis: an update on recent safety anxieties

Following their introduction in the 1990s, bisphosphonates have become the mainstay of treatment in the management of postmenopausal osteoporosis, and their use continues to rise. Commonly noted adverse effects in clinical practice include gastrointestinal side-effects, acute phase reactions (predominately seen with intravenous preparations) cutaneous reactions and more rarely, ocular side-effects. However, recent reports of potentially serious adverse effects of bisphosphonate therapy, including atypical subtrochanteric and femoral shaft fractures, atrial fibrillation, oesophageal carcinoma and osteonecrosis of the jaw, have prompted concerns regarding the long-term safety of this class of drugs. This review summarizes the benefits and potential adverse effects of bisphosphonates used in the treatment of postmenopausal osteoporosis. Although evidence of a definitive casual relationship between bisphosphonate therapy and serious adverse effects is lacking, concern remains particularly in relation to atypical subtrochanteric and femoral shaft fractures. This has important consequences in terms of determining optimum duration of therapy and how best to target therapy at those most at risk. Recently, attention has focused on individual fracture risk assessment in order to optimize the risk-benefit ratio of treatment for individual patients. A review of the role of hormone replacement therapy in younger women with significant risk of osteoporotic fractures may be timely in these circumstances.     

Bazedoxifene: a new selective estrogen receptor modulator for postmenopausal osteoporosis

An ongoing need for safe and effective pharmacological therapies exists for postmenopausal osteoporosis, which imposes a significant burden on both women and the health-care system. Bazedoxifene is a novel selective estrogen receptor modulator with a unique tissue-selectivity profile. In phase 3 clinical trials of nearly 10,000 postmenopausal women, bazedoxifene was shown to significantly reduce the risk of new vertebral fracture versus placebo, with favourable effects on bone mineral density, bone turnover markers and the lipid profile. Moreover, in a subgroup of women at increased risk of fracture, bazedoxifene significantly decreased non-vertebral fracture risk versus both placebo and raloxifene. Bazedoxifene has been shown to be safe and well tolerated, with no evidence of endometrial or breast stimulation. These data suggest that bazedoxifene may offer significant clinical benefit for postmenopausal women with or at risk of developing osteoporosis, which may subsequently lessen the medical and economic burden of this disease.     

Osteoporosis: an invisible, undertreated, and neglected disease of elderly men

This article highlights a silent disease that threatens the health and vitality of older men. Among elderly men and women, osteoporosis is among one of the leading causes of morbidity and mortality in the United States. Once perceived as only a female dominated disease, osteoporosis is now known to be gender blind. The following discussion will review the epidemiology and pathology of osteoporosis, and identify the concerns raised for men, including neglect. Special management considerations for older men and recommendations for future research into this overlooked major health problem will be explored. Better understanding of how osteoporosis affects older men may help to encourage prevention strategies earlier in life, appropriate screening and monitoring, as well as more effective treatment later in life.     

National Osteoporosis Society's Position statement on hormone replacement therapy in the prevention and treatment of osteoporosis

Hormone replacement therapy (HRT) has been shown to increase bone density, reduce the risk of fracture and can successfully relieve menopausal symptoms. From a time when HRT was the major therapeutic option for the management of osteoporosis, women and their clinicians now have a range of treatments available. Following the publication of the Women's Health Initiative (WHI) and the Million Women Study highlighting potential side-effects, such as breast cancer, heart disease and stroke, many doctors and women are now reluctant to use HRT. The National Osteoporosis Society felt that the role of HRT in the management of osteoporosis needed to be clarified. Using the Charity's expert clinical and scientific advisers, and through public consultation with members and key stakeholders, a Position Statement has been published. We conclude that HRT has a role to play in the management of osteoporosis in postmenopausal women below the age of 60 years. The key recommendations of the Position Statement are presented in this paper.     

The consequences of own and spousal disability on labor market outcomes and subjective well-being: evidence from Germany

In this paper, I contrast the effects of individual and spousal disability on subjective well-being and labor supply using data on couples from the German Socio-Economic Panel for the years 1984–2006. I find almost no effects in terms of labor market outcomes for both men and women, which stands in stark contrast to the effects of individual disability. The life-satisfaction of women, but not of men, is reduced considerably by their partners’ disability. The effects are about 50–73 % as large as those of individual disability. I also find no evidence that individuals adapt to their partners’ disability, although there is adaptation to individual disability.     

Osteoporosis in the aging population: the male perspective

The importance of senile osteoporosis in men as a public health problem has long been underestimated. Elderly men are at substantial risk for fracture, and morbidity after osteoporotic fractures appears to be more serious and mortality more common in men than in women. Risk factors for osteoporotic fractures in men appear to be qualitatively similar to those in women, but there are quantitative differences. Low bone mineral density (BMD) is an important risk factor for fracture in men; however, further clarification of the relationship between BMD, bone geometry and fracture risk is needed before formulating definitive proposals on operational densitometric criteria for diagnosis of osteoporosis in men and the identification of men at high risk for fracture. Understanding of the mechanisms underlying senile bone loss and the pathogenesis of senile osteoporosis in men remains fragmentary with, in particular, the need for further clarification regarding the precise impact of hormonal status in elderly men on skeletal homeostasis. Recommendations on prevention and treatment of senile osteoporosis in men should focus on the minimization of known risk factors for bone loss and falls. Testosterone treatment may be useful in those men with initially low serum testosterone. As to other pharmacological treatment modalities, prospective trials specifically in elderly men, and preferably with fracture incidence as the primary clinical endpoint, are required.     

Systemic lupus erythematosus and hormone replacement therapy

The indications for hormone replacement therapy (HRT) in postmenopausal women is the treatment of climacteric symptoms and the prevention of osteoporosis. Women with systemic lupus erythematosus (SLE) are more likely to have a premature menopause, osteoporosis and cardiovascular disease. HRT can induce SLE flares and cardiovascular or venous thromboembolic events. Therefore it should not be used in women with active disease or those with antiphospholipid (aPL) antibodies. In general, it should be used only for patients without active disease, a history of thrombosis or aPL antibodies. Non-oral administration of estrogen is recommended because of its lesser effect on coagulation. With regard to the progestogen, progesterone or pregnane derivatives are preferred. Otherwise, non-estrogen-based strategies should be used.     

Patriarchal Women: A Case Study of Newly Orthodox Jewish Women

Although it seems obvious why men might turn to a community steeped in patriarchal tradition, it is much more difficult to explain women's attraction. To explain their attraction the author conducted in-depth interviews with 75 newly orthodox Jewish women. Although many of these women began their journeys toward Jewish Orthodoxy partly as a backlash against feminism or any liberation movement they perceived as placing individual freedom above social responsibility, the data also suggest that almost all of them selectively incorporate and adapt some protofeminist values about the family and about men. This article explores the ways in which these women seem to make “feminist” sense out of patriarchal religion and social strucuture.     

Commitment to mothering and preference for employment: The voices of women on public assistance with young children

This study uses qualitative data to examine how welfare-dependent women with young children feel about the employment mandate in the 1996 welfare reform legislation, Personal Work Responsibility Opportunity Reconciliation Act (PWRORA). The voices of poor women have been overlooked in the policy debate about welfare reform, as well as in the social science literature. The data were drawn from individual and group interviews done with 14 women on public assistance during the initial phase of their participation in a voluntary welfare-to-work program. The women in this sample report that they have strong positive feelings about working outside of the home, as well as strong reservations. The paper presents new data on low-income women's role preference and perceived conflict regarding employment when their children are young. All the women in the sample had children under 2 years of age. The data demonstrate that there are aspects of role preference and conflict with employment that are unique to women on public assistance, as well as aspects that are universal across income groups.     

Prevalence of low forearm bone mineral density in Bulgarian men: a pilot study

Objective. To determine the prevalence of osteoporosis at the distal forearm in a male cohort referred for bone density testing and to compare it to published data of Bulgarian women.

Design and subjects. 315 consecutive Bulgarian men aged 20 to 84 years were included (mean age 53.74 ± 14.67 years). 59% of them were self-referrals. The comparative female group consisted of 8869 Bulgarian women whose forearm bone mineral density (BMD) was measured in another study.

Measurements. BMD was measured by single X-ray absorptiometry at the distal forearm (distal and ultradistal sites) in all men. T-scores were calculated from manufacturer-provided Danish male reference data.

Results. The ratio of female to male patients was 28.2 (8869 to 315). Peak BMD was observed in men aged 30 to 39 years: 0.560 ± 0.065 g/cm² (distal site) and 0.490 ± 0.070 g/cm² (ultradistal site). A steady BMD decline followed reaching 0.492 ± 0.064 g/cm² at the distal and 0.412 ± 0.069 g/cm² at the ultradistal site in age group >70. Age had a rather weak negative impact on forearm BMD described by a linear model. In men aged over 50 years the prevalence of osteoporosis at the distal site was 21.19%, compared to 20.45% in women. Low bone mass was seen in 48.77% of men and 32.50% of women. Normal BMD was more frequent in women (47.05%) than in men (30.04%).

Conclusions. We found a high prevalence of forearm osteoporosis in Bulgarian men which is comparable to that already known in women.     

Individual interviews or focus groups? Interview format and women’s self-disclosure

Individual interviews have traditionally been an important method of data collection in multiple disciplines, including psychology. However, research comparing individual interviews with focus groups has generated mixed results regarding which method is more effective in investigating sensitive topics. The purpose of the present study was to directly compare the two methods with respect to young women’s verbalizations on a sensitive topic, namely their thoughts and feelings related to body image. Female undergraduate students were randomly assigned to an individual interview (n = 32) or focus group (n = 33). Participants in the individual interviews disclosed more personal thoughts and feelings about body image and had more positive perceptions of the interpersonal climate of their sessions than participants in the focus groups. These findings suggest that individual interviews may provide women with a more supportive environment in which to discuss sensitive topics.     

American College Health Association

Abstract

Objective: The purpose of this cross-sectional investigation was to examine (1) gender differences in osteoporosis-related knowledge and beliefs and (2) if these beliefs could predict vigorous physical activity behavior in university students. Participants: Male (n = 176) and female (n = 351) university students participated in the study. Methods: Participants completed self-report measures of osteoporosis knowledge and health beliefs and vigorous physical activity. Results: Regardless of gender, osteoporosis knowledge was relatively poor. Women reported higher knowledge, perceived susceptibility, perceived severity, and calcium barriers, and lower exercise self-efficacy than men. Regression analyses showed that for women, perceived susceptibility, health motivation, and exercise self-efficacy predicted vigorous physical activity, whereas for men, exercise barriers was the only predictor. Conclusions: Gender differences in osteoporosis health beliefs appear to be greater in older adults than college-aged students. Interventions designed to increase vigorous physical activity may want to target different beliefs for men and women.     

Non-estrogen-based treatments for menopausal symptoms

The British Menopause Society Council is committed to provide up-to-date authoritative reviews to aid health professionals to inform and advise women about key issues in postreproductive health. This guidance refers to non-estrogen-based treatments for menopausal symptoms, such as hot flushes, symptoms of urogenital atrophy and lack of sexual desire. Treatment of choice should be based on up to-date information and targeted to individual women's needs. Non-hormonal strategies may be useful for women with estrogen-dependent disease such as breast cancer.     

Urogenital atrophy

The British Menopause Society Council aims to aid health professionals to inform and advise women about postreproductive health. This guidance refers to the long-term condition of urogenital atrophy. Treatment choice should be based on up to date information and targeted to individual women's needs. Non-estrogen and estrogen-based treatments are discussed.     

Individual and Familial Determinants of Married Arab Israeli Women's Labor Force Participation: Trends of Change and Stability

Although the Arab population in Israel has undergone important economic and social changes in the past decades, the labor force participation of Arab women, particularly married women, has remained limited. This study uses census data to learn about the individual and familial factors associated with the entry into paid work of married Arab women and examines the extent to which these factors have changed over time. A major advantage is that the study distinguishes between the Muslim, Christian, and Druze populations, who markedly differ in their demographic, social, and cultural characteristics. Results from logistic regression models and standardization analyses reveal that the growth in employment experienced by Arab women was associated with the increasing education of both wives and husbands. However, the returns to education significantly decreased over time, particularly among Druze women, suggesting it has become more difficult for highly educated women to find employment. Results further show that the growth in employment experienced by Muslim and Christian women was related both to a decline in fertility and to a decrease in the negative returns to having children. Overall, findings underscore the structural barriers that limit Arab Israeli women's employment opportunities and raise concerns about their future occupational prospects.     

Breasted experiences in pregnancy: an examination through photographs

Drawing on qualitative data from a sample of pregnant women in Hobart, Australia this article uses ‘feminist’ ‘memory work’ and the ‘photovoice’ method as frames for discussing the ways in which interviews and participant-produced photographs may be used to trace and understand pregnant embodiment. I argue that digital photographs taken by women during pregnancy can reveal important information about how they negotiate their own experiences of breastedness and wearing maternity underwear over time. Here, the concept of ‘breastedness’ itself is expanded as women’s individual embodied experiences of pregnancy are reflected in the production and viewing of their own photographic images.