A causa mais comum da osteoporose é o declínio do hormônio sexual feminino, o estrógeno, que ocorre após a menopausa. Esse hormônio regula a produção de citocinas que influenciam a proliferação dos osteoclastos, aumentando a reabsorção óssea. Os efeitos da cafeína no metabolismo ósseo são controversos e podem estar associados ao aumento significativo de doenças periodontais, fraturas, aumento do cálcio urinário e redução da densidade mineral óssea, por exercer efeitos inibidores sobre as funções dos osteoblastos. O principal objetivo deste estudo foi avaliar o efeito in vitro de diferentes concentrações de cafeína no metabolismo de células osteoblásticas da medula óssea de ratas osteoporóticas. Após aprovação pela Comissão de Ética no Uso de Animais, ratas Wistar foram divididas em dois grupos experimentais: controle (C) e submetidas à ovariectomia (OVX). Após 60 dias da cirurgia, as ratas foram sacrificadas para coleta dos fêmures e das células mesenquimais da medula óssea, que foram induzidas à diferenciação em osteoblastos com meio osteogênico com três concentrações de cafeína (1, 3 e 5 mM - grupos OVX1, OVX3 e OVX5) e cultivadas em placas de 24 poços (n = 5) para avaliação da proliferação celular, atividade de fosfatase alcalina (ALP) bioquímica e in situ, detecção e quantificação de nódulos mineralizados e análise da expressão de genes relacionados à atividade osteoblástica através de PCR em tempo real. Os ensaios foram realizados em triplicata e analisados por meio do software estatístico GraphPad Prism, com nível de significância fixado em 5%. A proliferação celular foi menor nos grupos osteoporóticos com adição de cafeína, tendo a menor queda o grupo com adição de 1mM. O método bioquímico de ALP não foi significante nos períodos analisados, entretanto, aos 10 e 14 dias, a atividade aumentou quando a concentração de cafeína era maior. Já na atividade de ALP in situ, o grupo OVX1 foi o que apresentou melhor resultado nos períodos avaliados (p < 0,05), com pico aos 14 dias. A quantificação de matriz mineralizada foi maior no grupo OVX comparado ao grupo C; entre as concentrações, a maior quantificação dos nódulos de cálcio se deu no grupo com 1mM de cafeína. Os resultados obtidos no PCR mostraram que o gene para fosfatase alcalina teve maior expressão no grupo OVX, seguido do grupo OVX1 aos 7 e 10 dias; a expressão gênica de osteocalcina foi maior para o grupo OVX1 aos 10 e 14 dias e esse grupo apresentou a maior expressão em todos os períodos para os genes Runx2 e RankL. No caso do Bmp4, o grupo OVX3 foi o mais expresso aos 10 e 14 dias. Os genes osteoprotegerina e osteopontina variaram sua expressão de acordo com o período e grupo avaliado. A expressão de osterix foi similar entre os grupos aos 7 e 10 dias, enquanto a expressão de Bsp, aos 7 e 14 dias, mostrou semelhança entre os grupos controle e OVX1. Frente aos resultados obtidos, sugere-se que a concentração de 1mM de cafeína pareceu ser a menos prejudicial ao metabolismo das células osteoblásticas neste modelo experimental de osteoporose. / The most common cause of osteoporosis is the decrease of estrogen after menopause. This hormone regulates the production of cytokines that influence osteoclast proliferation, increasing bone resorption. The effects of caffeine in bone metabolism are controversial and may be associated to periodontal disease, bone fractures, increase of urinary calcium levels and reduction of mineral bone density due to inhibition of osteoblast activities. Thus, the goal of this investigation was to evaluate the in vitro effect of different caffeine concentrations in the metabolism of bone marrow osteoblastic cells from osteoporotic rats (OVX). After Ethical Committee approval, wistar female rats were divided in two experimental groups: control (C) and submitted to ovariectomy (OVX). After 60 days of surgery, femurs were removed to isolate bone marrow mesenchymal cells, which were induced to osteoblastic differentiation in osteogenic medium along with three different concentrations of caffeine (1, 3 and 5 mM - OVX1, OVX3 e OVX5 respectively) and posteriorly seeded in 24-well plates (n = 5) to evaluate cell proliferation, alkaline phosphatase activity and its in situ detection, detection and quantification of mineralized nodules as well as assess quantitative expression of genes associated to osteoblastic activity by means of real time PCR. All the experiments were performed in triplicate and analyzed by means of the statistical software GraphPad Prism for p<0.05. Cell proliferation was diminished in the all osteoporotic groups that received caffeine, with group OVX1 being the less affected. Biochemical assay of ALP activity did not show differences among the groups in the periods analyzed; nevertheless there was a tendency to a higher activity proportional to the higher concentration of caffeine. The in situ detection of ALP showed better results in group OVX1 after 14 days of culture. Mineralized matrix quantification was higher in OVX groups when compared to control group; among the concentrations, the higher quantification of calcium nodules was in group OVX1. The results obtained with PCR showed that the gene for ALP had its highest expression in OVX group, followed by OVX1 at 7 and 10 days; expression of osteocalcin was higher in OVX1 after 10 and 14 days and this same group presented higher expression in all periods for genes Runx2 e Rankl. Analysis of Bmp4 gene showed that it was expressed in group OVX3 after 10 and 14 days. The genes that code for osteoprotegerin and osteopontin had different expression values in accordance to the period and group evaluated. The expression of osterix was similar between the groups after 7 and 10 days, whereas the expression of Bsp was similar between control and OVX1 groups after 7 and 14 days. The results suggest that the concentration of 1mM of caffeine is the most beneficial to the metabolism of osteoblastic cells in a model of osteoporosis.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-05-12T11:44:31Z No. of bitstreams: 1 alvarofernandopolisseni.pdf: 3023308 bytes, checksum: ac820cb32e133d257e326096624caa46 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-06-27T19:31:22Z (GMT) No. of bitstreams: 1 alvarofernandopolisseni.pdf: 3023308 bytes, checksum: ac820cb32e133d257e326096624caa46 (MD5) / Made available in DSpace on 2016-06-27T19:31:22Z (GMT). No. of bitstreams: 1 alvarofernandopolisseni.pdf: 3023308 bytes, checksum: ac820cb32e133d257e326096624caa46 (MD5) Previous issue date: 2013-02-20 / Como consequência do hipoestrogenismo que se instala a partir da perimenopausa, surgem sintomas vasomotores, atrofia vaginal, disfunções sexuais, sintomas urinários, além de aumento de risco para doença cardiovascular e osteoporose. Estes sinais e sintomas podem interferir na qualidade de vida da mulher climatérica. O interesse pelo estudo da qualidade de vida tem sido crescente em várias áreas humanas, pois é fundamental que o aumento da expectativa de vida seja acompanhado de melhor qualidade da mesma. Esta deve ser avaliada, contemplando os domínios físico, social, psicológico e espiritual. Vários fatores estão relacionados à qualidade de vida da mulher climatérica, como a escolaridade, estado marital, atividade remunerada, renda familiar, morbidades, dificuldades conjugais, familiares, sexuais e sociais, além dos hábitos de vida. Os sintomas que surgem nesta fase, decorrentes do hipoestrogenismo, são capazes de deteriorar a qualidade de vida destas mulheres. Visando a melhoria destes sintomas, o uso da terapia hormonal (TH) seja com estrogênio ou outra droga, como a tibolona, tem sido indicada. A questão da qualidade de vida, apesar de sua importância na atualidade, infelizmente ainda é pouco estudada no Brasil. A maioria dos estudos tem sido realizada em outros países, não sendo possível a transposição de seus resultados para a realidade brasileira, em razão das diferenças culturais e sócio-econômicas. É incontestável a importância da TH na melhoria dos sintomas climatéricos, contudo permanecem contraditórios os resultados dos estudos mostrando o impacto desta terapia na qualidade de vida das mulheres na pós-menopausa. Além disso, são estudos utilizando estrogênios e progestógenos diferentes, esquemas, doses de medicamentos e vias de administração diversas, chegando a resultados variados. Devido à importância do tema, a proposição deste estudo é comparar os efeitos de um esquema combinado-contínuo de baixa-dose (BD-TH) com os efeitos da tibolona e com o grupo-controle sobre a qualidade de vida de mulheres sintomáticas, no climatério (pós-menopausa). Cento setenta e quatro mulheres foram selecionadas e randomizadas em três grupos: o grupo 1 foi medicado com 2,5 mg/dia de tibolona; o grupo 2 com 50 mg carbonato de cálcio/200 UI vitamina D3/dia (controle) e o grupo 3 com 1 mg estradiol/0,5 mg de acetato de noretisterona/dia (BD-TH). Cento e trinta mulheres completaram o estudo. Nenhuma diferença significativa em relação ao tempo de menopausa e qualidade de vida antes do inicio do tratamento foi encontrada entre os três grupos. O Questionário da Saúde da Mulher (QSM) foi administrado antes do uso da medicação e após 4, 8 e 12 semanas de tratamento, nos três grupos. Houve melhora global da qualidade de vida, nos três grupos. A avaliação da qualidade de vida por domínios, ao longo do tempo, demonstrou melhora dos oito domínios estudados, nos três grupos, no final do tratamento. A BD-TH foi superior à tibolona e ao suplemento de Ca/vitamina D3 em relação aos sintomas vasomotores. A tibolona, comparada ao esquema E2/NETA e suplemento de Ca/vitamina D3 foi a que teve melhor resposta nas questões relacionadas a função sexual. Concluiu-se que houve melhora da qualidade de vida nos três grupos de estudo. A tibolona foi efetiva na melhoria da qualidade de vida das pacientes, atuando principalmente nas questões relacionadas a função sexual, sendo superior a BD-TH neste domínio. A associação estroprogestogênica também se mostrou eficaz na melhoria da qualidade de vida na pós-menopausa determinando melhor resposta nos sintomas vasomotores. / As a consequence of the hypoestrogenism that sets in during the perimenopause, there appear vasomotor symptoms, vaginal atrophy, sexual dysfunction, urinary symptoms, as well as increased risk of cardiovascular disease and osteoporosis. These signs and symptoms can interfere in the quality of life of climacteric women. The interest in studying quality of life has increased in several fields of human activity, since it is essential that an increase in life expectancy be accompanied by better quality of life. This should be evaluated with regard to the physical, social, psychological and spiritual domains. Several factors are related to the quality of life of climacteric women, such as education, marital status, paid work, family income, morbidities, marital, family, social and sexual difficulties, as well as lifestyle. The symptoms that arise at this stage, resulting from hypoestrogenism, are capable of worsening the quality of life of these women. To improve these symptoms, the use of hormonal therapy (HT) either with estrogen or another drug, such as tibolone, has been recommended. The issue of quality of life, despite its importance nowadays, is unfortunately still not widely studied in Brazil. Most studies have been carried out in other countries, and it is not possible to apply their results to the situation in Brazil, because of cultural and socio-economic differences. The importance of HT in the improvement of menopausal symptoms is indisputable; however the results of studies showing the impact of therapy on the quality of life of postmenopausal women are still conflicting. Apart from that, these studies use different estrogens and progestins, different schemes, doses of drugs and ways of administering them, with different results. Due to the importance of the topic, the purpose of this study is to compare the effects of a combined, continuous, low-dose hormone terapy (LD-HT) with the effects of tibolone and with the control group as regards to the quality of life for symptomatic postmenopause women. One hundred seventy-four women were selected and randomized into three groups: group 1 was treated with 2.5 mg / day of tibolone, group 2 with 50 mg calcium carbonate / 200 IU vitamin D3 / day (control) and group 3 with 1 mg oestradiol / 0.5 mg of norethindrone acetate / day (LD-HT). One hundred and thirty women completed the study. No significant difference in the time of menopause and quality of life before initiation of treatment was found among the three groups. The Women's Health Questionnaire (WHQ) was applied to the three groups before the use of medication and after 4, 8 and 12 weeks of treatment. Evaluation of quality of life by domains, over time, showed an improvement in the eight domains studied, in all three groups, at the end of treatment. The LD-HT was higher than the tibolone and calcium supplement / vitamin D3 as regards to the vasomotor symptoms. Tibolone, compared to the E2/NETA scheme and supplementary Ca / vitamin D3 group had a better response to issues related to the sexual function. Conclusions: There was improved quality of life in the three study groups. Tibolone was effective in improving the quality of life of patients, acting mainly on issues related to the sexual function and was better than LD-HT in this domain. The estrogen-progesterone combination was also effective in improving quality of life in the post-menopause, showing a better response in vasomotor symptoms.

Le ranélate de strontium, prescrit dans le traitement de l'ostéoporose ménopausique, possède 2 atomes de strontium stable pouvant se fixer au minéral osseux. Le strontium a un effet dissociant sur le remodelage osseux, diminuant la résorption tout en augmentant la formation. Cependant, ses effets osseux ne sont pas complètement élucidés, en particulier ses interactions avec le minéral. Chez le singe, le strontium maintient à un niveau physiologique les propriétés intrinsèques majeures du tissu osseux, que ce soit aux niveaux tissulaire global ou des unités de remodelage. Chez la femme ostéoporotique ménopausée traitée par le ranélate de strontium, les caractéristiques du cristal d'apatite sont maintenues à un niveau physiologique. Par ailleurs, quelle que soit la durée du traitement (2 à 96 mois), le strontium est toujours distribué de façon hétérogène, présent principalement dans l'os récent formé pendant le traitement, les aires osseuses contenant du strontium augmentent progressivement mais de moins en moins avec la durée du traitement. Le contenu osseux focal en strontium est stable de 2 à 60 mois puis augmente de 60 à 96 mois, et la minéralisation secondaire est maintenue à un niveau physiologique. Enfin, après 6 et 12 mois de traitement, le ranélate de strontium maintient normaux les principaux paramètres reflétant la minéralisation secondaire, et ses effets sont similaires à ceux de l’alendronate. En conclusion, le ranélate de strontium maintient une qualité normale de la minéralisation secondaire, que ce soit à court ou à long terme, et quel que soit le modèle étudié. Le ranélate de strontium maintient également la microdureté osseuse, les caractéristiques minérales et organique tissulaires, ainsi que la structure du cristal d'apatite / Strontium ranelate, a treatment of postmenopausal osteoporosis, contains 2 atoms of stable strontium which interact with bone mineral. Strontium have a dissociating effect on bone remodeling, decreasing resorption while increasing formation. However, its bone effects are not fully clarified, in particular its interactions with mineral. In monkeys, strontium maintains the major intrinsic properties of bone at a physiological level, either at the global tissue or the bone structural units levels. In postmenopausal women treated with strontium ranelate, the characteristics of apatite crystals are maintained at a physiological level. Moreover, whatever the duration of treatment (2 to 96 months), strontium is always heterogeneously distributed, mainly present in recent bone formed during treatment, bone areas containing strontium progressively increase but less and less with the duration of the treatment. Focal bone strontium content remains stable from 2 to 60 months and then increase from 60 to 96 months, and secondary mineralization is maintained at a physiological level. Finally, after 6 and 12 months of treatment, strontium ranelate maintains normal the main parameters reflecting secondary mineralization, and its effects are similar to those of alendronate. To conclude, strontium ranelate maintains a normal quality of secondary mineralization, either after a shortterm or a long-term treatment, and whatever the model studied. Strontium ranelate also maintains bone microhardness, tissular mineral and organic characteristics, as well as the structure of apatite crystals

Worldwide, between 5 and 18% of postmenopausal women experience depression. While the associations of estrogens with depression have been researched extensively, relations with other postmenopausal hormones remain unclear. We evaluated the association of follicle stimulating hormone (FSH) levels with prevalent depression the Kuopio Ischaemic Heart Disease Risk Factor Study (n = 588). Study participants were postmenopausal women aged 53 to 73 years and not using hormone therapy at enrollment (1998-2001). FSH was measured by radioimmuno-assays. Depression symptoms were measured using a scale based on DSM-III criteria (score range = 0-12), with a score ≥5 indicative of probable depression. We assessed the relation of FSH levels with depression in multivariable linear and logistic models adjusting for age, body mass index, estradiol, antidepressant use, and other factors, and evaluated effect modification by age. In adjusted analyses of all participants, higher FSH levels were associated with lower prevalence of depression (OR comparing ≥50 vs/L = 0.50, P = 0.02). Each 10-unit increase in FSH was associated with a 17% lower prevalence of depression (95% CI 0.70-0.99). Regression coefficients for Quartiles (Q) 2-4 vs. Q1 of FSH were 0.208, -0.170, -0.472, respectively (P = 0.14). Associations were mainly observed in older women (OR 0.47, P = 0.05; ages 64-73 years). Higher FSH levels in older postmenopausal women were associated with lower prevalence of depression and depressive symptoms, independent of estradiol, adiposity measures, and other factors. Further research is warranted to evaluate mechanisms underlying these associations, including effects of FSH on immune function.

An inverse association between estrogen therapy (ET) and Alzheimer disease (AD) has been reported in some, but not in all studies. We investigated the association between ET and AD in postmenopausal women using a population-based case-control design. Women who developed AD from 1985 through 1989 in Rochester, MN (cases, n=264) were individually matched by age (±1 y) to control women free of dementia from the same population (controls, n=264). ET exposure (≥6 mo after menopause) was ascertained by abstracting the complete medical records archived in the records-linkage system of the Rochester Epidemiology Project. The frequency of ET use was similar in cases (11.4%) and controls [10.6%; odds ratio=1.10; 95% confidence interval (CI)=0.63-1.93]. However, cases who used ET had a suggestive trend for an earlier age at start of ET compared with controls (median, 49.0 vs. 50.5 y; P=0.06). Although smoking (ever vs. never) was not associated with AD overall, we observed an interaction between smoking and ET. The odds ratio of AD in ET users was 4.55 (95% CI=1.33-15.53) among smokers, but was 0.68 (95% CI=0.35-1.32) among never-smokers (P for interaction=0.01). Our findings do not confirm a significant association between ET and AD overall; however, the possible interaction with smoking deserves further study.

No description available.

No description available.

Colorectal cancer is the third most common cancer among U.S. women; 63,610 new cases were estimated to have occurred in 2015. Prior studies found a reduced risk of colorectal cancer among antidepressant (AD) users, however, none adjusted for depression, which is itself linked to increased colorectal cancer risk and could confound this relationship. We assessed the relationship between ADs and AD drug classes with risk of colorectal cancer in a prospective cohort of 145,190 women between the ages of 50-79 without a previous history of cancer at enrollment. Current AD use was assessed at baseline. Over an average follow-up of 14 years, there were 5,280 incident cases of colorectal cancer cases. Cox proportional hazard ratios, adjusted for potential confounders including depressive symptoms, were used to estimate hazard ratios. Of all AD users, 51.1% used selective serotonin reuptake inhibitors (SSRIs), 40.7% used tricyclic antidepressants (TCAs), and 15.1% used other ADs. No association was observed between total AD use, SSRI use, and/or other ADs and risk of colorectal cancer. We observed a reduced risk of colorectal cancer among TCA users, which was significant for colon cancer specifically (HR 0.68, 95% CI: 0.48-0.96). Although a reduced risk of colon cancer was observed for TCAs use for less than two years (HR 0.39, 95%: CI 0.19-0.82), no association was observed for TCA use for two or more years (HR 0.85, 95%CI: 0.57-1.26). Our data suggests a protective association between TCA use and risk of colorectal cancer, however more research is needed to verify these findings.

Low trauma hip fractures, due to bone fragility, are a major healthcare burden with serious consequences for individuals in terms of long-term morbidity and mortality; and also for society due to the high medical and care costs associated with these injuries. Because of the association with low bone mass, these fractures are particularly prevalent in elderly populations and are likely to become more common as longevity increases globally. Avoidance of these fractures is therefore an extremely important goal. Low bone mass, manifested in the conditions of osteopenia and osteoporosis, is the primary cause of bone fragility, and reductions in bone mass are the inevitable corollary of aging and menopause. Bone loss may be exacerbated by immobilisation and reduced weight-bearing activity, giving rise to the condition of disuse osteopenia. Immobilisation may itself be the result of low trauma leg fragility fractures that potentially causes further bone density loss. If this loss occurs at the hip, there is an increased risk for hip fracture as a sequela to the original injury. Osteoarthritis is also a condition strongly associated with aging that may necessitate knee arthroplasty as a last stage treatment, potentially causing a period of reduced mobility and weight-bearing activity following surgery. Leg fracture and knee replacement both present additional risk factors for hip fracture due to changes in muscle mass, gait and postural stability that may increase the risk of falls. This study aims primarily to investigate the effects of immobilisation on leg fracture and knee replacement patients, immediately following injury or surgery, in order to quantify bone and muscle loss and to monitor recovery over a one year period. A postmenopausal population were studied as they are already losing bone density systemically and may be at greater risk of further bone loss following immobilisation. Factors of activity, function, weight-bearing, pain, treatments, therapies, health perceptions and mental wellbeing, that potentially contribute to bone loss and recovery, were also investigated. Results from the study may provide information relating to increased future hip fracture risk and lead to treatment options to alleviate bone loss in these groups.

Para elaboração deste estudo foram observadas e avaliadas 112 mulheres na pós-menopausa sem reposição hormonal, com e sem depressão. As características pessoais quantitativas são descritas com uso de medidas resumo (média, desvio padrão, mediana, mínimo e máximo) e as características qualitativas pessoais descritas com uso de frequências absolutas e relativas. O objetivo do estudo foi verificar se as mulheres com diagnóstico de depressão apresentavam diferenças nos resultados dos testes mnésticos e atencionais, quando comparadas às mulheres sem depressão. Verificar se os sintomas fogachos, sudorese noturna, funções mnésticas e atencionais interferiam nos resultados dos testes nas mulheres com e sem depressão, que foram realizados em quatro tempos: (T0) avaliação inicial, (T1) segunda avaliação, (T2) terceira avaliação, (T3) quarta avaliação, que foi efetuada seis meses após o término da terapia cognitiva comportamental. Acrescentou-se a nota de corte na Escala Climatérica Greene no tempo inicial obtendo-se assim, o coeficiente de correlação de Pearson e a validade de critério ? de Cronback, com índice geral de sensibilidade 0.91 e especificidade de 0.82, com nível de significância de 5% com poder de confiança de 95%. Os resultados dessa pesquisa demonstraram a eficácia da Terapia Cognitiva Comportamental, nos sintomas de ansiedade, depressão, fogachos, sudorese noturna, funções mnésticas e atencionais, em mulheres com e sem depressão na pós-menopausa, sem reposição hormonal / For this study, we observed and evaluated 112 postmenopausal women without hormonal reposition, with or without depression. Personal quantitative characteristics are described using summary statistics (average, standard deviation, median, minimum, maximum) and the personal qualitative characteristics described using absolute and relative frequencies. The main goal of this study was to verify if women diagnosed with depression show different results in mnestics and attentional tests when compared to women without depression. The work also verified if symptoms of hot flashes, night sweats, mnestics and attentional functions were associated with tests results of women with and without depression. The tests were applied four times: (T0) initial evaluation, (T1) second evaluation, (T2) third evaluation, and (T3) last evaluation, performed six months after the end of Cognitive Behavioral Therapy. Passing score was correlated with the Greene Climacteric Scale initial time to obtain the Pearson correlation coefficient and validation of Cronbach\'s criteria, with 0.91 as general index of sensitivity and 0.82 of specificity, significance level of 5%, with a confidence level power of 95%.This research showed the efficacy of Cognitive Behavioral Therapy for symptoms of anxiety, depression, hot flashes, night sweats, memory and attention functions in postmenopausal women with and without depression, without hormonal reposition