Sodas and colas are associated with an increase in fractures No abstract available

Menopause and high-intensity interval training: effects on body composition and physical performance No abstract available

Association between soft drink consumption and osteoporotic fractures among postmenopausal women: the Women's Health Initiative Objective: High consumption of soft drinks has been associated with lower bone mineral density among postmenopausal women. This study explores the association of soft drink consumption, osteoporosis, and incidental fractures in this population. Methods: Cross-sectional (at baseline) and cohort combined designs, over 11.9 years of median follow-up for 72,342 postmenopausal women participating in the Women's Health Initiative Observational Study. Multiple linear regression models were used to examine the cross-sectional associations between soft drink consumption and hip and lumbar spine bone mineral density. Cox proportional hazards regression models were used to examine the association of soft drink consumption with incident hip fractures. Results: There were no associations between soft drink consumption and hip or lumbar spine t scores. During 700,388 person-years of follow-up, 2,578 hip fractures occurred. Adjusted hazard ratios for incident hip fracture for the highest consumption category compared with no consumption were 1.26 (95% confidence interval [CI] 1.01-1.56) for total soda and 1.32 (95% CI 1.00-1.75) for caffeine-free soda. There was no association between caffeinated soda and incident hip fracture (hazard ratio = 1.16; 95% CI 0.86-1.57). There was no apparent linear trend in the risk of hip fracture across categories of soda consumption in the fully adjusted models, suggesting a threshold effect. A sensitivity analysis using adjudicated hip fractures showed significant associations for all three soda exposures in the highest intake groups. Conclusions: Consuming more than two servings of soft drinks per day on average showed potential associations with higher risk of hip fracture among postmenopausal women.

Comparative effects of high-intensity interval training with combined training on physical function markers in obese postmenopausal women: a randomized controlled trial Objectives: This study compared the effects of high-intensity interval training (HIIT) with effects of combined training (CT) on physical function, body composition, and muscle strength in obese postmenopausal women (PW) (trial registration: NCT03200639). Methods: PW were randomized to CT (n = 12) and HIIT (n = 12). The CT group performed 30 minutes of moderate walking at 70% of maximum heart rate (MHR) and five resistance exercises at 70% of one repetition maximum (1RM) for 12 weeks. The HIIT group performed 10 sets of vigorous exercises (30 seconds (s) of stair climbing and 30 s of body weight squats) at >80% MHR interspersed by a light walk (recovery period at 60% MHR). Results: Both groups reduced body fat percentage (0.5%), chair stand (3 s) and increased leg lean mass (0.3 kg). Only the CT, however, increased muscle strength (29%) and fast walking speed (5%) compared with HIIT. The fast walking speed changes were partially explained by the muscle strength changes (36%, r = 0.60, P = 0.027) in the CT group. Conclusions: These results suggest that HIIT is an alternative time-efficient protocol for improving chair stand and body composition when compared with CT, whereas only CT is an efficient protocol for improving muscular strength and fast walking speed in obese PW. Thus, CT must be prioritized when the increase of muscular strength and fast walking speed are the goals of training. Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A443.

Evidence map of ductal carcinoma in situ management options Objective: Ductal carcinoma in situ (DCIS) has the potential to progress to invasive carcinoma. The optimal management of DCIS and methods for individualizing treatment of DCIS are still being determined. This evidence map depicts the robustness and topical span of research on DCIS management choice on patient-centered and clinical outcomes. Methods: We searched PubMed, EMBASE, PsycINFO, PubMed Health, PROSPERO, and clinical practice guideline sites to identify systematic reviews of DCIS management options and consulted with topic experts. A bubble plot visualizes the literature volume and research content for patient-centered outcomes. An online decision tree facilitates discussions with patients and guides through the available evidence. Results: In total, 40 systematic reviews met inclusion criteria. The research syntheses addressed DCIS management options, including the role of magnetic resonance imaging, axillary surgery/sentinel lymph node biopsy, and excisional biopsy. The map shows existing evidence for mutually exclusive treatment options including active surveillance, breast-conserving surgery, nipple sparing mastectomy, and simple mastectomy. Research findings for intraoperative radiation, adjuvant radiation therapy, adjuvant hormone therapy, hypofractionation radiotherapy, accelerated partial breast irradiation, radiation therapy plus boost, and combined radiation and hormone therapy, as well as for breast reconstruction after mastectomy and surveillance mammography postsurgery are also displayed. The evidence map highlights a scarcity of robust evidence on patient-centered outcomes. Conclusions: The evidence map provides an overview of DCIS research showing the range of management options and remaining decisional dilemmas that follow a diagnosis of DCIS. It maps the evidence in accessible tools to guide practice and future research. Video Summary:http://links.lww.com/MENO/A448.

Early onset of action with a 17β-estradiol, softgel, vaginal insert for treating vulvar and vaginal atrophy and moderate to severe dyspareunia Objective: The softgel 17β-estradiol (E2) vaginal inserts (4 and 10 μg; Imvexxy; TherapeuticsMD, Boca Raton, FL) are FDA approved for treating moderate to severe dyspareunia associated with postmenopausal vulvar and vaginal atrophy (VVA). The objective here was to determine responder rates at week 2 and whether week-2 findings predicted week-12 responders in the REJOICE trial. Methods: Postmenopausal women received E2 vaginal inserts 4, 10, or 25 μg, or placebo for 12 weeks. Proportion of responders (having ≥2 of the following: vaginal superficial cells >5%, vaginal pH <5.0, or dyspareunia improvement of ≥1 category) were calculated. Odds ratios (ORs) for positive response at week 12 given a positive response at week 2 were determined in the efficacy evaluable (EE) population. Results: The responder rate (in EE population [n = 695]) was 74% to 82% with E2 inserts versus 24% with placebo at week 2, and 72% to 80% versus 33% at week 12. Positive treatment responses were 9- to 14-fold higher with vaginal E2 than with placebo at week 2, and 5- to 8-fold higher at week 12. Response at week 2 predicted response at week 12 in the total population (OR 13.1; 95% CI, 8.8-19.7) and with active treatment only (OR 7.9; 95% CI, 4.7-13.2). Conclusions: A high percentage of postmenopausal women with moderate to severe dyspareunia responded with the E2 softgel vaginal insert at week 2, and a positive response at week 2 predicted a positive response at week 12.

Early menarche is associated with an increased risk of type 2 diabetes in rural Chinese women and is partially mediated by BMI: the Henan Rural Cohort Study Objective: The aim of the study was to determine if early menarche is associated with an increased risk of type 2 diabetes mellitus (T2DM) in rural Chinese women and to estimate the proportion that can be attributed to adiposity. Methods: A total of 15,346 postmenopausal women were enrolled in this study. Logistic regression and restricted cubic spline analysis were performed to estimate the relationship between age at menarche and T2DM. Mediation analysis was used to investigate whether the association was mediated by body mass index (BMI). Results: After adjusting for multiple confounders, the early menarche group (≤14 y) had a higher risk of T2DM (odds ratio [OR] = 1.21; 95% CI = 1.06-1.38; P = 0.004) compared with the reference group (16-17 y), whereas the late onset group (≥19 y) had a lower risk of T2DM (OR = 0.78; 95% CI = 0.66-0.92; P = 0.003). BMI partially mediated the association between age at menarche and T2DM, and the proportion of the effect was 28%. Conclusions: Early menarche increases the risk of T2DM, whereas later menarche decreases the risk. The association seems to be partially mediated by BMI.

Association between obesity type and obstructive coronary artery disease in stable symptomatic postmenopausal women: data from the KoRean wOmen'S chest pain rEgistry (KoROSE) Objectives: This study investigated the association between obesity type and obstructive coronary artery disease (CAD) in postmenopausal women. Methods: Study data were obtained from a nation-wide registry, composed of 659 women older than 55 years with chest pain undergoing elective invasive coronary angiography in the suspicion of CAD. Obstructive CAD was defined as angiographic findings of ≥50% diameter stenosis with any major epicardial coronary artery. Overall obesity was defined as a body mass index of ≥25 kg/m2, and central obesity was defined as a waist circumference of ≥85 cm. Results: A total of 311 women (47.2%) had obstructive CAD. The incidence of overall obesity was not different between participants with and without obstructive CAD (P = 0.340), but the prevalence of obstructive CAD was significantly higher in participants with central obesity than those without (55.5% vs 41.0%, P < 0.001). There was no significant difference in body mass index between participants with and without obstructive CAD (P = 0.373). Multivariable analysis showed that central obesity was associated with obstructive CAD even after controlling for potential confounders (odds ratio, 1.61; 95% confidence interval, 1.10-2.34; P = 0.013). However, overall obesity was not associated with obstructive CAD in the same multivariable analysis (P = 0.228). Conclusions: Central obesity but not overall obesity is associated with obstructive CAD in postmenopausal women with stable chest pain undergoing invasive coronary angiography. Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A440.

Improved periodontal disease and prevention of tooth loss in osteoporosis patients receiving once-yearly zoledronic acid: a randomized clinical trial Objective: This randomized, clinical trial investigated whether zoledronic acid combined with oral health maintenance can improve periodontal disease associated with osteoporosis, thus reducing the risk of tooth loss. Methods: Participants were those of the ZONE (ZOledroNate treatment in efficacy to osteoporosis) study. None of the participants had symptomatic periodontal disease at baseline. Participants received either zoledronic acid (5 mg; n = 333 [male 21, female 312]) or placebo (n = 332 [male 19, female 313]) once yearly for 2 years, and their age was 74.0 ± 5.3 (65-88) and 74.3 ± 5.4 (65-87) years, respectively. Participants were instructed to maintain good oral hygiene at baseline and every 3 months. Participants with signs or symptoms involving their oral cavity at the monthly visit with their physician were referred to dentists for examination of oral disease. All cases were included to analyze adverse events in this study. Testing for significance was conducted using Fisher exact test (P < 0.05). Results: The incidence of oral adverse events was significantly higher in the control group (67 cases, 20.2%) than in the zoledronic acid group (47 cases, 14.1%; P = 0.04). The frequency of symptomatic periodontal disease observed during the study was significantly higher in the control group (40 cases, 12.0%) than in the zoledronic acid group (18 cases, 5.4%; P = 0.002). Loss of teeth was more frequent in the control group (36 cases, 10.8%) than in the zoledronic acid group (24 cases, 7.2%), although the difference was not significant. Conclusions: Zoledronic acid effectively prevented symptomatic periodontal disease in patients with osteoporosis who maintained good oral hygiene. Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A438.

Association of bone mineral density with a first-degree family history of diabetes in normoglycemic postmenopausal women Objective: A first-degree family history of diabetes (FHD) contributes to increased risks of metabolic and cardiovascular diseases. Bone is an insulin-resistant site and an organ susceptible to microvascular complications. The goal of the present study was to investigate the association of FHD with bone mineral density (BMD) in postmenopausal women. Methods: In all, 892 normoglycemic postmenopausal women were divided into subgroups of participants with or without a first-degree FHD. BMD was measured using dual-energy x-ray absorptiometry. Fasting plasma insulin and glucose levels were measured, and insulin resistance was evaluated using the Homeostasis Model Assessment—Insulin Resistance (HOMA-IR) index. Results: The BMD of the lumbar spine and femoral neck were much higher in the participants with a first-degree FHD than in those without an FHD (all P < 0.05). Lumbar spine BMD and femoral neck BMD were both positively associated with HOMA-IR (P = 0.041 and P = 0.005, respectively). Multiple stepwise regression analysis showed that a first-degree FHD was an independent factor that was positively associated with lumbar spine BMD (standardized β = 0.111, P = 0.001) and femoral neck BMD (standardized β = 0.078, P = 0.021). A first-degree FHD was associated with increased BMD, insulin resistance, and hyperinsulinemia. Conclusions: Our study indicated that normoglycemic postmenopausal women with a first-degree FHD exhibit increased BMD with insulin resistance and hyperinsulinemia. A first-degree FHD was an independent factor associated with elevated BMD in Chinese women after menopause.