Elsevier’s Maturitas Publishes Position Statement on the Role of Vitamin D in Postmenopausal Women
Amsterdam, January 25, 2012 – Elsevier, a world-leading provider of scientific, technical and medical information products and services, announced today the publication of a position statement by the European Menopause and Andropause Society (EMAS) in journal
Maturitas on the role of vitamin D in postmenopausal women with summary recommendations.
Vitamin D deficiency is common and may affect up to 70% of Europeans. It is classified as a public health issue as it can contribute to many diseases especially osteoporosis. EMAS has risen to the challenge of increasing awareness of vitamin D deficiency to women and health professionals. The position statement describes the implications of vitamin D deficiency and provides clear recommendations on why and how adequate levels should be maintained.
Osteoporosis is a common condition in postmenopausal women leading to bone fractures. However there is now evidence that vitamin D deficiency is also associated with other medical conditions also important in older women. These include cardiovascular disease, diabetes, cancer, infections and neurodegenerative disease. The major natural source of vitamin D is cutaneous synthesis through exposure to sunlight with a small amounts also coming from the diet in animal-based foods such as fatty fish, eggs and milk. Levels of vitamin D are lower in those with poor sun exposure and in the winter. Obesity, malabsorption syndromes and certain medications (e.g. anticonvulsants, antiretrovirals) can also lower vitamin D levels. Regular sunlight exposure (without sunscreens) for 15 minutes, 3-4 times a week, in the middle of the day in summer can generate healthy levels. Supplements of vitamin D are recommended for those women who cannot obtain the required quantity through sun exposure and diet. The recommended daily allowance is 600 IU/day increasing to 800IU/day for those aged 71 years and older.
These and other recommendations presented in the EMAS position statement are published in article: “Vitamin D and postmenopausal health” by Faustino R. Pérez-López, Marc Brincat, C. Tamer Erel, Florence Tremollieres, Marco Gambacciani, Irene Lambinoudaki, Mette H. Moeng, Karin Schenck-Gustafsson, Svetlana Vujovic, Serge Rozenberg, Margaret Ree (doi:10.1016/j.maturitas.2011.11.002). The article appears in Maturitas Volume 71, Issue 1 (January 2012) published by Elsevier.
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About European Menopause and Andropause Society (EMAS)
The European Menopause and Andropause Society (EMAS) is an international society that promotes the study and dissemination of research into all aspects of midlife health and beyond in both men and women. Through its activities, EMAS aims to guarantee and provide the same standard of education and information throughout Europe on postreproductive health in both genders. The statutes of EMAS have been submitted to and accepted by the Swiss Authorities and the Society is now acknowledged by the Swiss Government and the International Menopause Society as the official Regional European Menopause Society. EMAS also belongs to the Council of affiliated Menopause Societies (CAMS) of the International Menopause Society (IMS). For more information go to: http://www.emas-online.org/Pages/home.aspx
About Maturitas
Maturitas is an international multidisciplinary peer reviewed scientific journal of midlife health and beyond, publishing original research, reviews, consensus statements and guidelines. The scope encompasses all aspects of postreproductive health in both genders ranging from basic science to health and social care.
About Elsevier
Elsevier is a world-leading publisher of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet and Cell, and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier’s online solutions include SciVerse ScienceDirect, SciVerse Scopus, Reaxys, MD Consult and Nursing Consult, which enhance the productivity of science and health professionals, and the SciVal suite and MEDai’s Pinpoint Review, which help research and health care institutions deliver better outcomes more cost-effectively.
A global business headquartered in Amsterdam, Elsevier employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC, a world-leading publisher and information provider, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).
Media contact
Greyling Peoples
Elsevier
+31 20 485 3323
g.peoples@elsevier.com
Calcium Supplementation: Balancing the Cardiovascular Risks
Amsterdam, May 2011 -
Elsevier announced today the publication of important new research in the journal Maturitas (http://www.maturitas.org/) on the use of calcium supplementation in the prevention and treatment of osteoporosis.
Calcium supplementation has been widely accepted as a key strategy in the prevention and
treatment of osteoporosis. Its role has been undermined, to some extent, by its disappointing effects on fracture in randomised controlled trials, but its use has continued to be encouraged on the grounds that it is physiologically appealing, and is unlikely to cause harm. The latter assumption is now under threat from accumulating evidence that calcium supplement use is associated with an increased risk of myocardial infarction and, possibly, stroke. The latest data, based on meta-analysis of trials involving 29,000 participants, indicate that this risk is not mitigated by co-administration of vitamin D, and that the number of cardiovascular events caused is likely to be greater than the number of fractures prevented.
The consistent message from the meta-analyses of clinical trials is that calcium supplements probably carry a small but significant adverse effect on cardiovascular risk. Their beneficial effect on fractures is also small, so it is likely that there is no net benefit from their use. This suggests that we need to look elsewhere for strategies for preventing postmenopausal bone loss. Lifestyle interventions should
include smoking cessation, weight maintenance, and moderation of alcohol intake. Encouragement of dietary calcium intake is reasonable, since the balance of current evidence does not demonstrate a cardiovascular risk associated with calcium from food, although there is little compelling evidence that dietary calcium intake is associated with subsequent fracture risk. In individuals who have a fracture risk which justifies pharmaceutical intervention, then the use of bisphosphonates without calcium supplements has been shown to produce comparable changes in bone density [45, 46] and fractures [47] to those found with a combined intervention of calcium and bisphosphonate.
There is an urgent need for more research to gain insight into the mechanisms of the adverse vascular effect of calcium, since this might lead to strategies for circumventing it. However, it is inappropriate to delay changes in clinical practice pending the arrival of more research data, because the current meta-analyses are based on 29,000 study participants and more than 160,000 subject-years of data, and there are few studies of calcium supplementation of any size underway at the present time. Therefore, data to be presented in the next few years will impact minimally on the currently available results.
Important Position Statements From European Menopause And Andropause Society Published By Maturitas Regarding Managing Menopausal Women With a Personal or Family History of VTE
Article Date: June 2011
Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a serious cardiovascular event whose incidence rises with increasing age.
Randomized controlled trials have shown an increased risk of VTE in oral hormone therapy (HT) users. There are no randomized trial data on the effect of transdermal estrogen on VTE. Recent observational studies and meta-analyses suggest that transdermal estrogen does not increase VTE risk. These clinical observations are supported by experimental data showing that transdermal estrogen has a minimal effect on hepatic metabolism of hemostatic proteins as the portal circulation is bypassed. A personal or family history of VTE, especially in individuals with a prothrombotic mutation, is a strong contraindication to oral HT but transdermal estrogen can be considered after careful individual evaluation of the benefits and risks. Transdermal estrogen should be also the first choice in overweight/obese women requiring HT. Observational studies suggest that micronized progesterone and dydrogesterone might have a better risk profile than other progestins with regard to VTE risk. Although these findings should be confirmed by randomized clinical trials, they strongly suggest that both the route of estrogen administration and the type of progestin may be important determinants of the overall benefit-risk profile of HT
Florence Tremollieres, Marc Brincat, C. Tamer Erel, Marco Gambacciani, Irene Labrinoudaki, Mette H. Moen, Karin Shenck-Gustafsson, Svetlana Vujovic, Serge Rozenberg, Margaret Rees
Important new information about unopposed estrogen treatment
Geneva, 11 April 2011 - EMAS board would like its members to be aware of important new information about the use of unopposed estrogen coming from the Women’s Health Initiative randomized trial published in JAMA on April 6 2011 [1].
The paper describes health outcomes associated with conjugated equine estrogens (CEE) use for 6 years among women with prior hysterectomy after a mean of 10.7 years of followup. It confirms that there are differences between estrogen alone and estrogen progestin combined HT with regard to breast cancer risk and that outcomes such as effects on coronary heart disease (CHD) depends on age of initiation.
Over the entire follow-up, a significantly lower breast cancer incidence in the CEE group persisted and was 0.27% compared with 0.35% in the placebo group (HR, 0.77; 95% CI, 0.62-0.95). While overall CEE use was not associated with an increased or decreased risk of CHD, deep vein thrombosis, stroke, hip fracture, colorectal cancer, or total mortality, there were differences between younger and older women. Thus health outcomes were more favorable for younger compared with older women for CHD (P = .05 for interaction), total myocardial infarction (P = .007 for interaction), colorectal cancer (P = .04 for interaction), total mortality (P = .04 for interaction), and global index of chronic diseases (P = .009 for interaction).
These data are reassuring for hysterectomised women in their 50s taking estrogen therapy and they should certainly not be denied treatment if they require it. Health professionals should take this opportunity to inform their patients.
1 LaCroix AZ, Chlebowski RT, Manson JE et al. Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial. JAMA 2011;305:1305-1314.
Prof Serge Rozenberg President EMAS and Prof Margaret Rees on behalf of EMAS board
Important Position Statements From European Menopause And Andropause Society Published By Maturitas
Article Date: 03 Feb 2011
Elsevier has announced the publication of two further important position statements from the European Menopause and Andropause Society (EMAS) in the journal Maturitas on common management problems in the post-reproductive health of women.
EMAS is providing clear guidance in its position statements covering both hormone and non hormone therapy (HT) options as well as complementary and alternative therapies . The latest two position statements cover the management of the menopause in the context of Cardiovascular disease (CVD) including coronary heart disease (CHD) and Osteoporosis. These are common conditions affecting the expanding ageing female population. Each statement has summary recommendations as a quick aid for the busy clinician.
Cardiovascular disease (CVD) including coronary heart disease (CHD) and stroke is the most common cause of female death. Premenopausal CHD is very rare but when women enter the menopause the incidence of CHD increases markedly. CHD presents 10 years later in women than in men. The reason is still unclear but the protective effects of estrogens have been suggested. Based on long term randomized placebo-controlled studies hormone therapy (HT) is not recommended for the primary or secondary prevention of CHD in postmenopausal women. In most countries the only indication for HT is the treatment of menopausal symptoms. Women with known CHD or with many coronary risk factors seeking HT because of troublesome climacteric symptoms should be evaluated for their individual baseline risk of developing breast cancer, venous thromboembolism and CHD recurrence. The same applies to non hormone therapy-based treatments where long term clinical studies are lacking. Risks should be weighed against expected benefit from symptom relief and improved quality of life. The lowest effective estrogen dose should be used during the shortest possible time. Transdermal administration is preferred if risk factors for VTE exist. Different progestogens might differ in their cardiovascular effects. Observational studies suggest that micronized progesterone or dydrogesterone may have a better risk profile than other progestogens with regard to thrombotic risk. doi:10.1016/j.maturitas.2010.10.005
Osteoporosis and its consequent fractures is a major public health problem. Osteoporosis is still an often under-recognized disease and considered to be an inevitable consequence of ageing. The morbidity of osteoporosis is secondary to the fractures that can occur in the spine, hip, forearm and proximal humerus. These fractures, especially hip fractures, lead to high morbidity and mortality, as well as an increase in direct costs for health services. Bone densitometry has an important role in screening postmenopausal women for osteoporosis. For higher sensitivity and specificity, there may be a stronger case for screening in later life, depending on the extent to which risk factors add to the value of bone mineral density tests. doi:10.1016/j.maturitas.2010.09.009
Source:
Greyling Peoples
Elsevier
European Menopause and Andropause Society Publishes Four Position Statements about the Post-reproductive Health of Women
Statements, published in the journal Maturitas, cover the management of the menopause in the context of obesity, epilepsy, endometriosis and premature ovarian failure
Amsterdam, 2 September, 2010 - Elsevier announced today the publication of four important position statements from the European Menopause and Andropause Society (EMAS) in the journal Maturitas (http://www.maturitas.org/) on common management problems in the post-reproductive health of women. The statements cover the management of the menopause in the context of obesity, epilepsy, endometriosis and premature ovarian failure. Each statement has summary recommendations as a quick aid for the busy clinician.
“The expanding ageing female population means that clinicians increasingly have to deal with post-reproductive health problems,” said Professor Serge Rozenberg, President of EMAS. “EMAS has risen to the challenge and is providing clear guidance on the position statements covering both hormone and non hormone therapy (HT) options, as well as complementary and alternative therapies.”
The statements were published in the July 2010 issue and are summarized as follows:
(1) Obesity: Obesity affects about 20% of the adult world population and 44% of postmenopausal women. Obesity is a major risk factor for many diseases including diabetes mellitus, dyslipidemia and hypertension resulting in cardiovascular disease, as well as venous thromboembolism and breast and endometrial cancer. Thus transdermal (patch, gel) HT is preferred over oral tablets because of the reduced risk of venous thromboembolism. (doi:10.1016/j.maturitas.2010.03.025)
(2) Epilepsy: Women with epilepsy may undergo the menopause 3- 5 years early and can be at increased risk of osteoporortic fracture depending on their antiepileptic drug use. If HT is used, these women need to be closely monitored by specialists. Calcium and vitamin D supplements should be considered. Herbal preparations should be avoided as their efficacy is uncertain and they may interact with anti epileptic drugs. (doi:10.1016/j.maturitas.2010.03.026)
(3) Endometriosis: Endometriosis is a debilitating gynaecological condition frequently associated with infertility and abdominal pain. A major concern with HT is disease recurrence and the authors conclude that, although the available data are limited, it may be safer to prescribe either continuous combined estrogen–progestogen hormone therapies or tibolone in both hysterectomised and non-hysterectomised. Women not needing or not wanting HT or those who are advised against should be offered alternative treatment for climacteric symptoms or skeletal protection. (doi:10.1016/j.maturitas.2010.04.018)
(4) Premature ovarian failure: Premature ovarian failure (POF) is the menopause before the age of 40 which may occur naturally or after surgery or chemotherapy. Untreated, it increases the risk of osteoporosis, cardiovascular disease, dementia, Parkinsonism, and general cognitive decline. Therefore, the statement clearly recommends the use of HT until the average age of the natural menopause, i.e. the early 50s. (doi:10.1016/j.maturitas.2010.04.011)
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About European Menopause and Andropause Society (EMAS)
The European Menopause and Andropause Society (EMAS) was founded to promote the study of all aspects of midlife health and beyond in both men and women and to advance the interchange of research and clinical experience between its members. EMAS also participates in international congresses related to the menopause and andropause. Through its activities, EMAS aims to guarantee and provide the same standard of education and information throughout Europe on post reproductive health in both genders. The statutes of EMAS have been submitted to and accepted by the Swiss Authorities and the Society is now acknowledged by the Swiss Government and the International Menopause Society as the official Regional European Menopause Society. EMAS also belongs to the Council of affiliated Menopause Societies (CAMS) of the International Menopause Society (IMS).
About Elsevier
Elsevier is a world-leading publisher of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet (www.thelancet.com) and Cell (www.cell.com), and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier’s online solutions include ScienceDirect (www.sciencedirect.com), Scopus (www.scopus.com), Reaxys (www.reaxys.com), MD Consult (www.mdconsult.com) and Nursing Consult (www.nursingconsult.com), which enhance the productivity of science and health professionals, and the SciVal suite (www.scival.com) and MEDai’s Pinpoint Review (www.medai.com), which help research and health care institutions deliver better outcomes more cost-effectively.
A global business headquartered in Amsterdam, Elsevier (www.elsevier.com) employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC (www.reedelsevier.com), a world-leading publisher and information provider, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).
Media Contact
Greyling Peoples
+31 20 485 3323
g.peoples@elsevier.com
Greyling Peoples
Publishing Editor – Women’s Health
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