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Erschienen in:

01.02.2012 | Reviews

Update in Women’s Health for the General Internist

verfasst von: Judith M. E. Walsh, MD, MPH, Megan McNamara, MD, MSc, Redonda G. Miller, MD, MBA, Eleanor Bimla Schwarz, MD, MS

Erschienen in: Journal of General Internal Medicine | Ausgabe 2/2012

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Excerpt

This update summarizes articles and guidelines published in the last year that may impact general internists’ women’s health clinical practice (Table 1).

Table 1

Important Women’s Health Guidelines in 2010–2011: New or Updated

Topic	Issuing organization	Updated recommendations
Contraceptive guidelines	CDC^*	http://www.cdc.gov/mmwr/pdf/rr/ rr59e0528.pdf
Contraceptive guidelines	CDC^*	Now includes guidance after bariatric surgery, organ transplantation, and with inflammatory bowel disease
STD treatment guidelines	CDC^*	http://www.cdc.gov/std/treatment/
		Beware resistant gonorrhea
		Encourage expedited partner therapy
CHD prevention	AHA^†	Definition of “high risk” now includes women with 10-year risk of CHD of ≥10% (as opposed to previous risk of 20%)
		Definition of “at risk” broadened to include evidence of subclinical atherosclerosis (e.g., carotid plaque), collagen vascular disease, preeclampsia, gestational DM, and HTN in pregnancy
		More stringent physical activity and diet recommendations
Hormone therapy	NAMS^‡	No increased risk of CHD if combined hormone therapy is initiated in women aged 50–59 or within 10 years of menopause
		Breast cancer risk seems to be greater if combined hormone therapy is initiated within 5 years of menopause
		Hot flashes equally likely to recur if hormone therapy is tapered vs. discontinued abruptly
		Consider DEXA scanning after hormone therapy discontinuation in women with prolonged use
Osteoporosis screening	USPSTF^§	Screen women aged 65 and older
Osteoporosis screening	USPSTF^§	Screen women whose fracture risk is equal to or greater than a 65-year-old white woman who has no additional risk factors
Vitamin D	Institute of Medicine	RDA 600 IU for women aged 9–70
		RDA 800 IU for women over age 70
		Upper limit 4,000 IU per day
		25-OH Vitamin D level of 20 ng/ml is the goal

^* Centers for Disease Control and Prevention

^† American Heart Association

^‡ North American Menopause Society

^§United States Preventive Services Task Force

…

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Rossouw J, Anderson G, Prentice R, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321–33.PubMedCrossRef

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Loprinzi C, Sloan J, Stearns V, et al. Newer antidepressants and gabapentin for hot flashes: an individual patient pooled analysis. J Clin Oncol. 2009;271(17):2831–7.CrossRef

13.

Bath P, Gray L. Association between hormone replacement therapy and subsequent stroke: a meta-analysis. BMJ. 2005;330(7487):342.PubMedCrossRef

14.

Hemelaar M, van der Mooren M, Rad M, Kluft C, Kenemans P. Effects of non-oral postmenopausal hormone therapy on markers of cardiovascular risk: a systematic review. Fertil Steril. 2008;90(3):642–72.PubMedCrossRef

15.

Chlebowski R, Hendrix S, Langer R, et al. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial. JAMA. 2003;289(24):3243–53.PubMedCrossRef

16.

Chlebowski R, Kuller L, Prentice R, et al. Breast cancer after use of estrogen plus progestin in postmenopausal women. NEJM. 2009;360(6):573–87.PubMedCrossRef

17.

Jackson R, et al. Calcium plus vitamin D supplementation and the risk of fractures. NEJM. 2006;354(7):669–83.PubMedCrossRef

18.

Bolland M, Barber P, Doughty R, et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ. 2008;336:262–6.PubMedCrossRef

19.

Grant A, Anderson F, Avenell A, et al. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium or Vitamin D, RECORD). Lancet. 2005;365(9471):1621–8.PubMedCrossRef

20.

Trivedi D, Doll R, Khaw K. Effect of four monthly oral vitamin D supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ. 2003;326(7387):469–75.PubMedCrossRef

21.

Chapuy M, Arlot M, Delmas P, Meunier P. Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ. 1994;308(6936):1081–2.PubMedCrossRef

22.

Chapuy M, Arlot M, Duboeuf F, et al. Vitamin D₃ and calcium to prevent hip fractures in elderly women. NEJM. 1992;327(23):1637–42.PubMedCrossRef

23.

Porthouse J, Cockayne S, King C, et al. Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D₃) for prevention of fractures in primary care. BMJ. 2005;330(7498):1003.PubMedCrossRef

24.

Heikinheimo R, Inkovaara J, Harju E, et al. Annual injection of vitamin D and fractures of aged bones. Calcif Tissue Int. 1992;51(2):105–10.PubMedCrossRef

25.

Smith H, Anderson F, Raphael H, Maslin P, Crozier D, Cooper C. Effect of annual intramuscular vitamin D on fracture risk in elderly men and women: a population-based, randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford). 2007;46(12):1852–7.CrossRef

26.

Larsen E, Mosekilde L, Foldspang A. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res. 2004;19(3):370–8.PubMedCrossRef

27.

Dawson-Hughes B, Harris S, Krall E, Dallal G. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. NEJM. 1997;337(10):670–6.PubMedCrossRef

28.

Lyons R, Johansen A, Brophy S, et al. Preventing fractures among older people living in institutional care: a pragmatic randomised double blind placebo controlled trial of vitamin D supplementation. Osteoporos Int. 2007;18(6):811–8.PubMedCrossRef

29.

Prince R, Austin N, Devine A, Dick I, Bruce D, Zhu K. Effects of ergocalciferol added to calcium on the risk of falls in elderly high-risk women. Arch Intern Med. 2007;168(1):103–8.CrossRef

30.

Ing-Lorenzini K, Desmeules J, Plachta O, Suva D, Dayer P, Peter R. Low-energy femoral fractures associated with the long-term use of bisphosphonates: a case series from a Swiss university hospital. Drug Saf. 2009;32:775–85.PubMedCrossRef

31.

Kwek E, Goh S, Koh J, Png M, Howe T. An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury. 2008;39:224–31.PubMedCrossRef

32.

Capeci C, Tejwani N. Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy. J Bone Joint Surg Am. 2009;91:2556–61.PubMedCrossRef

33.

Odvina C, Levy S, Rao S, Zerwekh J, Sudhaker Rao D. Unusual mid-shaft fractures during long term bisphosphonate therapy. Clin Endocrinol (Oxf). 2009 March 19;(Epub ahead of print).

34.

Somford M, Draijer F, Thomassen B, Chavassieux P, Boivin G, Papapoulos S. Bilateral fractures of the femur diaphysis in a patient with rheumatoid arthritis on long-term treatment with alendronate: clues to the mechanism of increased bone fragility. J Bone Miner Res. 2009;24:1736–40.PubMedCrossRef

35.

Armamento-Villareal R, Napoli N, Diemer K, et al. Bone turnover in bone biopsies of patients with low-energy cortical fractures receiving bisphosphonates. Calcif Tissue Int. 2009;85:37–44.PubMedCrossRef

36.

Cheung R, Leung K, Lee K, Chow T. Sequential non-traumatic femoral shaft fractures in a patient on long-term alendronate. Hong Kong Med J. 2007;13:485–9.PubMed

37.

Armamento-Villareal R, Napoli N, Panwar V, Novack D. Suppressed bone turnover during alendronate therapy for high-turnover osteoporosis. NEJM. 2006;355:2048–50.PubMedCrossRef

38.

Goh S, Yang K, Koh J, et al. Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br. 207;89:349–53.

39.

Odvina C, Zerwekh J, Rao D, Maalouf N, Gottschalk F, Pak C. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005;90:1294–301.PubMedCrossRef

40.

Visekruna M, Wilson D, McKiernan F. Severely suppressed bone turnover and atypical skeletal fragility. J Clin Endocrinol Metab. 2008;93:2948–52.PubMedCrossRef

41.

Neviaser A, Lane J, Lenart B, Edobor-Osula F, Lorich D. Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma. 2008;22:346–50.PubMedCrossRef

42.

Lenart B, Lorich D, Lane J. Atypical fractures of the femoral diaphysis in postmenopausal women taking alendronate. NEJM. 2008;358:1304–6.PubMedCrossRef

Titel: Update in Women’s Health for the General Internist
verfasst von: Judith M. E. Walsh, MD, MPH
Megan McNamara, MD, MSc
Redonda G. Miller, MD, MBA
Eleanor Bimla Schwarz, MD, MS
Publikationsdatum: 01.02.2012
Verlag: Springer-Verlag
Erschienen in: Journal of General Internal Medicine / Ausgabe 2/2012
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-011-1877-4

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