A rapidly aging population in Korea has led to increased attention in the field of anti-aging medicine. The purpose of anti-aging medicine is to slow, stop, or reverse the aging process and its associated effects, such as disability and frailty. Anti-aging medicine is emerging as a growing industry, but many supplements or protocols are available that do not have scientific evidence to support their claims. In this review, the mechanisms of action and the clinical implications of anti-aging interventions were examined and explained. Calorie restriction mimetics define compounds that imitate the outcome of calorie restriction, including an activator of AMP protein kinase (metformin), inhibitor of growth hormone/insulin-like growth factor-1 axis (pegvisomant), inhibitor of mammalian target of rapamycin (rapamycin), and activator of the sirtuin pathway (resveratrol). Hormonal replacement has also been widely used in the elderly population to improve their quality of life. Manipulating healthy gut microbiota through prebiotic/probiotics or fecal microbiota transplantation has significant potential in anti-aging medicine. Vitamin D is expected to be a primary anti-aging medicine in the near future due to its numerous positive effects in the elderly population.
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Background : Since the Women's Health Initiative (WHI) study indicated that the significant risks are associated with hormone replacement therapy (HRT), it has been highly expected that postmenopausal women have decisional conflict about HRT. We investigated how much decisional conflict women have in taking HRT and what factors were associated with this conflict.
Methods : A total of 312 postmenopausal women, who had been on HRT or just began, were surveyed from May 10 to June 27, 2005. The subjects were asked by questionnaire that included demographic characteristics and factors related to decisional conflict. Decisional conflict was assessed using the Decisional Conflict Scale (DCS) composed of 16 items.
Results : The mean score of DCS was 2.61, which was severe and lack of support from friends and relatives was the most common major conflicting factor. Forty-five percent of the participants started HRT by doctor's recommendation, but had a higher decisional conflict compared to those who started on their own or by encouragement from family and friends. Women who were exposed to mass-media or who had discontinued HRT previously had a lower conflict. Higher the educational level and longer the duration of HRT before stopping lowered decisional conflict. DCS was not significantly influenced by age, income, menopausal symptoms, duration of HRT and the history of hysterectomy.
Conclusion : Postmenopausal women when making a decision to begin HRT had high conflict. The factors related to conflict were educational level, exposure to mass-media, and motivation to begin therapy. Therefore, adequate and continued counseling with doctors may reduce women's decisional conflict about HRT.
Background : Hormone replacement therapy (HRT) has been used as a effective therapeutic strategy of postmenopausal osteoporosis. However, the studies on HRT are insufficient, particularly in early postmenopausal women in Korea. This study was designed as a community based clinical trial and was conducted for 1 year.
Methods : One hundred and forty early postmenopausal women aged 49 to 54 years who resided in Ulsan in Korea were enrolled in this study. The osteoporosis prone life style and general characteristics of the participants and their measured BMD were investigated. The therapy groups included 45 women who were assigned to one of the following regimens in 28 day cycles for 1 year: (1) conjugate equine estrogen (CEE), 0.625 mg/d daily, medroxyprogesterone acetate (MPA) 2.5 mg/d daily and calcium 500 mg/d daily (2) CEE 0.625 mg/d daily, MPA 10 mg/d for days 1 through 12 and calcium 500 mg/d daily.
Results : The women in the therapy groups had an average gain of 5.4%, 4.2%, 2.1%, 4.9% in BMD in the lumbar spine, femur total, femur neck and ward's area, respectively. HRT has significantly influenced the BMD after controlling age, month since menopause, alcohol intake, smoking, calcium intake, exercise, body mass index and baseline BMD. The baseline BMD and the BMI were factors that influenced the effect of HRT in BMD.
Conclusion : HRT had positively influenced the BMD in Korean women. The baseline BMD and the BMI were predictors of the effect of HRT in BMD change.
Background : This study was performed to find out about the factors related to administration of hormone replacement therapy (HRT) in postmenopausal women.
Methods : One thousand seventy three postmenopausal women living in Busan and Kimhae were surveyed from August, 2000 to February, 2001. The subjects were asked whether they were receiving the HRT or not and about several factors that have known to be related to receiving the HRT.
Results : Among the total, 16.3% of women were current users, 12.4% were ex-users, and 71.2% were non-users. There were significant differences in age, marital status, number of children, education level, and income among the three groups. The proportions of hysterectomy and health-related behaviors were higher among current and ex-users than non-users. The current users were receiving the HRT by continuous combination method rather than cyclic therapy. Among them, 70% responded 'physician's recommendation' as the main reason for receiving the HRT. Among the current users 48% responded 'improved general condition' for receiving as the main reason the HRT currently. However, 29% of ex-users stopped therapy because of side effects. Among non-users 55% have not been provided with information about the HRT. Women having regular exercise at least once a week were 3.5 times more likely to be current users (95% C.I.: 1.3∼9.6). One year after menopause women were 1.2 times (95% C.I: 1.0∼1.4) more likely to be current users.
Conclusion : Postmenopausal women who exercised regularly and experienced menopause at an older age seemed to be more likely current users. Therefore, women having such characteristics may need more adequate information about the HRT.
Background : Hormone replacement therapy (HRT) is the most effective treatment for climacteric symptoms. It also has definitive role in reducing or preventing the risk of osteoporosis. However, compliance with HRT is very poor. This study was conducted to know the compliance of hormone replacement therapy and investigate the determining factors for compliance.
Methods : Review of charts and telephone questionnaires were completed among 107 women who had received HRT in a family medicine clinic at a university hospital. Compliance was determined by the medication availability ratio (MAR): (HRT treated days)/(total number of observed days). An individual with MAR less than 0.75 was considered as partial compliance, and more than 0.75 was considered as complete compliance group.
Results : The average age of 107 subjects was 57.4 years. Among the 107 study subjects, 59 persons (55.1%) were compliant with HRT. Mean observation period was 17.6 months. The compliance with HRT was 60.9%, 55.1%, 49.6% at 12, 24, 36 months, respectively. The compliance was higher in high-perception group compared to low- perception group (P=0.01). Education level, presence of osteoporosis, hysterectomised state, difference in doctor and past fracture history were not associated with compliance. The reasons for starting HRT were physician's recommendation, osteoporosis prevention, treatment of menopausal symptoms, and influence of mass media, in descending order.
Conclusion : The compliance with HRT was 61% at one- year treatment and 50% at three-year teatment period. Positive attitude for HRT was related to higher compliance with HRT. Patient education on HRT is essential for successful compliance of HRT.
Background : Hormone replacement therapy is effective for improvement of climacteric symptoms, and prevention of postmenopausal osteoporosis but patient compliance is very low. The aim of the study was to assess the comprarative effects on bone mineral density(BMD). lipid, mammographic finding, biochemical bone markers of tibolone and continuous combined hormone replacement therapy in postemeopusal women.
Methods : Body mass index, BMD in the spine and femur neck. lipid, alkaline phosphatase, serum osteocalcin, urine deoxypyridinolone were measured before and after 1 year therapy in 88 post - menopausal subjects. Of theses, 54 women received CEE 0.625 ㎎ and MPA 2.5 ㎎ (CEE/MPA) per oral, 34 tibolone alone for 1 year.
Results : Body mass index didn't changed in both groups. Significantly increased mammographic density in CEE/MPA groups(p<0.05). Total cholesterol was decreased in both group, but no significant differences between the different treatment groups. Triglyceride decreased in tibolone group and ther are significant difference between the two groups(p<0.01). HDL-cholesterol increased in CEE/MPA group(p<0.01) but decreased in tibolone group(p<0.01). There are significant difference in HDL- cholesterol response between two groups(p<0.01). LDL-cholesterol respone between two groups(p<0.05). Total alkaline phosphatase(TALP) and serum osteocalcin decreased in 새호 groups(p<0.01) but no differences between two groups. Urine deoxypyridinoline was not decreased in both groups and no differences between two groups. Spine bone mineral density(BMD) increased in both groups(p=0.0001) but no differences in treatment response between two groups. Femur neck BMD didn't not increased in both groups and no differenced of treatment responses between two groups. Urine deoxypyridinoline was not decreased in both groups and no differences between two groups.
Conclusion : Tibolone was effective on BMD of lumbar spine as much as CEE/MPA and may be safe in terms of mammographic changes in postmenopausal women.
Background : The positive effects of hormone replacement therapy (HRT) on the skeleton in postmenopausal women are well defined. However, the effects of vitamin D supplementation on BMD in postmenopausal women are controversial. But many women, who are contraindicated to HRT or afraid of side effects of HRT or are already on HRT regimen, take calcium plus vitamin D supplement for prevention of osteoporosis. Therefore, this study was designed to examine the effect of vitamin D supplementation on BMD in postmenopausal women and to determine whether vitamin D supplementation can give additional benefit to HRP.
Methods : Subjects were 109 postmenopausal women out of total 213, who visited the Sacred Heart Hostpital, Chuncheon and had followed up BMD study one year after during January, 1996 to May, 1999. The study group was as follows : No treatment (n=31) ; Vit D (n=11) ; HRT (n=50) ; HRT+Vit D (n=17). We compared and analyzed the changes of BMD in the region of lumbar spine (L2-4) and femur (femoral neck, trochanter, Ward's triangle). SPSSWIN 7.5 was used for statistical procedure.
Results : Subject had a mean age of 54.4±5.7 years, mean menopausal age of 48.4±2.4 years, mean postmenopausal duration of 6.1±4.1 years, and mean body mass index of 24.1±2.8 kg/m2. No correlation was observed between general characteristics (age, menopausal age, postmenopausal duration, and body mass index) and changing rate of BMD. Lumbar BMD had increased by 1.83% in the Vit D group, by 1.95% in the HRT group and by 3.15% in the HRT+Vit D group, whereas it had decreased by 1.99% in the no treatment group. The increase of femoral neck BMD in the Vit D group was 1.5%, in the HRT group 0.66%, and in the HRT+Vit D group 2.09%, but the loss in the no treatment group was 1.65%. The changes of trochanteric BMD were as follows: No treatment group(-2.49%), Vit D group (0.04%), HRT group (1.48%), and HRT+Vit D group (-4.09%), Vit D group (1.17%), HRT group (-0.01%), HRT+Vit D group (0.16%). In the Vit D group, except for the trochanteric area (P<0.05), there was a significant increase in BMD of L2-4, femoral neck, and Ward's triangle (P<0.05) whereas in the HRT group and HRT+Vit D group significant increases were observed in all areas (P<0.05). But there was no significance among Vit D group, HTR group and HRT+Vit D group.
Conclusion : This study confirmed the beneficail effect of HRT on lumbar and femoral BMD. It also showed that low dose Vitamin D supplementation had effect in the prevention of osteoporosis in postmenopausal women, In the HRT+Vit D group. BMD had increaed more than HRT alone, but does not give benefit additional to that of HRT alone.
Background : Osteoporosis after menopause is known as a disease that needs preventive measures before medical treatment. Many patients, however, do not undergo hormone therapy to prevent it. This paper investigates some obstacles to hormone replacement therapy (HRT).
Methods : A total of 85 menopausal women who underwent bone-mineralodensitometry (BMD) examination at Chuncheon Sungshim Hosptal Health Care Clinic from May, 1995 to April, 1997 were the subjects of our study. We interviewed them by telephone, examined their medical records including their BMD results. We also examined what the obstacles were for them to receive HRT for osteoporosis.
Results : The average age of the subjects was 55.8 years. Only 40 women(47%) replied that they knew beforehand the purpose of the BMD examination. The rest of the subjects replied that they simply went through the examination because it was inclusive to health items. Those who had heard of HRT for osteoporosis were only 43 people because(50.1%), and those who did not currently receive HRT amounted to 32 (74.4%). The reasons why they do not undergo the therapy were fear of cancer, no symptoms related to osteoporosis, financial difficulty, and weight gain. Among the 32 subjects, only 1 person replied that she would not receive the HRT even if the above obstacles were removed. Therefore , it seems that most of out subjects would receive HRT if such obstacles removed. Those who were currently receiving HRT were 11people(12.9%). According to the open questionnaire, many of them replied that they do not feel any inconvenience while receiving the HRT, but some of them complained of epigastric pain, dysmenorrhea, or mastalgia. They replied that after the HRT they felt no arthralgia and felt far better in body and mind than before treatment. All the 11 people replied that they will continue to receive the HRT.
Conclusion : The main reason why so few people received HRT for osteoporosis proved to be the lack of knowledge of the therapy. Even those who had heard of HRT complained about the negative aspects, which in fact can be overcome, and as a result a considerable number of them do not receiver HRT. Therefore we conclude that in order to increase the number of patients who will undergo HRT for osteoporosis after menopause we need to strengthen education about the merits of this therapy rather than just performing BMD examination.
Background : To predict the therapeutic efficacy of osteoporosis, one or two years is needed to evaluate the therapeutic effect by the measurement of bone mineral density(BMD), whereas three to six months is sufficient with bone markers. Using this information, we can change therapeutic plan or modulate drug dosage if necessary. This approach would provide appropriate therapy for osteoporosis. The purpose of this study is to evaluate the association between the percentage change of BMD which was measured by peripheral quantitative computed tomography(pQCT), and bone markers after 1 year of hormone replacement therapy(HRT) in healthy postmenopausal women.
Methods : Bone mineral density of nondominant distal forearm in 89 postmenopausal women was measured by pQCT. We measured serum alkaline phosphatase(ALP) and intact osteocalcin(iOC, Novocalcin™) as bone formation markers, urinary deoxypyridinoline(dPyr, PyriLinks-D™) as bone resorption marker by using enzyme immunoassay. After 1 year of HRT, 54 subjects dropped out and 33 subjects were reevaluated.
Results : After 1 year of HRT, the dropout rate was 61%. There was no significant difference in age, age of menopause, years since menopause, initial BMD, initial bone markers between remained and drop-out groups. But osteocalcin level was significantly high in remained group(p=0.02). ALP(-27.6%), iOC(-29.9%), dPyr(-25.2%) were significantly decreased after 1 year of HRT(p<0.001). Trabecular BMD was increased by 2.4%(p=0.003), but the percentage change of total and cortical BMD was not significant(p>0.05). The levels of BMD and bone markers between before and after was significantly correlated, demonstrating the homogeneity of response to HRT. The percentage change of trabecular BMD was negatively correlated with the percentage change of dPyr after HRT(r=-0.45, p=0.01). The variance of the percentage change of dPyr contributed to the percentage chang of trabecular BMD by 20%. There was no correlation between the percentage change of total BMD or cortical BMD and the change of ALP, iOC, or dPyr after HRT.
Conclusion : After 1 year of HRT in postmenopausal women, all biochemical bone markers were decreased significantly, whereas only trabecular BMD measured by pQCT was increased significantly. This result suggests that bone markers was more sensitive than BMD to monitor the therapeutic efficacy of HRT. The percentage change of trabecular BMD was correlated with the change of dPyr after HRT only. dPyr might be the most sensitive marker among bone markers tested. Therefore, we can predict the change of BMD after HRT through monitoring the levels of dPyr.
Background : Hormone replacement therapy(HRT) has an established role in reducing cardiovascular risk and in preventing osteoporosis. But compliance with HRT is not good as expected. Therefore, so we assessed perimenopausal women's knowledge and attitude towards menopause and HRT too.
Methods : Questionnaires were provided to the students' mothers of a high school located in Seoul from June 10th to 15th, 1996. General characteristics and routine breast examination, routine Pap smear, the knowledge and practice of high calcuim diet for preventing osteoporosis, their menstrual pattern, the information source of HRT, in attitude for HRT, and the reasons for refusing.
Results : Among 560 women, 362 women(64.6%) responsed, and the mean age was 45.5 years. For osteoporosis prevention, they knew milk(74.7%) were, anchovy(27.4%), calcium(23.6%). HRT(7.4%) were beneficial. And almost(91.8%) all subjects answered that menopause was a natural course and 40.5% of women answered that physical change after menopause could not prevent. Among 34 postmenopause, 5(14.2%) received HRT and 48(20.3%) answered that they would receive HRT, and 57(24.1%) answered that they would not receive HRT. The reasons for refusing HRT were that menopause was a natural course, therefore devoiding the need for artificial hormone therapy(22.4%), increased incidence of breast cancer(21.8%), and that lack of information for HRT(13.9%). The association was not proven between the attitude for HRT and regular Pap smear, regular breast examination, exercise, oral intake for osteoporosis prevention.
Conclusion : Almost all of the respondents recognized that menopause was a natural course. And the effectiveness of diet and exercise in preventing osteoporosis was more well known compared to HRT.
Background : This study was performed to assess the effect of hormone replacement therapy(HRT) on the menopausal symptoms of Korean women by comparing the postmenopausal symptoms before and after HRT in women who continued therapy and those who stopped.
Methods : The subjects were 40 menopausal women(24 women on continuous medication, 16 women who discontinued medication) who received HRT and were aiding follow-up of at least 2 months later in the Department of Family Practice. The menopausal symptoms were evaluated by two doctors according to the modified Kupperman Index.
Results : The basic values of Kupperman Index were not significantly different between women who had received the HRT continuously and those who discontinued HRT. In women with continued HRT improved symptoms after HRT were hot flushes, sweating, fatigue, headache, tachycardia and total score of Kupperman Index. However, only vertigo and headache were improved in women who discontinued HRT. Treatment period was the single most predictor of total score of Kupperman Index after therapy. And it could explain the 44.1% of variance of total score in the direction of improvement proportional to the treatment period.
Conclusion : The HRT is helpful to relieve the menopausal symptoms. And the treatment period is more important than the severity of basic symptoms to improve menopausal symptoms after therapy.
Background : As life span is increasing, so is interest about adult disease. Especially the number of postmenopausal women has increased, and postmenopausal symptoms have become an important problem causing low quality of life. Hormone replacement therapy was introduced to overcome these problems. Authors investigated to evaluate the effect hormone replacement therapy on the quality of life of postmenopausal women.
Methods : From April to June 1997, we surveyed 188 postmenopausal women(91 women were on hormone replacement therapy, and 97 women were in the controlled group in Sungnam Center Hospital) with COOP/WONCA chart Korean version.
Results : COOP/WONCA chart(Korean version) is composed of seven dimensions, among these four dimensions(change in health, overall health, daily activity and pain) were shown statistically significant difference between two groups. But three dimensions (social activity, physical fitness and feelings) were not shown to be statistically different. Total mean score of COOP/WONCA chart showed statistically significant difference.
Conclusion : To improve the quality of life of postmenopausal women, primary care physician should consider hormone replacement therapy along with proper patient selection and periodic follow up.
Background : Osteoporosis is a major public problem. Although clinicians have advocated hormone replacement therapy and other clinical measures, few studies have assessed whether these measures are being adopted by primary care physicians in practice. The purpose of this study is to investigate the practice patterns of primary care physicians and to assess the impact of doctors' specialty on osteoporosis management.
Methods : Questionnaire was sent to all primary care physicians in Inchon city. The questionnaire contained questions regarding general characteristics of physicians, practice pattern and whether he(she) participates in the management of osteoporosis.
Results : Among 451 practitioners, 172 replies were received. 53.3% primary care providers participated in the management of osteoporosis. 70.4% family physicians, 73.5% gynecologists and 70.4% orthopedic surgeons, 25.9% general internists, 30.3% general physician participated. Female physicians participated more than males. Concerning the reason why they did not participate, their reasons were deficiency of laboratory or radiologic facility in 70.1%, insufficient knowledge in 22%. 88.9% of physicians evaluated risk factors for osteoporosis. Groups concerning postmenopausal women, older age, history of bilateral oophorectomy were evaluated at high rate(above 75% physicians). Concerning prescription, they recommended exercise and dietary calcium in 51.5% and recommended HRT in 37.7%, calcium in 36.5%, calcitonin in 22.8%, vitamin D in 18.6%. 55.6% family physicians, 73.5% gynecologists, 20% general physicians, 11.1% general internists were prescribing HRT. History taking was done in 92.1%, along with breast examination in 58.7%, pelvic examination in 31.7% before HRT. Patient education was given in 45.5%.
Conclusion : Insignificant proportion of primary care physicians participated in the management of osteoporosis and in HRT. Their attitudes and practice patterns appear to be influenced by their profession and sex but not by age. We conclude that more participation of primary care physicians and their continuing education are required in the management of osteoporosis.
Background : The improvement is social economic standard of living and aging bring high attention to osteoporosis in women. Many studies have been released so far about how effectively Hormone Replacement Therapy(HRT) in postmenopausal women works for the increase in Bone Mineral Density(BMD) in hip and vertebrae with the different rate of bone formation. In addition, it has been believed that HRT could increase BMD of hip and lumbar vertebrae reduce fractures caused by osteoporosis. In this study, we will find the effect of HRT on the increase in BMD of lumbar vertebrae and hip in postmenopausal women, by measuring and comparing BMD of lumbar vertebrae with high rate of trabecular bone to that of hip with high rate of cortical bone one year after HRT in postmenopausal women.
Methods : Subjects were 48 out of 325 postmenopausal women patients who visited osteoporosis clinic, Sun Hospital, Taejeon, from January, 1995 to December, 1995 and had the osteoporosis test and the vertebrae osteoporosis test one year after. We compared and analyzed the change of BMD in each part by retesting BMD of lumbar vertebrae and hip one year after the continuous HRT in women. SPSS/PC was used for statistical procedure.
Results : Subjects have mean age of 54.8±4.5 years, mean menopausal age of 48.4±3.5 years, mean postmenopause period of 6.5±5.9 years, mean body mass index 23.4±3.1kg/m², mean weight of 56.7±7.8kg and mean height of 154±5.5cm. No correlation was observed of their age, menopausal age, the number of years since menopause and body mass index to the changing rate of BMD in lumbar vertebrae and femur one year after HRT in women. The BMD prior to treatment was, respectively, as follows ; L2-L4(0.8983±0.11g/cm²), Hip(neck, 0.7597±0.10g/cm² ; trochanter, 0.6259±0.08g/cm² ; Ward's triangle, 0.5186±0.90g/cm²), and that one year after treatment ; L2-L4(0.9277±0.11g/cm²), Hip(neck 0.7592±0.00g/cm² ; trochanter, 0.6322±0.08g/cm² l Ward's triangle, 0.5340±0.09g/cm²). There was significant increase in BMD of lumbar vertebrae and femur Ward's triangle(P<0.01) among BMD of each part one year after HRT, but BMD of femur nexk and that of trochanter region has no significant increase.
Conclusion : It was found that one year treatment with HRT in postmenopausal women resulted in significant increase in BMD of not only lumbar vertebrae with lots of trabecular bone but also Ward's triangle regions of femur, regardless of age and postmenopausal period of postmenopausal women at the beginning of treatment. It is considered that HRT may be effective in preventing osteoporotic fractures of lumbar vertebrae and hip on postmenopausal women, and that postmenopausal period would not be an important factor in the beginning of HRT treatment.
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