Untitled Deck Flashcards
How does estrogen deficiency affect bone health?
Estrogen deficiency leads to bone loss, particularly affecting trabecular bone, increasing the risk of osteoporosis in postmenopausal women.
Why is attaining peak bone mass important?
Attaining peak bone mass in the late teens to early twenties helps offset natural bone loss associated with aging and menopause, reducing osteoporosis risk.
What is osteoporosis?
Osteoporosis is a condition characterized by compromised bone strength, making bones more susceptible to fractures.
What are the diagnostic T-score ranges for bone health?
• Normal: T-score ≥ -1.0
• Osteopenia (low bone mass): T-score between -1.0 and -2.5
• Osteoporosis: T-score ≤ -2.5
How does estrogen maintain bone health?
Estrogen maintains bone density by suppressing bone turnover, promoting osteoclast apoptosis, and protecting osteoblasts from glucocorticoid-induced apoptosis.
What are osteoclasts, and how does estrogen affect them?
Osteoclasts are bone-resorbing cells. Estrogen reduces their activity and promotes their apoptosis, limiting bone resorption.
What are osteoblasts, and how does estrogen affect them?
Osteoblasts are bone-forming cells. Estrogen protects them from apoptosis and supports bone formation and maintenance.
What role do Bone Multicenter Units (BMUs) play in bone health?
BMUs are sites of continuous bone remodeling, where old bone is resorbed, and new bone is formed. Estrogen ensures a balance between these processes.
What type of bone is most affected by estrogen deficiency?
Trabecular bone, such as the spine, is more affected than cortical bone (long bones).
How does estrogen affect the balance of bone remodeling?
Estrogen maintains equilibrium in bone remodeling by balancing bone resorption and formation.
Why is osteoporosis a significant concern for postmenopausal women?
Postmenopausal women are at increased risk of osteoporosis due to accelerated bone loss from estrogen deficiency, leading to fractures.
What is the primary mechanism of estrogen in reducing bone resorption?
Estrogen decreases osteoclast activity by promoting their apoptosis, reducing bone resorption.
How is Bone Mass Density (BMD) assessed?
BMD is measured using T-scores to diagnose bone health as normal, osteopenic, or osteoporotic, enabling targeted treatment.
How does estrogen affect osteocytes?
Estrogen decreases apoptosis in osteocytes, supporting their role in bone remodeling.
What is the effect of estrogen on osteoblasts?
Estrogen reduces apoptosis, oxidative stress, and NF-κB activity in osteoblasts, promoting bone formation and maintaining bone density.
How does estrogen influence osteoclast activity?
Estrogen increases apoptosis and decreases RANKL-induced differentiation in osteoclasts, reducing bone resorption.
What role do T-cells play in estrogen’s effect on bone?
Estrogen modulates T-cell activity, influencing bone cell function and helping maintain bone balance.
What are the key changes in bone remodeling due to estrogen deficiency?
Estrogen deficiency causes increased bone remodeling, prolonged resorption, shortened bone formation, and increased osteoclast recruitment, leading to bone loss.
What is the standard diagnostic tool for osteoporosis?
Dual-Energy X-Ray Absorptiometry (DEXA) scans are the standard diagnostic tool for osteoporosis.
What are the T-score ranges for normal bone density, osteopenia, and osteoporosis?
• Normal: T-score ≥ -1.0
• Osteopenia: T-score between -1.0 and -2.5
• Osteoporosis: T-score ≤ -2.5
How does a T-score reflect bone health?
A T-score indicates the number of standard deviations from the peak bone mass of a young adult, showing the degree of bone loss.
How is the response to osteoporosis treatment monitored?
Biochemical assays measure bone resorption and formation markers in blood and urine to assess treatment effectiveness.
What serum markers are used to evaluate osteoporosis treatment?
Serum markers measure changes in bone turnover over time, helping monitor treatment response.
Why is estrogen critical for bone health?
Estrogen maintains balance in bone remodeling by supporting osteocytes, promoting osteoblast activity, and reducing osteoclast-induced bone resorption.
What happens to bone remodeling in the absence of estrogen?
Without estrogen, bone resorption increases while bone formation decreases, leading to net bone loss and increased osteoporosis risk.
Why is DEXA the gold standard for osteoporosis diagnosis?
DEXA accurately measures bone mass and provides T-scores to classify bone health, allowing for early detection and management.
What is the FRAX tool used for?
The FRAX tool calculates the 10-year risk of osteoporotic fractures based on various risk factors.
Which age group is at the highest risk for osteoporosis?
Individuals aged 50-90 years are at the highest risk.
How does family history influence osteoporosis risk?
A parental history of fragility fractures, such as hip fractures, increases osteoporosis risk.
Which gender has a higher risk of osteoporosis?
Female sex is associated with a higher risk of osteoporosis.
How does body weight affect osteoporosis risk?
Lower body weight contributes to an increased risk of osteoporosis.
How does bone mineral density (BMD) influence fracture risk?
Low femoral neck BMD is a significant risk factor for osteoporotic fractures.
Why are previous fractures a risk factor for osteoporosis?
A history of prior fragility fractures increases the likelihood of future fractures.
How does smoking affect osteoporosis risk?
Current tobacco smoking is a modifiable risk factor that increases the risk of osteoporosis.
How does alcohol intake contribute to osteoporosis risk?
Consuming more than 3 units of alcohol daily increases the risk of fractures.
Give an example of 1 unit of alcohol.
Examples include 1 glass of beer (285 ml), 1 medium glass of wine (120 ml), or 1 measure of spirits (30 ml).
How does glucocorticoid use influence osteoporosis?
Long-term glucocorticoid therapy contributes to bone loss and increases fracture risk.
What is the relationship between rheumatoid arthritis and osteoporosis?
Rheumatoid arthritis increases bone resorption, contributing to a higher fracture risk.
Name some secondary causes of osteoporosis.
Secondary causes include hyperthyroidism, malabsorption disorders, and certain medications that affect bone density.
What are modifiable risk factors for osteoporosis?
Modifiable factors include smoking, alcohol intake, and long-term glucocorticoid use.
What are non-modifiable risk factors for osteoporosis?
Non-modifiable factors include age, gender, family history, and height.
Why is understanding osteoporosis risk factors important?
Identifying risk factors helps guide preventive measures like lifestyle changes, dietary adjustments, and pharmacologic interventions to reduce fracture risk.
How does menopause affect the risk of cardiovascular disease (CVD)?
Post-menopause, the risk of CVD increases significantly due to the decline in estrogen levels, which previously provided protective effects.
What is the leading cause of death in postmenopausal women?
Coronary artery disease is the leading cause of death in postmenopausal women, with a lifetime risk of 31%.
How does premature ovarian failure affect CVD risk?
Premature ovarian failure increases the risk of myocardial infarction by 2-3 times.
How does early oophorectomy (before age 35) affect myocardial infarction risk?
Early oophorectomy raises the risk of myocardial infarction by 7 times.
What lipid changes occur in postmenopausal women?
• Total cholesterol increases.
• LDL-C levels rise and become more prone to oxidation.
• VLDL and Lipoprotein (a) levels increase.
• HDL-C levels trend downward slightly.
How does menopause affect vascular changes?
Menopause leads to decreased blood flow, increased vasoconstriction due to lower prostacyclin and higher endothelin, and reduced nitric oxide (NO) activity.
What are the protective cardiovascular effects of estrogen?
Estrogen improves cholesterol profiles, enhances vasodilation, and increases blood flow, supporting overall cardiovascular health.
How does reduced nitric oxide activity impact vascular health post-menopause?
Reduced nitric oxide activity decreases vasodilation capacity, contributing to increased vasoconstriction and reduced oxygen delivery to tissues.
Why does menopause lead to a less favorable lipid profile?
Menopause causes increased LDL-C (and its oxidation), decreased HDL-C, and elevated VLDL, promoting atherosclerosis.
How does decreased estrogen post-menopause affect vascular flexibility?
Reduced estrogen leads to less prostacyclin, higher endothelin, and lower nitric oxide, causing decreased vascular flexibility and increased blood pressure.
Why is estrogen decline the primary driver of increased CVD risk in menopausal women?
Estrogen decline disrupts lipid profiles and vascular functions, accelerating atherosclerosis and increasing the risk of hypertension and heart disease.
How can early intervention reduce CVD risk in postmenopausal women?
Early intervention with lifestyle changes and possibly hormone replacement therapy (HRT) can manage risk factors and reduce CVD risk.
What group of women may benefit from estrogen therapy for vascular health?
Younger postmenopausal women without established cardiovascular disease (stage B1) may benefit from estrogen therapy.
Why is estrogen therapy risky for women with significant coronary plaque burden?
Estrogen therapy may destabilize plaques, increasing the risk of stroke or myocardial infarction (MI) in women with significant coronary plaque burden.
Does estrogen therapy protect women with established coronary disease?
No, estrogen therapy provides no protective effect and may increase the risk of plaque destabilization and thrombosis in these women.
How does estrogen contribute to plaque destabilization?
Estrogen upregulates matrix metalloproteinase-9 (MMP-9), which weakens the gelatinous covering of plaques, increasing the risk of plaque rupture and thrombosis.
What is the target level for total cholesterol to reduce cardiovascular risk?
Total cholesterol should be less than 200 mg/dL (untreated).
What are the target levels for HDL-C and LDL-C?
• HDL-C: At least 50 mg/dL
• LDL-C: Below 100 mg/dL
What is the target blood pressure for cardiovascular health?
Blood pressure should be maintained at <120/<80 mm Hg (untreated).
What is the fasting blood glucose target for cardiovascular health?
Fasting blood glucose should be below 100 mg/dL (untreated).
What is the recommended BMI for reducing cardiovascular risk?
A BMI below 25 kg/m² is the target.
How much exercise is recommended weekly for cardiovascular health?
• Moderate exercise: At least 150 minutes per week
• Vigorous exercise: At least 75 minutes per week, or a combination of both.
What dietary approach supports cardiovascular health?
A DASH-like diet, rich in fruits, vegetables, whole grains, lean proteins, and low sodium, supports heart health.
Why is smoking cessation important for cardiovascular health?
Smoking cessation is essential as it significantly reduces cardiovascular risk.
What is the significance of the Timing Hypothesis in estrogen therapy?
Estrogen therapy is safest and most effective when initiated soon after menopause onset, while later initiation increases the risk of adverse cardiovascular events.
How can lifestyle changes improve cardiovascular health in postmenopausal women?
Maintaining optimal cholesterol, blood pressure, glucose, and BMI through a healthy diet, regular exercise, and smoking cessation reduces cardiovascular risk.
Does menopause increase cancer risk?
No, menopause itself does not increase cancer risk, but cancer rates naturally rise with age.
How often should women aged 50-64 undergo cervical cancer screening with a PAP test?
Women aged 50-64 should have a PAP test every 3 years.
What is the screening interval for cervical cancer co-testing with HPV for women aged 50-64?
Co-testing with HPV can be done every 5 years.
When can cervical cancer screening be discontinued in women aged 65 and older?
Screening can be discontinued if the patient has had 3 consecutive normal PAP tests or 2 or more negative PAP tests in the past 10 years with no abnormal results.
How often should women aged 50-74 undergo mammograms?
Mammograms should be done every 2 years, as per USPSTF guidelines.
When should earlier breast cancer screening be considered?
Earlier screening is recommended if there is a strong family history, such as a sister diagnosed with breast cancer at age 40.
At what age should colorectal cancer screening begin?
Colorectal cancer screening should start at age 50.
What are the options for colorectal cancer screening?
Options include colonoscopy every 10 years, fecal occult blood test (FOBT), sigmoidoscopy, or barium enema every 5 years.
What should be done if a postmenopausal woman experiences bleeding?
Any postmenopausal bleeding should be evaluated with a pelvic ultrasound and/or endometrial biopsy to rule out endometrial cancer.
Are there reliable screening tests for ovarian cancer?
No, there are no reliable screening tests for ovarian cancer, but symptoms such as bloating, pelvic pain, or urinary urgency require prompt investigation.
What is the recommended interval for a barium enema as a colorectal cancer screening tool?
A barium enema is recommended every 5 years as an alternative screening option.
Why is regular cancer screening important in postmenopausal women?
Regular screening is essential for early detection of cancers, which naturally become more common with age.
What factors influence individualized cancer screening?
Family history and symptoms influence screening decisions, such as early breast cancer screening for a strong family history or prompt evaluation of postmenopausal bleeding.
What factors influence individualized cancer screening?
Family history and symptoms influence screening decisions, such as early breast cancer screening for a strong family history or prompt evaluation of postmenopausal bleeding for endometrial cancer.
Why is smoking cessation important in menopause management?
Smoking cessation reduces health risks, including cardiovascular disease and osteoporosis.
How does limiting alcohol intake help menopausal women?
Limiting alcohol reduces cardiovascular risk factors and may help minimize hot flashes.
What are some ‘common sense’ solutions for managing menopausal symptoms?
Wearing loose, breathable clothing and staying hydrated can alleviate hot flashes and improve overall comfort.
What are the benefits of increasing physical activity during menopause?
Physical activity enhances mood, reduces stress, boosts body image, and helps manage menopausal symptoms.
How does weight loss impact vasomotor symptoms (VMS)?
Weight loss improves vasomotor symptoms like hot flashes and night sweats, enhancing quality of life.
Why are lifestyle changes the initial focus in managing menopause?
Lifestyle modifications improve overall health, address menopausal symptoms, and may reduce the need for medical treatments.
How does regular exercise benefit emotional well-being during menopause?
Regular exercise reduces stress, improves mood, and promotes a healthy body image.
How does staying hydrated help manage menopausal symptoms?
Staying hydrated helps manage symptoms like hot flashes and supports overall well-being.
Why is wearing loose, breathable clothing recommended for menopausal women?
Loose, breathable clothing helps alleviate discomfort from hot flashes and night sweats.
What is the overall goal of lifestyle modifications in menopause management?
Lifestyle modifications aim to improve physical and emotional well-being while addressing specific menopausal symptoms.
