Effect of Menopause on Melatonin and Alertness Rhythms Investigated in Constant Routine Conditions

Although studies have reported the effects of the menstrual cycle on melatonin rhythmicity, none has investigated the effects of menopause on the melatonin rhythm. The circadian rhythm in melatonin and its relationship to subjective alertness was investigated in pre‐ and postmenopausal women under constant routine conditions (controlled posture, dim lighting, calorie intake, temperature, and prolonged wakefulness). Eleven healthy pre‐menopausal (42±4 yr) and 10 postmenopausal women (55±2 yr) participated in the study. Salivary melatonin samples and subjective measures of alertness and sleepiness were assessed hourly during the 22 h constant routine protocol. Postmenopausal women had a significantly earlier melatonin acrophase (1.1±0.5 h clock time in decimal h; mean±SEM, p<0.05) compared to the pre‐menopausal women (2.3±0.3 h). There was no significant difference between melatonin onset and amplitude between the pre‐menopausal and postmenopausal women. Self‐rated alertness declined in both study groups as the length of sleep deprivation increased. Melatonin onset preceded the onset of self‐rated sleepiness in both groups. The time interval between melatonin onset and the onset of sleepiness and alertness offset was significantly greater in the postmenopausal women compared to the pre‐menopausal women. In conclusion, under controlled experimental conditions the timing of the melatonin rhythm was advanced in postmenopausal women altering its phase relationship to subjective alertness and sleepiness.     

Correlation of serum oestrogen with salivary calcium in post-menopausal women with and without oral dryness feeling

doi: 10.1111/j.1741‐2358.2011.00580.x
Correlation of serum oestrogen with salivary calcium in post‐menopausal women with and without oral dryness feeling Objective: The aim of this study was to verify the association between salivary calcium and serum oestrogen levels with oral dryness in post‐menopausal women. Also, the correlation between these variables was evaluated. Methods: A case‐control study was carried out on 60 selected menopausal women with and without oral dryness feeling (30 as case and 30 as control) conducted in the Department of Oral Medicine and Radiology, Maharishi Markandeshar University, Mullana, India. Paraffin‐stimulated saliva samples were obtained by expectoration. Salivary calcium concentrations were assessed colorimetrically using Arsenazo III reaction. The serum oestrogen concentration was measured using ELISA. Statistical analysis of Student’s t‐test and Pearson correlation was used. Results: There was significant difference in mean values of both salivary calcium concentration and serum oestrogen between case and control groups. The result obtained also showed that an inverse correlation was found between salivary calcium concentration and serum oestrogen levels in both the groups and in total sample size. Conclusion: Oral dryness in post‐menopausal women is associated with high levels of salivary calcium and low levels of serum oestrogen. The concentrations of salivary calcium and serum oestrogen are inversely correlated in post‐menopausal women, regardless of the presence or absence of oral dryness.     

Oral health‐related quality of life and nutritional status of institutionalized elderly population aged 60 years and above in Mysore City,India

doi: 10.1111/j.1741‐2358.2012.00651.x Oral health‐related quality of life and nutritional status of institutionalized elderly population aged 60 years and above in Mysore City, India Objective: To assess whether oral health–related quality of life (OHRQoL) is associated with nutritional status in the institutionalised elderly population of Mysore. Background: Malnutrition in the elderly has an evident impact on their general health and quality of life. Analysis of data of the Geriatric Oral Health Assessment Index (GOHAI) and their association with the Mini Nutritional Assessment (MNA) results improves our understanding of the complex relationship between oral health and malnutrition. Materials and methods: The study was conducted among the institutionalised elderly population in Mysore city, Karnataka. Data on socio‐demographic, oral health status were gathered. OHRQoL was evaluated using GOHAI, and malnutrition risk using MNA. Results: Out of 141 elderly, 41.1% were men and 58.9% were women with mean age of 72.2 ± 7.5 years. Mean GOHAI score was 47.03 ± 9.2, with 69.5% had low perception of oral health. Mean MNA score was 9.91 ± 2.4, 15.6% were malnourished, 52.5% were at risk of malnutrition and 31.9% were adequately nourished. A strong association was found between the mean GOHAI and MNA scores. Conclusion: Oral health–related quality of life was associated with nutritional deficit, and it requires a greater integration between dentistry and nutrition in the health promotion of older adults.     

Evaluation of Ki‐67 and Bcl‐2 antigen expression in breast carcinomas of women treated with raloxifene

Objectives: To evaluate the effect of raloxifene on Ki‐67 and Bcl‐2 antigen expression in operable, stage II, oestrogen‐receptor‐positive invasive ductal breast carcinomas. Materials and methods: Twenty post‐menopausal women who had taken 60 mg of raloxifene daily for 28 days prior to definitive surgery were enrolled in the investigation. Two tumour samples were obtained by incisional biopsy during the study, one at the time of confirmation of diagnosis of invasive ductal carcinoma and evaluation of oestrogen receptor status, and the other 29 days later, at the time of definitive surgery. Immunohistochemistry was performed on tumour samples, prior to and after raloxifene treatment, to evaluate Ki‐67 and Bcl‐2 expression. Friedman and McNemar tests were used for statistical analysis of the data, significance being established at 5%. Results: Mean percentage of Ki‐67‐stained nuclei was 24.86 ± 2.95 prior to raloxifene treatment and 13.33 ± 1.52 after treatment (P < 0.001). Prior to raloxifene treatment, only 9/20 cases (45%) were classified as Bcl‐2‐positive, whereas after treatment, 17/20 (85%) were classified as Bcl‐2‐positive (P < 0.013). Conclusions: Raloxifene treatment significantly reduced Ki‐67 antigen expression and increased Bcl‐2 expression in breast carcinomas of post‐menopausal women.     

Relationship of serum and saliva calcium, phosphorus and alkaline phosphatase with dry mouth feeling in menopause

doi: 10.1111/j.1741‐2358.2012.00619.x Relationship of serum and saliva calcium, phosphorus and alkaline phosphatase with dry mouth feeling in menopause Objectives: The aim of this study was to compare serum and saliva calcium, phosphorus and alkaline phosphatase of menopausal women with/without dry mouth (DM) feeling. Background: The composition of saliva in menopause women with/without DM feeling is different. Some of these differences are in hormones that are related to bone turnover. Methods: A case–control study was carried out on 60 selected menopausal women aged 45–79 years with or without DM feeling (30 as case, 30 as control), conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences. The phosphorus concentration was measured by photometrical measurement of the blue colour formed after the addition of ammonium molybdate and stannous chloride; calcium was measured by Arsenazo reaction; and alkaline phosphatase by the pNPP‐AMP method. Statistical analysis of Student’s t‐test was used. Results: The mean serum phosphorus and alkaline phosphatase, stimulated and unstimulated saliva calcium and alkaline phosphatase levels were significantly higher in the menopausal women suffering from DM. There were no significant differences between groups regarding saliva phosphorus and serum calcium concentration. Conclusion: Calcium, phosphorus and alkaline phosphatase appear associated with DM feeling in menopause.     

Vaginal and oral cytology of the menopause. A comparative study

A comparative cytologic study was made of the hormonal content of the vaginal and oral mucosa of menopausal women. Twenty-three women between one and ten years (early menopause) and 33 patients more than ten years (late menopause) after cessation of menstruation had oral and vaginal smears taken. Comparable smears from 21 young women, and oral smears from 18 males served as controls. The smears were evaluated by the maturation value method, and averages were established for each group. The vaginal smears had low maturation values of 40 and 22 in the early and late menopausal groups, respectively. In these women, the buccal smears' maturation values were high, above 70. Similar high maturation values were found in buccal smears of the young women and men. It was concluded that the high maturation values found in the oral smears of the menopausal women are not the result of hormonal effect but that of local mechanisms or irritative factors.     

Oral health of the elderly living in residential homes in Slovenia

doi: 10.1111/j.1741‐2358.2011.00497.x
Oral health of the elderly living in residential homes in Slovenia Objectives:  To evaluate oral health status of the elderly, living in eight randomly selected residential homes for senior citizens across the country. Background: The percentage of the elderly is growing worldwide. With ageing, risks of various oral diseases, including dental caries and periodontal disease, are growing. Methods: Altogether 296 elderly people (88 men, 208 women) of average age 79.89 ± 7.4 years were questioned about their medical condition and oral health practice and examined orally. Evaluation of clinical examination was carried out by DMFT, plaque index ( 10 ) and Community Periodontal Index of Treatment Need (CPITN). Results: Of 296 participants, 106 (35.8%) were edentulous, 95 (32.1%) had one to nine teeth and 95 persons (32.1%) had 10 or more teeth. The average number of teeth in an individual was small: 6.76 ± 7.47. The average number of teeth with caries lesions was 3.59 ± 4.70, filled teeth 1.94 ± 3.63 and teeth without caries or fillings 1.19 ± 2.41. The average DMFT value was 30.75. In 69.5% of participants, dental plaque was visible with the naked eye. Of 171 subjects, in whom CPITN index was appraised, 81.9% would need oral hygiene education, 56.7% would need scaling and root planning and 21.6% would need periodontal surgical treatment. Conclusions: The results of this study indicate poor oral health of the elderly living in residential homes situated in different towns in Slovenia. It is of utmost importance to highlight the necessity of improving oral health care of this population.     

Age at menopause of Tamang women tea-labourers of Jalpaiguri district,West Bengal,India

The Tamang women tea-labouren of Jalpaiguri district show no significant difference in age at menopause among their three «migration status» groups, viz., MO, M1 and M2+. The mean age at menopause is 47.3±4.26 and the median age is 47.68 years. A significant difference occurs between the observed mean age at menopause and 45 years, which is generally taken to be the menopausal age by convention. These Tamang women seem to be similar to other hill women in respect of age at menopause.     

Oral health promotion among older persons and their care providers in a nursing home facility

Objectives: To assess oral health status and oral health‐related quality of life (OHRQoL) of residents in an extended care facility and to assess the care providers’ oral health attitudes and knowledge. Methods: Participants included 137 residents (58.1% female, age range 32–94 years, 91% African–American) and 22 care providers. Residents received an oral examination and completed the Oral Health Impact Profile (OHIP‐14), an OHRQoL questionnaire. Care providers completed an oral health knowledge (OHK) questionnaire before and after the on‐site geriatric oral health education and training programme. Results: Oral examinations showed that 58% of the residents had extensive oral health needs. On the OHIP‐14, the mean severity was 9.2 (SD = 12.0), extent (number of items rated as ‘fairly often’ or ‘often’) was 1.2 (SD = 2.6) and prevalence (participants rating at least one item at least ‘fairly often’) was 37.8%. Most prevalent negative impact items were about ‘oral pain’, ‘appearance’ and ‘self‐consciousness’. Regarding OHK, caregivers’ knowledge improved following instruction from 65% correct on the pre‐test to 90% correct on the post‐test (p < 0.05). Subsequent to the eight in‐service workshops, providers reported that physical limitations, fear of getting bitten and time constraints were barriers to providing oral hygiene to their residents. Conclusion: Examination data showed a high level of dental needs among the majority of residents, accompanied by significantly reduced OHRQoL. Although care providers’ OHK improved following the geriatric service programme, they reported specific barriers regarding their provision of oral hygiene care to the residents.     

Relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth in menopausal women

doi: 10.1111/j.1741‐2358.2010.00403.x Relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth in menopausal women Objectives: To evaluate the relationship of stimulated whole saliva cortisol level with the severity of a feeling of dry mouth (DM) in menopausal women. Background: A feel of DM is a major complaint for many elderly individuals and strongly associated with the menopause. The exact mechanisms that mediate sensation of DM in menopausal women have not been firmly established. Methods: A case–control study was carried out on 104 selected menopausal women with/without a feeling of DM, conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences. Xerostomia Inventory (XI) score was used as an index of DM severity. Stimulated whole saliva cortisol concentration (stimulated by chewing standard‐sized paraffin for 60 s) was measured by ELISA. Statistical analysis by Student’s t‐test and Spearman correlation was used. Results: The mean cortisol concentration of saliva, but not saliva cortisol output, was significantly higher in the cases than in the controls. There was significant positive correlation between XI score and concentration (r = 0.357, p = 0.000) or output (r = 0.223, p = 0.017) of stimulated whole saliva cortisol. Conclusions: It appears that stimulated whole saliva cortisol is high in menopausal women with a feeling of DM.     

Resilience of arboreal folivores to habitat damage by a severe tropical cyclone

Abstract Severe tropical cyclones greatly modify habitat of arboreal folivores by destroying forest canopy, reducing structure and complexity and defoliating remaining trees. We hypothesized that forest modification following severe Cyclone Larry would stress arboreal folivores of the Family Pseudocheiridae and be reflected in increased home ranges and a decrease in body condition. We conducted 19 pre‐cyclone and 24 post‐cyclone spotlighting surveys at a site with severe cyclone damage, and 18 post‐cyclone surveys at a site with minor damage. We detected a greater number of lemuroid, Hemibelideus lemuroides and green, Pseudochirops archeri, ringtail possums as these possums remained in the severely damaged canopy and forest edge. In contrast, Herbert River ringtail possums, Pseudochirulus herbertensis, were detected in smaller numbers. We radio‐tracked eight P. herbertensis before the cyclone, following two of these and nine new animals after the category 4 cyclone. No significant post‐cyclone alteration in home range area or span was recorded in data pooled across the two sites or in limited post‐cyclone data at the severely disturbed site, but a greater variability in home range was observed after cyclone (pooled across sites: 1.72 ± 0.77 ha; 197 ± 47 m) than before the cyclone (1.35 ± 0.30 ha; 196 ± 23 m). In contrast, pooled pre‐ and post‐cyclone home range areas and spans were larger at the severely‐disturbed site (2.08 ± 0.56 ha; 231 ± 32 m) than at the site with minor damage (0.68 ± 0.11 ha; 114 ± 25 m), suggesting resources were more widely spread at the former site. Post‐cyclone home ranges were also larger at the severely damaged site (severe: 3.33 ± 1.36 ha, n = 3; minor: 0.52 ± 0.07 ha, n = 4). Condition of P. herbertensis (mass/tail length) did not differ significantly pre‐ and post‐cyclone or between less and severely disturbed sites. These results and observations of breeding after cyclone suggest that possum populations may be resilient to severe cyclone damage under the relatively wet conditions experienced post‐Cyclone Larry.     

The relationship between seven health practices and oral health status in community‐dwelling elderly Thai

Gerodontology 2012; doi: 10.1111/j.1741‐2358.2012.00672.x The relationship between seven health practices and oral health status in community‐dwelling elderly Thai Objective: This study aims to analyse the relationship between seven health practices, oral health behaviors, and oral health status in community dwelling elderly Thai. Materials and methods: The subjects were 612 elderly people (mean age = 68.8 ± 5.9 years). Questionnaires survey about sociodemographics, self‐reported seven health practices and oral health behaviors were conducted by trained interviewers. Oral examinations investigated the number of teeth present, decayed teeth, periodontal status and functional tooth units (FTUs). Oral malodor was assessed by Organoleptic Test, and unstimulated saliva was collected for 5 min. Results: Five health practices (smoking, drinking, physical activity, breakfast and weight maintenance) were significantly related with oral health behaviors. ancova analysis demonstrated the following significant associations: (i) smoking behavior with number of teeth present, number of FTUs, decayed teeth, periodontal disease, oral malodor and salivary flow rate, (ii) drinking alcohol behavior with number of teeth present, number of FTUs, periodontal disease, oral malodor and salivary flow rate, (iii) eating breakfast behavior with periodontal disease, oral malodor and salivary flow rate, (iv) eating between‐meal snack with number of teeth present, number of FTUs, decayed teeth and periodontal disease, (v) maintaining weight with number of teeth present, number of FTUs, periodontal disease and oral malodor, (vi) sleeping with number of teeth present, number of FTUs, periodontal disease, oral malodor and salivary flow rate, (vii) physical activity with periodontal disease and salivary flow rate. Conclusion: Good health practices were related with good oral health behaviors. Moreover, general health practices were associated with the clinical oral health status such as number of teeth present, decayed teeth, FTUs, periodontal disease, oral malodor and salivary flow rate. The elderly with good general health practices were considered to have good oral health status. Improving general health habits are suggested to lead to better oral health for the elderly, and vice versa.     

Does menopausal transition really influence mental health? Findings from the prospective long‐term Zurich study

In the prospective long‐term Zurich study, we re‐examined the hypothesized association between mental health problems in women and the transition through menopausal stages. One hundred sixty‐eight women from a population‐based Swiss community cohort were prospectively followed up from age 21 to 50. At age 50, the occurrence of hot flushes/night sweats and sleep disturbances was significantly more frequent in peri‐ and post‐menopausal women. Irritability/nervousness was increased only in peri‐menopausal women, but that association was accounted for by neuroticism trait scores at age 30. Transitions to peri‐ or post‐menopause were not related to changes in either the prevalence rates of DSM major depressive episode or anxiety disorders, or the course of psychopathological syndromes as assessed by the Symptom Checklist 90 ‐ Revised. The null associations held when adjusting for duration of reproductive period or age at menopause. Preceding mental health problems between ages 21 and 41, increased neuroticism trait scores at age 30, and concurrent psychosocial distress were significantly related to mental health problems occurring between ages 41 and 50. Depending upon the cut‐off point that was chosen, the arbitrary dichotomization of a continuous depression outcome produced spurious associations with the menopausal transition. We conclude that mental health problems between ages 41 and 50 are probably not directly related to the menopausal transition, and that previously reported associations could be false positives due to inadequate dichotomizations, reporting bias, undisclosed multiple adjustments or overfitting.     

Secular Trends of Reproductive Indices in Chuvashian Women

In the present cross-sectional study of the Chuvashian rural population, we examined the secular trends of age at menarche, the age at menopause, the reproductive period, and the age of the first marriage of Chuvashian women. The cohort included 745 women aged 18–90 years; age at menarche (N = 653) ranging from 10 to 24 years (mean 15.42 ± 2.11). Data regarding menopausal age was obtained from 316 women born between 1920 and 1950 (mean 48.5 ± 4.6). Statistical analyses included the maximum likelihood estimation and a Whiskers plot. Women born during the second through the fourth decade of the 20th century showed increasing mean values of age at menarche from 15.4 (second decade) up to 16.5 (fourth decade) and after that a decrease of the mean values to 14.0 (ninth decade). The mean values of menopausal age increased from 47.0 (women born from 1920 to 1925) to 49.3 (born from 1945 to 1950). Age at first marriage showed a trend of decreasing age. Our study demonstrated secular trends of age at menarche in Chuvashian women who had matured after World War II and also confirmed secular trends of increased age at menopause and the duration of the reproductive period. Women, whose maturation was during or immediately after World War II, showed a higher age at menarche and a higher dispersion of age at menopause.     

Translation and validation of the Hindi version of the Geriatric Oral Health Assessment Index

doi: 10.1111/j.1741‐2358.2011.00609.x Translation and validation of the Hindi version of the Geriatric Oral Health Assessment Index Purpose: To translate the original English version of the Geriatric Oral Health Assessment Index (GOHAI) into Hindi and assess its validity and reliability for use among people in India. Materials and Method: After translation into Hindi, a total of 385 participants aged 55+ demonstrated acceptable validity and reliability when used for people in India. Individual GOHAI items were recorded and summed as originally recommended. The questionnaire sought information about socio‐demographic characteristics and self‐reported perception of general and oral health. Clinical examination included assessment of periodontal status and number of decayed teeth, missing teeth, filled teeth and crowned teeth. Result: Mean GOHAI score was 40.9 (SD, 10.6; range, 12–60). Cronbach’s alpha for the GOHAI score was 0.88, indicating a high degree of internal consistency and homogeneity between the GOHAI items. The test–retest correlation coefficient for add‐GOHAI scores was 0.72, indicating good stability. Add‐GOHAI scores increased with poorer perceived general and oral health. Convergent validity, construct validity and discriminant validity of the GOHAI were demonstrated. Conclusion: It could therefore be used as a valuable instrument for measuring oral health–related quality of life for people in this region.     

Differences in daily energy expenditure in lean and obese women: the role of posture allocation

Objective: A low resting metabolic rate (RMR) is considered a risk factor for weight gain and obesity; however, due to the greater fat‐free mass (FFM) found in obesity, detecting an impairment in RMR is difficult. The purposes of this study were to determine the RMR in lean and obese women controlling for FFM and investigate activity energy expenditure (AEE) and daily activity patterns in the two groups. Methods and Procedures: Twenty healthy, non‐smoking, pre‐menopausal women (10 lean and 10 obese) participated in this 14‐day observational study on free‐living energy balance. RMR was measured by indirect calorimetry; AEE and total energy expenditure (TEE) were calculated using doubly labeled water (DLW), and activity patterns were investigated using monitors. Body composition including FFM and fat mass (FM) was measured by dual energy X‐ray absorptiometry (DXA). Results: RMR was similar in the obese vs. lean women (1601 ± 109 vs. 1505 ± 109 kcal/day, respectively, P = 0.12, adjusting for FFM and FM). Obese women sat 2.5 h more each day (12.7 ± 3.2 h vs. 10.1 ± 2.0 h, P < 0.05), stood 2 h less (2.7 ± 1.0 h vs. 4.7 ± 2.2 h, P = 0.02) and spent half as much time in activity than lean women (2.6 ± 1.5 h vs. 5.4 ± 1.9 h, P = 0.002). Discussion: RMR was not lower in the obese women; however, they were more sedentary and expended less energy in activity than the lean women. If the obese women adopted the activity patterns of the lean women, including a modification of posture allocation, an additional 300 kcal could be expended every day.     

Daily variation of oral malodour and related factors in community-dwelling elderly Thai

doi: 10.1111/j.1741‐2358.2011.00593.x Daily variation of oral malodour and related factors in community‐dwelling elderly Thai Objectives: The purposes of this study were (i) to estimate the prevalence of oral malodour, (ii) to evaluate the daily variation of oral malodour and (iii) to assess associations of volatile sulphur compound (VSC) concentrations with socio‐demographics, health behaviours and oral health status in community‐dwelling elderly Thai. Methods: The subjects were 428 dentate elderly people (67.6 ± 5.6 years) living in Phitsaulok, Thailand. Information on their socio‐demographics, general health and health behaviours was obtained by a questionnaire. Their dental condition, periodontal status and tongue coating were clinically examined. Their flow rates and the pH of unstimulated saliva were also assessed. Oral malodour was measured at four different times of day using an Oral Chroma?. Results: The proportions of subjects diagnosed with oral malodour using the thresholds of H₂S, CH₃SH and (CH₃)₂S were 60.5%, 62.9% and 80.7%, respectively. Concentrations of H₂S showed significant daily variation. Linear regression analysis demonstrated the following significant associations: (i) oral malodour from H₂S and thickness of the tongue coating, (ii) oral malodour from CH₃SH and periodontal pocket depth of 5 mm or more and the presence of gingival bleeding and (iii) oral malodour from (CH₃)₂S and systemic disease, medications and thickness of the tongue coating. Discussion: Oral malodour was shown to be prevalent among the elderly. Daily variation was observed in the concentration of H₂S. Tongue coating, periodontal disease, systemic diseases and medications were related to oral malodour. Therefore, these factors should be taken into consideration in oral malodour treatment and prevention programmes for the elderly.     

Pre‐ to Postoperative Physical Activity Changes in Bariatric Surgery Patients: Self Report vs. Objective Measures

Bariatric surgery patients report significant pre‐ to postoperative increases in physical activity (PA). However, it is unclear whether objective measures would corroborate these changes. The present study compared self‐reported and accelerometer‐based estimates of changes in moderate‐to‐vigorous intensity PA (MVPA) from pre‐ (pre‐op) to 6 months postsurgery (post‐op). Twenty bariatric surgery (65% laparoscopic‐adjustable gastric banding, 35% gastric bypass) patients (46.2 ± 9.8 years, 88% female, pre‐op BMI = 50.8 ± 9.7 kg/m²) wore RT3 accelerometers as an objective measure of MVPA and completed the Paffenbarger Physical Activity Questionnaire (PPAQ) as a subjective measure before and 6 months after bariatric surgery. Time (min/week) spent in MVPA was calculated for the PPAQ and RT3 (≥1‐min and ≥10‐min bouts) at pre‐op and post‐op. Self‐reported MVPA increased fivefold from pre‐op to post‐op (44.6 ± 80.8 to 212.3 ± 212.4 min/week; P < 0.005). By contrast, the RT3 showed nonsignificant decreases in MVPA for both ≥1‐min (186.0 ± 169.0 to 151.2 ± 118.3 min/week) and ≥10‐min (41.3 ± 109.3 to 39.8 ± 71.3 min/week) bouts. At pre‐op, the percentage of participants who accumulated ≥150‐min/week of MVPA in bouts ≥10‐min according to the PPAQ and RT3 was identical (10%). However, at post‐op, 55% of participants reported compliance with the recommendation compared to 5% based on RT3 measurement (P = 0.002). Objectively‐measured changes in MVPA from pre‐op to 6 months post‐op appear to be much smaller than self‐reported changes. Further research involving larger samples is needed to confirm these findings and to determine whether self‐report and objective PA measures are differentially associated with surgical weight loss outcomes.     

Hip Fracture Incidence in Relation to Age,Menopausal Status,and Age at Menopause: Prospective Analysis

Background

Bone mineral density is known to decrease rapidly after the menopause. There is limited evidence about the separate contributions of a woman''s age, menopausal status and age at menopause to the incidence of hip fracture.

Methods and Findings

Over one million middle-aged women joined the UK Million Women Study in 1996–2001 providing information on their menopausal status, age at menopause, and other factors, which was updated, where possible, 3 y later. All women were registered with the UK National Health Service (NHS) and were routinely linked to information on cause-specific admissions to NHS hospitals. 561,609 women who had never used hormone replacement therapy and who provided complete information on menopausal variables (at baseline 25% were pre/perimenopausal and 75% postmenopausal) were followed up for a total of 3.4 million woman-years (an average 6.2 y per woman). During follow-up 1,676 (0.3%) were admitted to hospital with a first incident hip fracture. Among women aged 50–54 y the relative risk (RR) of hip fracture risk was significantly higher in postmenopausal than premenopausal women (adjusted RR 2.22, 95% confidence interval [CI] 1.22–4.04; p = 0.009); there were too few premenopausal women aged 55 y and over for valid comparisons. Among postmenopausal women, hip fracture incidence increased steeply with age (p<0.001), with rates being about seven times higher at age 70–74 y than at 50–54 y (incidence rates of 0.82 versus 0.11 per 100 women over 5 y). Among postmenopausal women of a given age there was no significant difference in hip fracture incidence between women whose menopause was due to bilateral oophorectomy compared to a natural menopause (adjusted RR 1.20, 95% CI 0.94–1.55; p = 0.15), and age at menopause had little, if any, effect on hip fracture incidence.

Conclusions

At around the time of the menopause, hip fracture incidence is about twice as high in postmenopausal than in premenopausal women, but this effect is short lived. Among postmenopausal women, age is by far the main determinant of hip fracture incidence and, for women of a given age, their age at menopause has, at most, a weak additional effect. Please see later in the article for the Editors'' Summary