Hormone Therapy for Aging Women: Focus on Skeleton and Sleep

Symposium held October 2010 at the American Society for Reproductive Medicine Annual Meeting in Denver, Colorado. Supported by an educational grant from Abbott Laboratories.

Faculty

	Lubna Pal, MBBS, MRCOG, MS Associate Professor Yale University School of Medicine New Haven, Connecticut
	Hadine Joffe, MD, MSc Associate Professor of Psychiatry Harvard Medical School Director of Research Center for Women’s Mental Health Department of Psychiatry Massachusetts General Hospital Boston, Massachusetts
	Ann E. Kearns, MD, PhD Assistant Professor of Medicine Division of Endocrinology Mayo Clinic Rochester, Minnesota

NEEDS ASSESSMENT
Aging is accompanied by bodily changes that seemingly result from gradually declining levels of numerous hormones, including sex steroids, growth hormone, adrenal steroids, and insulin-like growth factor. Alterations in the metabolic milieu accompany the changing hormonal profile of aging. Sex steroids play a pivotal role in maintaining female physiology, sex organs, and bones, and they are also relevant to brain physiology.

Common menopausal symptoms, such as hot flushes, night sweats, and dyspareunia related to vaginal atrophy, occur relatively early in the process of reproductive senescence. These symptoms are associated with a decline in reproductive hormones and respond to menopausal hormone therapy. Disordered sleep, depression, and osteoporosis are relatively covert entities that are also associated with age-related changes in reproductive hormones; they are further impacted by processes of chronologic aging.

In recent years, hormonal and nonhormonal treatment strategies for osteoporosis have given clinicians increasing flexibility in providing individualized management for prevention of fragility fractures. An overall deterioration in quality of life is commonly described in the context of aging, and loss of ovarian function is suggested as contributory to underlying processes that remain poorly understood. Sleep disturbances are increasingly appreciated in the context of aging in general—and menopause in particular—and are recognized to partly contribute to the decline in quality of life in aging populations.

LEARNING OBJECTIVES
At the completion of this activity, participants should be better able to:

1. Discuss the relevance of estrogen and progesterone for the sleep-wake physiology of the brain and for the bones.
   
2. Differentiate between preventive versus therapeutic strategies for skeletal health, identify the spectrum of therapeutic options available to minimize fragility fractures in aging women, and be able to select the optimal therapy for an individual patient.
   
3. Summarize the importance of sleep hygiene for overall well-being in the aging population, and appreciate the relevance of sleep history in routine clinical assessment.
   
4. Identify therapeutic options and strategies that may facilitate improved sleep in symptomatic women.
   

TARGET AUDIENCE
This activity is designed to meet the educational needs of physicians and allied health professionals who care for aging female patients.

ACGME COMPETENCIES
Medical Knowledge
Patient Care

ACCREDITATION STATEMENT
The American Society for Reproductive Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The American Society for Reproductive Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: February 23, 2011
Expiration date: August 23, 2011
Estimated time to complete activity: 1.0 hour

SUCCESSFUL COMPLETION REQUIREMENTS
Successful completion of this educational activity requires the learner to:

• View a course overview page, containing all CME and disclosure information, including acknowledgement of commercial support and disclosure of unlabeled use, prior to the start of the activity.
• Complete a 10-question pretest prior to the module.
• Be given the option of downloading a printed syllabus containing the transcript of the Webcast.
• Participate in the interactive activity by viewing/listening to the Webcast.
• Complete a 10-question post-test, with feedback of correct/incorrect answers, scoring a minimum of 70% in two attempts.
• Complete the evaluation.
• Print certificate of completion.

DISCLOSURE POLICY
All speakers were required to complete a disclosure of commercial and financial relationships with manufacturers of pharmaceuticals, laboratory supplies, or medical devices and with commercial providers of medically related services.These disclosures were reviewed and potential conflicts of interest resolved by the Subcommittee on Standards of Commercial Support of the Continuing Medical Education Committee of the American Society for Reproductive Medicine.

DISCLOSURES
Lubna Pal, MBBS, MRCOG, MS, reports nothing to disclose.
Hadine Joffe, MD, MSc, reports that she has received grant support from Bayer HealthCare Pharmaceuticals; Forest Laboratories, Inc; and GlaxoSmithKline; and has served as a consultant for Sanofi-Aventis and Pfizer.
Ann E. Kearns, MD, PhD, reports nothing to disclose.
Andrew R. La Barbera, PhD, HCLD, Scientific Director of the American Society for Reproductive Medicine, reports nothing to disclose.
Nancy A. Bowers, BSN, RN, MPH, Education Specialist for the American Society for Reproductive Medicine, reports nothing to disclose.

DISCLOSURE OF UNLABELED USE
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration.

DISCLAIMER STATEMENT
The content and views presented in this educational activity are those of the faculty/authors and do not necessarily reflect those of the American Society for Reproductive Medicine. This material was prepared based on a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, health care professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information contained within this educational activity to make clinical decisions about individual patients.

COMMERCIAL SUPPORT
This activity is supported by an educational grant from Abbott Laboratories.

Click here to take the CME pretest.

Click here to skip the pretest and view the Webcast (non-CME credit).

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