320 Obstetrics and Gynecology Board Review •••
❍ What effect does estrogen have on body fat distribution?
It prevents the tendency to increase central body fat with aging.
❍ What is the relationship between truncal adiposity and coronary heart disease?
An increased waist to hip circumference ratio is associated with an increased risk of coronary heart disease. Truncal
adiposity is associated with an androgenic state, hypertension, insulin resistance, hyperinsulinemia, and an
atherogenic lipid profile, all risk factors for coronary heart disease.
❍ What lipid profiles are correlated with women who have a central body fat distribution?
Positive correlation with increases in total cholesterol, triglycerides, and LDL and negatively correlated with HDL.
❍ What effect does oral estrogen have on diabetes?
The Nurses Health Study documented a 20% decreased risk of noninsulin dependent diabetes in current users
of estrogen.
❍ Does postmenopausal estrogen replacement therapy adversely affect hypertension?
No.
❍ What did the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial demonstrate regarding
hormone replacement therapy (HRT) and cardiovascular disease risk factors?
Estrogen as well as estrogen progestin combinations had a favorable impact on cardiovascular risk factors, an
increase in HDL, a decrease in LDL, as well as prevention of the age-related increase in fibrinogen.
❍ In the PEPI trial, which progesterone combined with conjugated equine estrogen had the most favorable
effect on HDL?
Cyclic micronized progesterone resulted in a significantly greater increase in HDL than either sequential or cyclic
medroxyprogesterone acetate.
❍ What did the Women’s Health Initiative (WHI) show regarding cardiovascular risk of HRT?
An increase in coronary events with Prempro and no significant difference with Premarin.
OSTEOPOROSIS
❍ What is osteoporosis?
A progressive, systemic skeletal disease characterized by low bone density and microarchitectural deterioration of
bone tissue, leading to an increase in bone fragility and susceptibility to fracture (World Health Organization).
❍ In what type of bone is resorption more prevalent?
Trabecular bone, which is the predominant type of bone in the spine, because it is most sensitive to changes in
estrogen levels.
❍ What is the role of osteoclasts?
They absorb and remove osseous tissue, forming lacuna.