Vitamin D supplementation effects with or without calcium in pregnancy for reducing risk of preeclampsia and gestational or pregnancy induced hypertension are controversial. Literature was systematically searched in Medline, Scopus and Cochrane databases from inception to July 2017. Only randomized controlled trials (RCTs) in English were selected if they had any pair of interventions (calcium, vitamin D, both, or placebo). Systematic review with two-step network-meta-analysis was used to indirectly estimate supplementary effects. Twenty-seven RCTs with 28,000 women were eligible. A direct meta-analysis suggested that calcium, vitamin D, and calcium plus vitamin D could lower risk of preeclampsia when compared to placebo with the pooled risk ratios (RRs) of 0.54 (0.41, 0.70), 0.47 (0.24, 0.89) and 0.50 (0.32, 0.78), respectively. Results of network meta-analysis were similar with the corresponding RRs of 0.49 (0.35, 0.69), 0.43 (0.17, 1.11), and 0.57 (0.30, 1.10), respectively. None of the controls were significant. Efficacy of supplementation, which was ranked by surface under cumulative ranking probabilities, were: vitamin D (47.4%), calcium (31.6%) and calcium plus vitamin D (19.6%), respectively. Calcium supplementation may be used for prevention for preeclampsia. Vitamin D might also worked well but further large scale RCTs are warranted to confirm our findings.

Vitamin E is a strong anti-oxidative stress agent that affects the bone remodeling process. This study evaluates the effect of mixed-tocopherol supplements on bone remodeling in postmenopausal osteopenic women. A double-blinded, randomized, placebo-controlled trial study was designed to measure the effect of mixed-tocopherol on the bone turnover marker after 12 weeks of supplementation. All 52 osteopenic postmenopausal women were enrolled and allocated into two groups. The intervention group received mixed-tocopherol 400 IU/day, while the control group received placebo tablets. Fifty-two participants completed 12 weeks of follow-up. Under an intention-to-treat analysis, vitamin E produced a significant difference in the mean bone resorption marker (serum C-terminal telopeptide of type I collagen (CTX)) compared with the placebo group (−0.003 ± 0.09 and 0.121 ± 0.15, respectively (p < 0.001)). In the placebo group, the CTX had increased by 35.3% at 12 weeks of supplementation versus baseline (p < 0.001), while, in the vitamin E group, there was no significant change of bone resorption marker (p < 0.898). In conclusion, vitamin E (mixed-tocopherol) supplementation in postmenopausal osteopenic women may have a preventive effect on bone loss through anti-resorptive activity.

Probiotics have been found to have beneficial effects on bone metabolism. In this randomized, double-blind, placebo-controlled trial, the effects of multispecies probiotic supplementation on bone turnover markers were evaluated after 12 weeks. Forty postmenopausal women with osteopenia were included and randomly divided into two groups. The intervention group received multispecies probiotics, while the control group received identical placebo sachets daily. The baseline characteristics of both groups were similar. Still, the median serum bone resorption marker C-terminal telopeptide of type I collagen (CTX) was slightly higher in the multispecies probiotic group than in the placebo group (0.35 (0.12, 0.53) vs. 0.16 (0.06, 0.75); p-value = 0.004). After 12 weeks, the mean difference in serum CTX at baseline versus 12 weeks was significantly different between the multispecies probiotic and placebo groups (−0.06 (−0.29, 0.05) vs. 0.04 (−0.45, 0.67); p-value < 0.001). The multispecies probiotic group showed a significant decrease in serum CTX at 12 weeks compared with baseline (p-value 0.026). However, the placebo group showed no significant change in serum CTX (p-value 0.18). In conclusion, multispecies probiotics may have a preventive effect on bone through their antiresorptive effect in osteopenic postmenopausal women.

Polycystic ovarian syndrome (PCOS) is a common and complex condition characterized by endocrine features and influenced by genetic and environmental factors. In Southeast Asia and Thailand, the prevalence of PCOS is unknown. The aim of this study was to estimate the prevalence of and determine factors associated with PCOS in Thai adolescents. We administered a validated questionnaire to 600 university female participants aged 17–19 years from Mahidol University in Bangkok. Of these, 548 (91.33%) responded and agreed to participate. Two-hundred and seventy-nine girls (50.91%) were identified as likely having PCOS and defined as ‘probable cases’. Of those 279 participants, 248 (88.88%) were evaluated further for PCOS using the Rotterdam criteria. A complete history was taken, and a physical examination including trans-abdominal ultrasound was performed. Blood chemistry tests were performed to exclude similar conditions and to investigate potential co-morbidities. The prevalence of PCOS in Thai adolescents was found to be 5.29%. After multivariate analyses, moderate acne was the strongest risk factor for PCOS. The odd ratios (95% confidence interval) for the presence of mild acne, moderate acne, and oligo- or amenorrhea in participants with PCOS were 2.83 (1.01–7.90; p = .47), 31.69 (10.07–99.67; p < .001), and 5.89 (2.42–14.37; p < .001), respectively.

The effects of oral vitamin D supplements on vaginal health in postmenopausal women with vulvovaginal atrophy (VVA) was evaluated. A double-blinded, randomized placebo-controlled trial was conducted for 12 weeks to investigate changes on vaginal maturation index (VMI), vaginal pH, and the visual analog scale (VAS) of VVA symptoms. The vitamin D group received oral ergocalciferol, at 40,000 IU per week, while the placebo group received an identical placebo capsule. Eighty postmenopausal women were enrolled. There were no significant differences in baseline characteristics between both groups. In an intention-to-treat analysis, VMI, vaginal pH, and VAS of VVA symptoms showed no significant differences between both groups at the six and 12 weeks. However, the mean difference of VMI in the vitamin D group between baseline and at six weeks showed significant improvement (5.5 + 16.27, p <0.05). Moreover, the mean vaginal pH and VAS of VVA patients in the vitamin D group were significantly improved at both six and 12 weeks compared to baseline. The oral vitamin D supplementation for 12 weeks potentially improves vaginal health outcomes in postmenopausal women with VVA symptoms, demonstrated by the improved mean VMI, vaginal pH, and VAS at six and 12 weeks between baseline, however, no significant differences were observed from the placebo treatment.

Summary: The cross-sectional study of postmenopausal Thai women discovered a strong association between both sarcopenia and sarcopenic obesity and osteoporosis. The risk of sarcopenic obesity was found to increase with poor nutritional status, while a history of menopausal hormone therapy was shown to offer protection. Purpose: The study aims to investigate the association between sarcopenic obesity and osteoporosis in postmenopausal women and to identify risk factors for sarcopenic obesity. Methods: Our comprehensive cross-sectional study involved 248 Thai postmenopausal women aged 45-80. Osteoporosis was defined as a bone mineral density (BMD) T-score of less than −2.5 at the lumbar spine, total hip, or femoral neck, as measured by dual-energy X-ray absorptiometry (DXA). Sarcopenic obesity is defined as the co-existence of obesity and sarcopenia according to the criteria established by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). Sarcopenia was defined as skeletal muscle mass adjusted by weight (SMM/W) <35.6%, assessed via Bioelectrical Impedance Analysis (BIA), and compromised muscle function, which includes low hand grip strength (41%, a body mass index (BMI) ≥25 kg/m ² , or a waist circumference ≥80 cm. Moreover, a questionnaire of baseline characteristics and the factor associated with sarcopenic obesity was collected, including age, years since menopause, history of menopausal hormone therapy, underlying diseases, medications, nutritional status assessed by the Mini Nutritional Assessment (MNA), and physical activity assessed by The Global Physical Activity Questionnaire (GPAQ). Univariate and multiple logistic regression analyses were used to examine the associated factors with sarcopenic obesity. Results: The prevalence of sarcopenic obesity was 13.3%, and sarcopenia was present in 28.63%, while osteoporosis affected 39.91% of the participants. Sarcopenia and sarcopenic obesity were significantly associated with osteoporosis (odds ratio (OR) 3.05; 95% CI, 1.69-5.49; p < 0.05 and OR 2.65; 95% CI, 1.23-5.68; p < 0.05, respectively). In univariate and stepwise logistic regression analyses, a lower MNA score was significantly associated with an increased risk of sarcopenic obesity. Specifically, participants with an MNA score of 8–11 had an OR of 2.26; 95% CI,1.04-4.92; p < 0.04, while those with a score <8 exhibited a markedly elevated risk (OR 25.6; 95% CI, 1.04–4.92; p < 0.05). Conversely, the use of menopausal hormone therapy (MHT) was identified as a significant protective factor against sarcopenic obesity (OR 0.29; 95% CI, 0.10–0.79; p < 0.05). Conclusion: Both sarcopenia and sarcopenic obesity are linked to osteoporosis. Menopausal hormone therapy and nutritional status are significantly associated with sarcopenic obesity in postmenopausal women.