To assess standard dose hormone therapy (HT) and bone mass in premature ovarian insufficiency (POI), 239 women with POI, 132 using standard estrogen dose HT and 107 women without HT, were evaluated. All underwent bone mineral density (BMD) evaluation in the lumbar spine (LS) and total femur (TF). Mean age, age at last period and body mass index (BMI) for the untreated and for the HT groups were 38.1 ± 6.1 and 36.8 ± 7.3 years; 31.4 ± 7.3 and 30.7 ± 7.2 years; 26.6 ± 7.1 and 25.8 ± 4.6 kg/m, respectively, (p=NS). The women taking standard dose HT started treatment at the age of 33.8 ± 6.3 years and had been on hormone treatment for 3 years at the time of the bone densitometry examination. The BMD in LS was 1.06 ± 0.15 and 1.00 ± 0.17 g/cm (p = 0.003); the BMD in TF was 0.92 ± 0.19 and 0.91 ± 0.13 g/cm (p = 0.039), respectively, for the untreated and HT groups. A 45% altered BMD (osteopenia/osteoporosis) in LS was verified in women without treatment and 60.1% in those using the standard dose TH (p = 0.01). The BMD in TF was altered in 32.3% in those without HT and 36.4% in the HT users (p = 0.34). In conclusion, standard dose HT was not adequate to reduce impaired bone mass in the spine and femur of women with POI.

Although women with primary ovarian insufficiency who are receiving estrogen + progestogen therapy maintain stable bone mass throughout an 8-year follow-up period, this treatment is not sufficient to decrease the number of women who experience some level of low bone density. Therapeutic regimens should be reviewed, probably with resumption of discussions about the need for other therapeutic strategies.

Premature ovarian insufficiency has the following causes: genetic, autoimmune, metabolic, infectious, and iatrogenic dysfunctions (including radiotherapy, chemotherapy and surgery). However, premature ovarian insufficiency remains without a definite cause in a substantial number of cases. This article describes GAPO syndrome in association with premature ovarian insufficiency, as well as a novel ANTXR1 gene mutation. Histopathological study of the ovaries of a woman with hypergonadotropic hypogonadism revealed extensive deposition of hyaline extracellular material, with bilateral parenchymal atrophy and follicular depletion. Molecular study revealed a novel ANTXR1 gene mutation. The homozygous c.378 + 3A > G transition at the consensus donor splice site of intron 4 was identified. Our results support the involvement of ANTRX1 gene mutations in deregulated extracellular matrix. In addition, our study identified a novel ANTXR1 mutation causing GAPO syndrome, indicating it as a new cause of early loss of ovarian function.

É crescente o número de pacientes que procuram o cirurgião-dentista em busca de tratamentos estéticos que harmonizem seu sorriso. Com o avanço dos sistemas cerâmicos e adesivos e das técnicas minimamente invasivas, é possível obter excelentes resultados na Odontologia restauradora. Os laminados cerâmicos são indicados para modificação da anatomia e da cor dos dentes e, quando associados às técnicas de cirurgia plástica gengival, podem resultar em um sorriso harmônico e belo. A indicação, sucesso e longevidade de tais procedimentos, entretanto, exigem um correto diagnóstico e minucioso planejamento multidisciplinar. O presente artigo tem o objetivo de apresentar um caso clínico de reabilitação em dentes anteriores, envolvendo cirurgia estética gengival e laminados cerâmicos, relatando as indicações e as técnicas dos procedimentos realizados, com acompanhamento de 24 meses.