Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
Department of Obstetrics and Gynecology, Pelvic Floor Research and Therapy Unit, Central Finland Central Hospital, Jyväskylä, Finland.
J Cachexia Sarcopenia Muscle. 2020 Jun;11(3):698-709. doi: 10.1002/jcsm.12547. Epub 2020 Feb 3.
Women experience drastic hormonal changes during midlife due to the menopausal transition. Menopausal hormonal changes are known to lead to bone loss and potentially also to loss of lean mass. The loss of muscle and bone tissue coincide due to the functional relationship and interaction between these tissues. If and how physical activity counteracts deterioration in muscle and bone during the menopausal transition remains partly unresolved. This study investigated differences between premenopausal, early perimenopausal, late perimenopausal, and postmenopausal women in appendicular lean mass (ALM), appendicular lean mass index (ALMI), femoral neck bone mineral density (BMD) and T score. Furthermore, we investigated the simultaneous associations of ALM and BMD with physical activity in the above-mentioned menopausal groups.
Data from the Estrogen Regulation of Muscle Apoptosis study were utilized. In total, 1393 women aged 47-55 years were assigned to premenopausal, early perimenopausal, late perimenopausal, and postmenopausal groups based on follicle-stimulating hormone concentration and bleeding diaries. Of them, 897 were scanned for ALM and femoral neck BMD by dual-energy X-ray absorptiometry and ALMI (ALM/height ) and neck T scores calculated. Current level of leisure-time physical activity was estimated by a validated self-report questionnaire and categorized as sedentary, low, medium, and high.
Appendicular lean mass, appendicular lean mass index, femoral neck bone mineral density, and and T score showed a significant linear declining trend across all four menopausal groups. Compared with the postmenopausal women, the premenopausal women showed greater ALM (18.2, SD 2.2 vs. 17.8, SD 2.1, P < 0.001), ALMI (6.73, SD 0.64 vs. 6.52, SD 0.62, P < 0.001), neck BMD (0.969, SD 0.117 vs. 0.925, SD 0.108, P < 0.001), and T score (-0.093, SD 0.977 vs -0.459, SD 0.902, P < 0.001). After adjusting for potential confounding pathways, a higher level of physical activity was associated with greater ALM among the premenopausal [β = 0.171; confidence interval (CI) 95% 0.063-0.280], late perimenopausal (β = 0.289; CI 95% 0.174-0.403), and postmenopausal (β=0.278; CI 95% 0.179-0.376) women. The positive association between femoral neck BMD and level of physical activity was significant only among the late perimenopausal women (β = 0.227; CI 95% 0.097-0.356).
Skeletal muscle and bone losses were associated with the menopausal transition. A higher level of physical activity during the different menopausal phases was beneficial, especially for skeletal muscle. Menopause-related hormonal changes predispose women to sarcopenia and osteoporosis and further to mobility disability and fall-related fractures in later life. New strategies are needed to promote physical activity among middle-aged women. Longitudinal studies are needed to confirm these results.
女性在更年期过渡期间经历剧烈的荷尔蒙变化。已知更年期荷尔蒙变化会导致骨质流失，并且可能还会导致瘦体重流失。由于这些组织之间的功能关系和相互作用，肌肉和骨骼组织同时发生损失。在更年期过渡期间，身体活动是否以及如何抵消肌肉和骨骼的恶化仍然部分未解决。本研究调查了绝经前、早期围绝经期、晚期围绝经期和绝经后妇女的四肢瘦体重（ALM）、四肢瘦体重指数（ALMI）、股骨颈骨矿物质密度（BMD）和 T 评分之间的差异。此外，我们还调查了上述绝经组中 ALM 和 BMD 与身体活动的同时关联。
利用雌激素调节肌肉凋亡研究的数据。共有 1393 名年龄在 47-55 岁的女性根据卵泡刺激素浓度和出血日记被分配到绝经前、早期围绝经期、晚期围绝经期和绝经后组。其中，897 名女性接受了双能 X 射线吸收法的四肢瘦体重和股骨颈 BMD 扫描，并计算了四肢瘦体重指数（ALM/身高）和颈部 T 评分。当前的休闲时间体力活动水平通过经过验证的自我报告问卷进行评估，并分为久坐、低、中、高。
在所有四个绝经组中，四肢瘦体重、四肢瘦体重指数、股骨颈骨矿物质密度和 T 评分均呈明显线性下降趋势。与绝经后女性相比，绝经前女性的 ALM（18.2，SD 2.2 与 17.8，SD 2.1，P <0.001）、ALMI（6.73，SD 0.64 与 6.52，SD 0.62，P <0.001）、颈部 BMD（0.969，SD 0.117 与 0.925，SD 0.108，P <0.001）和 T 评分（-0.093，SD 0.977 与-0.459，SD 0.902，P <0.001）更高。在调整了潜在的混杂途径后，较高水平的体力活动与绝经前（β=0.171；95%置信区间[CI] 95% 0.063-0.280）、晚期围绝经期（β=0.289；95% CI 95% 0.174-0.403）和绝经后（β=0.278；95% CI 95% 0.179-0.376）女性的 ALM 增加相关。仅在晚期围绝经期女性中，股骨颈 BMD 与体力活动水平之间的正相关具有统计学意义（β=0.227；95% CI 95% 0.097-0.356）。
骨骼肌肉和骨丢失与更年期过渡有关。在不同的更年期阶段，更高水平的体力活动是有益的，尤其是对骨骼肌肉。与更年期相关的荷尔蒙变化使女性易患肌肉减少症和骨质疏松症，并进一步导致以后生活中的行动能力丧失和与跌倒相关的骨折。需要新的策略来促进中年女性的身体活动。需要进行纵向研究来证实这些结果。
