A1 Journal article (refereed)
Muscle and bone mass in middle‐aged women : role of menopausal status and physical activity (2020)

Sipilä, S., Törmäkangas, T., Sillanpää, E., Aukee, P., Kujala, U. M., Kovanen, V., & Laakkonen, E. K. (2020). Muscle and bone mass in middle‐aged women : role of menopausal status and physical activity. Journal of Cachexia, Sarcopenia and Muscle, 11(3), 698-709. https://doi.org/10.1002/jcsm.12547

JYU authors or editors

Sipilä, Sarianna
Törmäkangas, Timo
Sillanpää, Elina
Kujala, Urho
Kovanen, Vuokko
Laakkonen, Eija

Publication details

All authors or editors: Sipilä, Sarianna; Törmäkangas, Timo; Sillanpää, Elina; Aukee, Pauliina; Kujala, Urho M.; Kovanen, Vuokko; Laakkonen, Eija K.

Journal or series: Journal of Cachexia, Sarcopenia and Muscle

ISSN: 2190-5991

eISSN: 2190-6009

Publication year: 2020

Volume: 11

Issue number: 3

Pages range: 698-709

Publisher: Wiley-VCH Verlag

Publication country: Germany

Publication language: English

DOI: https://doi.org/10.1002/jcsm.12547

Publication open access: Openly available

Publication channel open access: Open Access channel

Publication is parallel published (JYX): https://jyx.jyu.fi/handle/123456789/67742

Abstract

Background. 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.
Methods. 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 folliclestimulating 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/height2 ) 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.
Results. 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).
Conclusions. 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.

Keywords: muscle mass; muscular atrophies; bone; osteoporosis; middle age; menopause; women; sex hormones