Elsevier

Maturitas

Volume 68, Issue 4, April 2011, Pages 331-336
Maturitas

Review
Menopause and sarcopenia: A potential role for sex hormones

https://doi.org/10.1016/j.maturitas.2011.01.014Get rights and content

Abstract

Menopause is associated with a decline in estrogen levels, which could lead to an increase in visceral adiposity as well as a decrease in bone density, muscle mass and muscle strength. This decline in muscle mass, known as sarcopenia, is frequently observed in postmenopausal women. Potential causes of sarcopenia include age-related changes in the hormonal status, low levels of physical activity, reduced protein intake and increased oxidative stress. However, the role of sex hormones, specifically estrogens, on the onset of sarcopenia is controversial. Preventing sarcopenia and preserving muscle strength are highly relevant in order to prevent functional impairment and physical disability. To date, resistance training has been shown to be effective in attenuating age-related muscle loss and strength. However, results on the effect of hormonal supplementation to treat or prevent sarcopenia are contradictory. Further research is needed to identify other potential mechanisms of sarcopenia as well as effective interventions for the prevention and treatment of sarcopenia. Therefore, the purpose of this review will be to examine the role of sex hormonal status in the development of sarcopenia. We will also overview the physical as well as metabolic consequences of sarcopenia and the efficiency of different interventions for the prevention and treatment of sarcopenia.

Introduction

It is well known that menopause is characterized by important changes in hormonal status and that these changes have an important effect on bone mass density and body fat distribution [1]. In addition, a good body of evidence supports the hypothesis that the decline in estrogen levels with menopause may play a role in muscle mass loss in postmenopausal women [2]. The term that is widely used to describe the normal age-related loss in muscle mass is sarcopenia. Functional impairment and physical disability are the major consequences of sarcopenia and are associated with increased healthcare expenditures [3]. Indeed, it is estimated that the consequences of sarcopenia are responsible for approximately $18 billion in direct healthcare costs in the US annually [4]. Considering that the number of older adults is expected to double over the next 25 years, sarcopenia has become an important clinical research topic. Therefore, investigating the mechanisms underlying this condition and developing efficient interventions for the prevention and treatment of sarcopenia may be of great interest for health care professionals. In this review, we will (1) summarize the hormonal changes associated with menopause; (2) examine the role of sex hormones with regards to sarcopenia; (3) discuss the physical and metabolic consequences of sarcopenia and (4) address the potential effect of hormone replacement therapy and phytoestrogens supplementation combined or not with exercise training on muscle mass.

Section snippets

Menopause

Menopause is defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity and marks the end of natural female reproductive life. Menopause is preceded by a period of menstrual cycle irregularity, known as the menopause transition or peri-menopause, which usually begins in the mid-40s. The menopause transition is characterized by many hormonal changes predominantly caused by a marked decline in the ovarian follicle numbers [5]. A significant decrease

Definition of sarcopenia

Sarcopenia refers to the loss of muscle mass associated with normal aging [8]. However, over the past decade, sarcopenia has often been defined as the age-related loss in muscle mass and muscle strength, which implies that these are causally linked and that changes in muscle mass are directly and fully responsible for changes in muscle strength. However, this concept has been challenged since it has been shown that age-associated changes in muscle mass explained less than 5% of the variance in

Changes in muscle morphology with sarcopenia

All skeletal muscles are composed of motor units and each motor unit contains a motor neuron and muscle fibers. Motor units can be differentiated in two main types based on the fiber type present in the motor unit. Slow motor units are mainly composed of type I fibers while fast motor units predominantly consist of type II fibers [15]. The decrease in muscle mass with aging results from loss of both slow and fast motor units, with an accelerated loss of fast motor units [16]. Moreover, there

Epidemiology of sarcopenia

The prevalence of sarcopenia highly depends on the criteria used to identify sarcopenic individuals. To our knowledge, only one study investigated the prevalence of sarcopenia in a representative sample of men and women aged 18–80 years old [12]. Indeed, Janssen al. [12] observed that the prevalence of class I and class II sarcopenia increased from the third to sixth decade and remained relatively constant thereafter. In addition, it was reported that the prevalence of class I and class II

Role of menopause associated with hormonal changes

It has been hypothesized that menopause transition and the subsequent decline in estrogen may play a role in muscle mass loss [23], [24], [25], [26]. That is, van Geel et al. [27] reported a positive relationship between lean body mass and estrogen levels. Similarly, Iannuzzi-Sucich et al. [28] observed that muscle mass is correlated significantly with plasma estrone and estradiol levels in women. However, Baumgartner et al. [29] reported that estrogen levels were not associated with muscle

Hormone replacement therapy (HRT) and phytoestrogens for improving muscle mass

Estrogen supplementation or HRT is considered as a potential strategy to play a protective role on muscle mass and muscle strength although contradictory results have been reported. For example, Sorensen et al. [42] performed a 12-week double-blind study where estrogen or placebo was administered and observed a significant increase in lean body mass. Moreover, in the Women's Health Initiative study, subjects who were randomized to receive HRT for 3 years lost 0.04 kg of lean body mass, which was

Consequences of sarcopenia

Several studies have shown an association between the loss in muscle mass and adverse clinical outcomes such as mobility limitations and fractures. That is, Janssen et al. [12] used the data of the Third National Health and Nutrition Examination Survey to investigate if sarcopenia was related to functional impairment and physical disability. Functional impairment was defined as having limitations in mobility performance such as walking and climbing stairs while physical disability refers to

Conclusion

The decrease in estrogens levels with menopause may play a potential role in the decline in muscle mass after the 5th decade of life. Sarcopenia is a complex condition involving hormonal, biological, nutritional and physical activity mechanisms. It is however difficult to establish the relative contribution of sex hormones on the onset of sarcopenia. Prospective observational studies with regular measurement of sex hormones and body composition during menopause transition, taking into account

Competing interests

This manuscript was supported by CIHR (Canadian Institute for Health Research) grants: 63279 MONET study (Montreal Ottawa New Emerging Team) and 88590 SOMET study (Sherbrooke Montreal Ottawa Emerging Team). Dr Rémi Rabasa-Lhoret and Dr Antony D. Karelis are supported by the Fonds de la recherche en santé du Québec (FRSQ). Finally, Dr Rémi Rabasa-Lhoret is the recipient of the J-A De Sève Research Chair for Clinical Research. The authors declare no conflict of interest.

Contributors

Virginie Messier: drafting; Rémi Rabasa-Lhoret: revision; Sébastien Barbat-Artigas: revision; Belinda Elisha: revision; Antony D. Karelis: revision; Mylène Aubertin-Leheudre: revision.

Provenance and peer review

Commissioned and externally peer reviewed.

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