Role of Menopausal Transition and Physical Activity in Loss of Lean and Muscle Mass: A Follow-Up Study in Middle-Aged Finnish Women.

Hanna-Kaarina Juppi,Vuokko Kovanen,Sarianna Sipilä,Tuija H Tammelin,Eija K Laakkonen,Jari E Karppinen,Urho M Kujala,Neil J Cronin,Pauliina Aukee,Sira Karvinen

doi:10.3390/jcm9051588

Abstract

In midlife, women experience hormonal changes due to menopausal transition. A decrease especially in estradiol has been hypothesized to cause loss of muscle mass. This study investigated the effect of menopausal transition on changes in lean and muscle mass, from the total body to the muscle fiber level, among 47–55-year-old women. Data were used from the Estrogenic Regulation of Muscle Apoptosis (ERMA) study, where 234 women were followed from perimenopause to early postmenopause. Hormone levels (estradiol and follicle stimulating hormone), total and regional body composition (dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) scans), physical activity level (self-reported and accelerometer-measured) and muscle fiber properties (muscle biopsy) were assessed at baseline and at early postmenopause. Significant decreases were seen in lean body mass (LBM), lean body mass index (LBMI), appendicular lean mass (ALM), appendicular lean mass index (ALMI), leg lean mass and thigh muscle cross-sectional area (CSA). Menopausal status was a significant predictor for all tested muscle mass variables, while physical activity was an additional significant contributor for LBM, ALM, ALMI, leg lean mass and relative muscle CSA. Menopausal transition was associated with loss of muscle mass at multiple anatomical levels, while physical activity was beneficial for the maintenance of skeletal muscle mass.

Highlights

Skeletal muscle is responsible for movements under voluntary control, but it has an important role in metabolism [1,2]
94% of subjects in the early and 89% in the late perimenopausal group fulfilled the national recommendations of moderate-to-vigorous physical activity and can be considered to be active
The lean and muscle mass results obtained from the sub-group of non-hormone replacement therapy (HT) users did not differ from the results presented in Table 3, except for self-reported physical activity, which was significantly higher at final follow-up in the non-HT users (4.3 ± 4.0 vs. 4.6 ± 3.7 metabolic equivalent (MET)-hours/day, P = 0.043)

Summary

Introduction

Skeletal muscle is responsible for movements under voluntary control, but it has an important role in metabolism [1,2]. Menopausal transition starts when the hypothalamus begins to show signs of aging and the release of gonadotropin-releasing hormone becomes unsynchronized [7] This leads to an imbalance between the release of luteinizing hormone (LH) and follicle stimulating hormone (FSH), and when combined with simultaneous ovarian aging, estradiol levels decrease [7]. I.e., when the menstrual cycle ceases completely, systemic FSH levels are set high and estradiol levels low These hormonal changes, the loss of systemic estradiol from the ovaries, have been suggested to have an impact on whole body and skeletal muscle composition, whereby more adipose tissue is accumulated and total muscle mass decreases [8,9,10].

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Discussion

Conclusion