Abstract
This prospective study set out to determine factors that underlie changes in bone characteristics and physical performance during postmenopausal years. Of 101 peri-menopausal women that originally participated in a randomized, controlled exercise intervention trial, 80 attended the follow-up measurements 9 years later. At follow-up, bone mineral content (BMC) of the lumbar spine, femoral neck and distal radius, as well as the maximal isometric muscle strength of leg extensors and arm flexors, and maximal oxygen uptake, were measured with the same protocols and devices as at the baseline. In addition, the hip structure analysis (HSA) was used to assess changes in the structure and strength at the narrowest section of the femoral neck. Changes in physical fitness or bone characteristics were independent of the original exercise intervention. In general, physical fitness declined with age from 5% to 30% and bone characteristics from 3% to 10%, except for the lumbar spine BMC and the periosteal diameter of the femoral neck, where no changes were observed. The use of hormone therapy (HRT) was the major factor accounting for the maintenance of BMC. Use of HRT alone explained 44% of the variability in the change at the femoral neck BMC, but it was not associated with changes in physical fitness. Change in the body weight was the only factor associated with the change in physical fitness: better maintenance in body weight predicted better maintenance of physical fitness. In conclusion, our results indicate that HRT helps to maintain bone mass and structure, which are important factors in prevention of fragility fractures in later life. However, HRT had no effect on physical fitness, which is highly associated with the risk of falling, the most important cause of fractures.
Similar content being viewed by others
References
Heaney RP, Barger-Lux MJ, Davies KM, Ryan RA, Johnson ML, Gong G (1997) Bone dimensional change with age: interactions of genetic, hormonal, and body size variables. Osteoporos Int 7:426–431
Beck TJ, Oreskovic TL, Stone KL, et al (2001) Structural adaptation to changing skeletal load in the progression toward hip fragility: the study of osteoporotic fractures. J Bone Miner Res 16:1108–1119
Beck TJ, Looker AC, Ruff CB, Sievanen H, Wahner HW (2000) Structural trends in the aging femoral neck and proximal shaft: analysis of the Third National Health and Nutrition Examination Survey dual-energy X-ray absorptiometry data. J Bone Miner Res 15:2297–2304
Duan Y, Beck TJ, Wang XF, Seeman E (2003) Structural and biomechanical basis of sexual dimorphism in femoral neck fragility has its origins in growth and aging. J Bone Miner Res 18:1766–1774
van der Meulen MC, Beaupre GS, Carter DR (1993) Mechanobiologic influences in long bone cross-sectional growth. Bone 14:635–642
Gregg EW, Pereira MA, Caspersen CJ (2000) Physical activity, falls, and fractures among older adults: a review of the epidemiologic evidence. J Am Geriatr Soc 48:883–893
Grisso JA, Kelsey JL, Strom BL, et al (1991) Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. N Engl J Med 324:1326–1331
Parkkari J, Kannus P, Palvanen M, et al (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65:183–187
Heinonen A, Oja P, Sievänen H, Pasanen M, Vuori I (1998) Effect of two training regimens on bone mineral density in healthy perimenopausal women: a randomized controlled trial. J Bone Miner Res 13:483–490
Durnin JV, Womersley J (1974) Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 32:77–97
Sievänen H, Heinonen A, Kannus P (1996) Adaptation of bone to altered loading environment: a biomechanical approach using X-ray absorptiometric data from the patella of a young woman. Bone 19:55–59
Sievänen H, Oja P, Vuori I (1994) Scanner-induced variability and quality assurance in longitudinal dual- energy X-ray absorptiometry measurements. Med Phys 21:1795–1805
Heinonen A, Sievänen H, Viitasalo J, Pasanen M, Oja P, Vuori I (1994) Reproducibility of computer measurement of maximal isometric strength and electromyography in sedentary middle-aged women. Eur J Appl Physiol Occup Physiol 68:310–314
Uusi-Rasi K, Salmi H-M, Fogelholm M (1994) Estimation of calcium and riboflavin intake by a short diary. Scand J Nutr 38:122–124
Dalsky GP, Stocke KS, Ehsani AA, Slatopolsky E, Lee WC, Birge SJ Jr (1988) Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med 108:824–828
Iwamoto J, Takeda T, Ichimura S (2001) Effect of exercise training and detraining on bone mineral density in postmenopausal women with osteoporosis. J Orthop Sci 6:128–132
Lufkin EG, Wahner HW, O’Fallon WM, et al (1992) Treatment of postmenopausal osteoporosis with transdermal estrogen. Ann Intern Med 117:1–9
Effects of hormone therapy on bone mineral density: results from the postmenopausal estrogen/progestin interventions (PEPI) trial. The Writing Group for the PEPI. JAMA (1996) 276:1389–1396
Komulainen M, Kröger H, Tuppurainen MT, Heikkinen AM, Honkanen R, Saarikoski S (2000) Identification of early postmenopausal women with no bone response to HRT: results of a five-year clinical trial. Osteoporos Int 11:211–218
Beck TJ, Stone KL, Oreskovic TL, et al (2001) Effects of current and discontinued estrogen replacement therapy on hip structural geometry: the study of osteoporotic fractures. J Bone Miner Res 16:2103–2110
Ahlborg HG, Johnell O, Turner CH, Rannevik G, Karlsson MK (2003) Bone loss and bone size after menopause. N Engl J Med 349:327–334
Skelton DA, Greig CA, Davies JM, Young A (1994) Strength, power and related functional ability of healthy people aged 65–89 years. Age Ageing 23:371–377
Lauretani F, Russo CR, Bandinelli S, et al (2003) Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol 95:1851–1860
Heikkinen J, Kyllönen E, Kurttila-Matero E, et al (1997) HRT and exercise: effects on bone density, muscle strength and lipid metabolism. A placebo controlled 2-year prospective trial on two estrogen–progestin regimens in healthy postmenopausal women. Maturitas 26:139–149
Skelton DA, Phillips SK, Bruce SA, Naylor CH, Woledge RC (1999) Hormone replacement therapy increases isometric muscle strength of adductor pollicis in post-menopausal women. Clin Sci (Lond) 96:357–364
Sipilä S, Taaffe DR, Cheng S, Puolakka J, Toivanen J, Suominen H (2001) Effects of hormone replacement therapy and high-impact physical exercise on skeletal muscle in post-menopausal women: a randomized placebo-controlled study. Clin Sci (Lond) 101:147–157
Kohrt WM, Snead DB, Slatopolsky E, Birge SJ Jr (1995) Additive effects of weight-bearing exercise and estrogen on bone mineral density in older women. J Bone Miner Res 10:1303–1311
Preisinger E, Alacamlioglu Y, Saradeth T, Resch KL, Holzer G, Metka M (1995) Forearm bone density and grip strength in women after menopause, with and without estrogen replacement therapy. Maturitas 21:57–63
Seeley DG, Cauley JA, Grady D, Browner WS, Nevitt MC, Cummings SR (1995) Is postmenopausal estrogen therapy associated with neuromuscular function or falling in elderly women? Study of Osteoporotic Fractures Research Group. Arch Intern Med 155:293–299
Taaffe DR, Luz Villa M, Delay R, Marcus R (1995) Maximal muscle strength of elderly women is not influenced by oestrogen status. Age Ageing 24:329–333
Armstrong AL, Oborne J, Coupland CA, Macpherson MB, Bassey EJ, Wallace WA (1996) Effects of hormone replacement therapy on muscle performance and balance in post-menopausal women. Clin Sci (Lond) 91:685–690
Uusi-Rasi K, Sievänen H, Vuori I, et al (1999) Long-term recreational gymnastics, estrogen use, and selected risk factors for osteoporotic fractures. J Bone Miner Res 14:1231–1238
Ribom EL, Piehl-Aulin K, Ljunghall S, Ljunggren O, Naessen T (2002) Six months of hormone replacement therapy does not influence muscle strength in postmenopausal women. Maturitas 42:225–231
Greeves JP, Cable NT, Reilly T, Kingsland C (1999) Changes in muscle strength in women following the menopause: a longitudinal assessment of the efficacy of hormone replacement therapy. Clin Sci (Lond) 97:79–84
Brown M, Birge SJ, Kohrt WM (1997) Hormone replacement therapy does not augment gains in muscle strength or fat-free mass in response to weight-bearing exercise. J Gerontol A Biol Sci Med Sci 52:B166–170
Redberg RF, Nishino M, McElhinney DB, Dae MW, Botvinick EH (2000) Long-term estrogen replacement therapy is associated with improved exercise capacity in postmenopausal women without known coronary artery disease. Am Heart J 139:739–744
Asikainen TM, Miilunpalo S, Oja P, et al (2002) Randomised, controlled walking trials in postmenopausal women: the minimum dose to improve aerobic fitness? Br J Sports Med 36:189–194
Sievänen H (2000) A physical model for dual-energy X-ray absorptiometry-derived bone mineral density. Invest Radiol 35:325–330
Bolotin HH, Sievänen H (2001) Inaccuracies inherent in dual-energy X-ray absorptiometry in vivo bone mineral density can seriously mislead diagnostic/prognostic interpretations of patient-specific bone fragility. J Bone Miner Res 16:799–805
Rossouw JE, Anderson GL, Prentice RL, et al (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333
Anderson GL, Limacher M, Assaf AR, et al (2004) Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 291:1701–1712
Acknowledgments
The authors wish to thank the Foundation of Juho Vainio, Helsinki, Finland and the Finnish Ministry of Education for their financial support.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Uusi-Rasi, K., Sievänen, H., Heinonen, A. et al. Determinants of changes in bone mass and femoral neck structure, and physical performance after menopause: a 9-year follow-up of initially peri-menopausal women. Osteoporos Int 16, 616–622 (2005). https://doi.org/10.1007/s00198-004-1724-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-004-1724-0