Pre-sarcopenia Among Postmenopausal Women Younger Than 65

Abstract and Introduction

Abstract

Objective: Sarcopenia is associated with high morbidity and mortality in older women. Early detection and intervention during the postmenopausal period were hypothesized to help maintain muscle mass and performance. Although the Asian Working Group has developed guidelines for sarcopenia management, the condition has not been sufficiently investigated in the middle-aged cohort of the Asian population. This study aimed to measure the prevalence of pre-sarcopenia and sarcopenia in middle-aged postmenopausal women and to determine the factors associated with low muscle mass.

Methods: In this cross-sectional study conducted in the Menopause Clinic, King Chulalongkorn Memorial Hospital, we used the bioelectrical impedance analysis method to determine the appendicular muscle mass using a body composition analyzer (TANITA MC980 Plus). Appendicular muscle mass index, handgrip strength, and 6-m gait speed were measured in 340 women aged 45 to 65 years. Hormonal profiles, anthropometric data, and relevant history were recorded.

Results: The mean age of the study participants and time since menopause were 57.8 ± 4.5 years and 9.4 ± 5.5 years, respectively. The proportion of pre-sarcopenic, sarcopenic, and nonsarcopenic women were 11.8%, 2.7%, and 85.6%, respectively. A body mass index ≤ 20 kg/m² had the strongest correlation with low muscle mass (odds ratio 7.1; 95% confidence interval 3.0–16.8, P < 0.001).

Conclusion: Nearly 12% of Thai middle-aged postmenopausal women were pre-sarcopenic. Early detection of symptoms of pre-sarcopenia and maintenance of a healthy body mass index may reduce the burden of this condition for middle-aged and older women.

Introduction

Sarcopenia—a syndrome characterized by the gradual and generalized loss of skeletal muscle mass with progressive loss of muscle strength—increases the risk of other adverse events such as falling and causes physical disability, reduces the overall quality of life, and increases the risk of mortality.^[1] The European Working Group on Sarcopenia in Older People (EWGSOP1) has defined three conceptual stages of sarcopenia.^[2] Pre-sarcopenia is characterized by low muscle mass, which does not affect muscle strength or physical performance. Sarcopenia is characterized by low muscle mass and decreased muscle strength or low physical performance. Severe sarcopenia is characterized when all the criteria were met.

Studies in women found loss of muscle mass and muscle strength as they encounter menopause and aging.^[3,4] Thus, muscle deterioration is likely to progress with time. The incidence of falls in older women progressively increased with the severity of sarcopenia from 15% to 72%.^[5] Therefore, to reduce fall and fracture risk, it is important to prevent muscle mass loss and the consequential progression of pre-sarcopenia to sarcopenia.

As the proportion of the aged population increases, nearly one-third of older women are being diagnosed with sarcopenia, the risk factors of which are loss of weight and lower quadriceps strength.^[6] An early diagnosis of pre-sarcopenia and sarcopenia in those women with recent menopause is a challenging task that would help prevent falls and fractures and promote healthy aging. Therefore, this study aimed to determine the prevalence of pre-sarcopenia and associated factors in postmenopausal women aged ≤65 years.

Table 1. Demographic data of participants (n = 340)
Characteristic	Value
Age (y)	57.8 ± 4.6
Year since menopause (y)	9.4 ± 5.5
BMI (kg/m²)	23.8 ± 4.2
Waist-to-hip ratio	0.9 ± 0.1
BMI group, n (%)
<25 kg/m²	238 (70)
≥25 kg/m ²	102 (30)
Gait speed (m/s)	3.3 ± 0.5
Hand grip strength (kg)	22.8 ± 3.8
Menopausal hormone treatment, n (%)
Never	323 (95)
Ever	17 (5)
Serum 25OHD level (ng/mL)	21.9 ± 8.2
Vitamin D status, n (%)
Sufficiency	53 (15.6)
Insufficiency	136 (40)
Deficiency	151 (44.4)
Estradiol level (pg/mL), median (IQR)	0 (6.1)
Free androgen index (%), median (IQR)	0.3 (0.7)
Total testosterone level (nmol/L), median (IQR)	0.2 (0.4)
Free testosterone level (ng/dL), median (IQR)	0.1 (0.1)
Bioavailable testosterone (ng/dL), median (IQR)	1.5 (3.2)
SHBG (nmol/L), median (IQR)	62.9 (51.8)
Fat mass (%)	34.2 ± 6.7
ASMI	6.4 ± 1.0
ASMI status, n (%)
<5.7 kg/m²	49 (14.4)
≥5.7 kg/m²	291 (85.6)
Exercise, n (%)
No (<3 d)	186 (54.7)
Yes (≥3 d)	154 (45.3)
Exercise duration per session, n (%)
<30 min	32 (16.3)
30–60 min	139 (70.9)
>60 min	25 (12.8)
Sunscreen used, n (%)
None	110 (32.4)
Face only	177 (52.1)
Face and body	53 (15.6)
Alcohol consumption, n (%)
No	320 (94.1)
Yes	20 (5.9)
Vasomotor symptoms, n (%)
None	167 (49.1)
Mild	103 (30.3)
Moderate	45 (13.2)
Severe	25 (7.4)

Table 1. Demographic data of participants (n = 340)

Characteristic

Value

Age (y)

57.8 ± 4.6

Year since menopause (y)

9.4 ± 5.5

BMI (kg/m²)

23.8 ± 4.2

Waist-to-hip ratio

0.9 ± 0.1

BMI group, n (%)

<25 kg/m²

238 (70)

≥25 kg/m ²

102 (30)

Gait speed (m/s)

3.3 ± 0.5

Hand grip strength (kg)

22.8 ± 3.8

Menopausal hormone treatment, n (%)

Never

323 (95)

Ever

17 (5)

Serum 25OHD level (ng/mL)

21.9 ± 8.2

Vitamin D status, n (%)

Sufficiency

53 (15.6)

Insufficiency

136 (40)

Deficiency

151 (44.4)

Estradiol level (pg/mL), median (IQR)

0 (6.1)

Free androgen index (%), median (IQR)

0.3 (0.7)

Total testosterone level (nmol/L), median (IQR)

0.2 (0.4)

Free testosterone level (ng/dL), median (IQR)

0.1 (0.1)

Bioavailable testosterone (ng/dL), median (IQR)

1.5 (3.2)

SHBG (nmol/L), median (IQR)

62.9 (51.8)

Fat mass (%)

34.2 ± 6.7

ASMI

6.4 ± 1.0

ASMI status, n (%)

<5.7 kg/m²

49 (14.4)

≥5.7 kg/m²

291 (85.6)

Exercise, n (%)

No (<3 d)

186 (54.7)

Yes (≥3 d)

154 (45.3)

Exercise duration per session, n (%)

<30 min

32 (16.3)

30–60 min

139 (70.9)

>60 min

25 (12.8)

Sunscreen used, n (%)

None

110 (32.4)

Face only

177 (52.1)

Face and body

53 (15.6)

Alcohol consumption, n (%)

320 (94.1)

Yes

20 (5.9)

Vasomotor symptoms, n (%)

None

167 (49.1)

Mild

103 (30.3)

Moderate

45 (13.2)

Severe

25 (7.4)

Table 2. Characteristic data comparing women with normal ( n = 291) and low muscle mass ( n = 49)
	Normal (n = 291)	Low muscle mass (n = 49)	P value
Age (y)	57.8 ± 4.6	58.3 ± 4.4	0.5
Year since menopause (y)	9.3 ± 5.5	10.1 ± 5.4	0.4
Year since menopause, n (%)	0.6
<6 y	89 (30.6)	13 (26.5)
≥6 y	202 (69.4)	36 (73.5)
Waist-to-hip ratio	0.9 ± 0.1	0.8 ± 0.1	0.07
BMI (kg/m²)	24.3 ± 4.1	20.4 ± 3.3	<0.001^a
BMI group, n (%)	<0.001^a
<25 kg/m²	193 (66.3)	45 (91.8)
≥25 kg/m ²	98 (33.7)	4 (8.2)
Menopausal hormone therapy, n (%)	0.72
Never	277 (95.2)	46 (93.9)
Ever	14 (4.8)	3 (6.1)
Exercise, n (%)	0.12
No ( <3 d)	154 (52.9)	32 (65.3)
Yes (≥3 d)	137 (47.1)	17 (34.7)
Alcohol, n (%)	0.05
No	277 (95.2)	43 (87.8)
Yes	14 (4.8)	6 (12.2)
Vasomotor symptoms, n (%)	0.75
None	145 (49.8)	22 (44.9)
Mild	87 (29.9)	16 (32.7)
Moderate	39 (13.4)	6 (12.2)
Severe	20 (6.9)	5 (10.2)
Serum total 25 (OHD) (ng/mL)	21.6 ± 7.7	24.1 ± 10.2	0.10
Vitamin D, n (%)	0.22
No deficiency (≥20)	156 (53.6)	31 (63.3)
Deficiency ( <20)	135 (46.4)	18 (36.7)
Free androgen index (%), median (IQR)	0.4 (0.8)	0.2 (0.3)	<0.001^a
Testosterone (nmol/L), median (IQR)	0.2 (0.4)	0.1 (0.2)	0.04^b
Free testosterone (ng/dL), median (IQR)	0.08 (0.15)	0.04 (0.05)	<0.001^a
Bioavailable testosterone (ng/dL), median (IQR)	1.8 (3.5)	0.8 (1.2)	<0.001^a
ASMI (kg/m²)	6.6 ± 0.8	4.9 ± 1.2	<0.001^a
Fat (%)	35.0 ± 6.6	29.3 ± 5.1	<0.001^a
Fat mass	21.1 ± 7.8	14.7 ± 4.9	<0.001^a
Gait speed (m/s)	3.3 ± 0.5	3.2 ± 0.4	0.03^b
Handgrip strength (kg)	23.1 ± 3.8	21.4 ± 3.8	0.005^a

Table 2. Characteristic data comparing women with normal ( n = 291) and low muscle mass ( n = 49)

Normal (n = 291)

Low muscle mass (n = 49)

P value

Age (y)

57.8 ± 4.6

58.3 ± 4.4

0.5

Year since menopause (y)

9.3 ± 5.5

10.1 ± 5.4

0.4

Year since menopause, n (%)

0.6

<6 y

89 (30.6)

13 (26.5)

≥6 y

202 (69.4)

36 (73.5)

Waist-to-hip ratio

0.9 ± 0.1

0.8 ± 0.1

0.07

BMI (kg/m²)

24.3 ± 4.1

20.4 ± 3.3

<0.001^a

BMI group, n (%)

<0.001^a

<25 kg/m²

193 (66.3)

45 (91.8)

≥25 kg/m ²

98 (33.7)

4 (8.2)

Menopausal hormone therapy, n (%)

0.72

Never

277 (95.2)

46 (93.9)

Ever

14 (4.8)

3 (6.1)

Exercise, n (%)

0.12

No ( <3 d)

154 (52.9)

32 (65.3)

Yes (≥3 d)

137 (47.1)

17 (34.7)

Alcohol, n (%)

0.05

277 (95.2)

43 (87.8)

Yes

14 (4.8)

6 (12.2)

Vasomotor symptoms, n (%)

0.75

None

145 (49.8)

22 (44.9)

Mild

87 (29.9)

16 (32.7)

Moderate

39 (13.4)

6 (12.2)

Severe

20 (6.9)

5 (10.2)

Serum total 25 (OHD) (ng/mL)

21.6 ± 7.7

24.1 ± 10.2

0.10

Vitamin D, n (%)

0.22

No deficiency (≥20)

156 (53.6)

31 (63.3)

Deficiency ( <20)

135 (46.4)

18 (36.7)

Free androgen index (%), median (IQR)

0.4 (0.8)

0.2 (0.3)

<0.001^a

Testosterone (nmol/L), median (IQR)

0.2 (0.4)

0.1 (0.2)

0.04^b

Free testosterone (ng/dL), median (IQR)

0.08 (0.15)

0.04 (0.05)

<0.001^a

Bioavailable testosterone (ng/dL), median (IQR)

1.8 (3.5)

0.8 (1.2)

<0.001^a

ASMI (kg/m²)

6.6 ± 0.8

4.9 ± 1.2

<0.001^a

Fat (%)

35.0 ± 6.6

29.3 ± 5.1

<0.001^a

Fat mass

21.1 ± 7.8

14.7 ± 4.9

<0.001^a

Gait speed (m/s)

3.3 ± 0.5

3.2 ± 0.4

0.03^b

Handgrip strength (kg)

23.1 ± 3.8

21.4 ± 3.8

0.005^a

Variable	OR 95% CI	P value	Adjusted OR 95% CI	P value
Age (y)	1.03 (0.96–1.10)	0.45	1.03 (0.95–1.12)	0.45
Year since menopause (y)
≥6 y	1.2 (0.6–2.4)	0.57
BMI
≤20 kg/m²	12.7 (6.3–25.9)	<0.001^a	7.1 (3.0–16.8)	<0.001^a
Waist-to-hip ratio
Abdominal obesity	0.2 (0.1–0.4)	<0.001^a	0.5 (0.2–1.1)	0.1
Gait speed (m/s)	0.5 (0.3–1.0)	0.06	0.5 (0.2–1.1)	0.07
Hand grip strength (kg)	0.89 (0.82–0.97)	0.006^a	0.9 (0.82–1.0)	0.039^b
MHT use
Yes	1.3 (0.4–4.7)	0.7
Vitamin D status
Deficiency ( <20)	0.7 (0.4–1.3)	0.2
Free testosterone (ng/dL)	0.003 (0–0.16)	0.004^a	0.077 (0–3.8)	0.2
Exercise
Yes	0.6 (0.3–1.1)	0.1	0.5 (0.2–1.1)	0.09

Prevalence of Pre-sarcopenia Among Postmenopausal Women Younger Than 65 Years

Abstract and Introduction

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Prevalence of Pre-sarcopenia Among Postmenopausal Women Younger Than 65 Years

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