Association Between Hormone Therapy and Muscle Mass in Postmenopausal Women: A Systematic Review and Meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 31461147 · doi:10.1001/jamanetworkopen.2019.10154
What was done
The authors performed a systematic review and meta-analysis of randomized clinical trials evaluating whether hormone therapy (HT) reduces lean body mass (LBM) loss in postmenopausal women aged 50 years and older compared with no HT or placebo. Five databases were searched from inception to April 2018. Eligible studies assessed LBM or fat-free mass via dual-energy x-ray absorptiometry, dual-photon absorptiometry, or bioelectrical impedance analysis in community-dwelling women. Data were pooled using a fixed-effects model, and evidence quality was evaluated using GRADE.
What was found
Twelve randomized clinical trials with 4,474 total participants (mean age 59.0 years, median follow-up 2 years [range, 6 months to 6 years]) were included across 22 HT intervention arms (15 combined estrogen-progesterone, 7 estrogen-only). Overall, HT users lost 0.06 kg less LBM (95% CI, -0.05 to 0.18 kg; P = .26) compared with controls, a non-significant difference. Subgroup analyses by HT formulation, dose, follow-up length, time since menopause, study quality, and measurement modality showed no significant differences, ranging from 0.06 kg more loss to 0.20 kg less loss among HT users. The overall quality of evidence was rated low.
Why it matters
This review demonstrates that hormone therapy does not meaningfully preserve lean body mass in postmenopausal women. Strategies targeting muscle mass retention in aging women should focus on alternative interventions.
Limits
The certainty of evidence was graded as low. Only 2 of the 12 studies reported participant ethnicity, limiting generalizability across diverse populations. The review assessed muscle mass rather than muscle strength or functional physical performance, and median follow-up was relatively short (2 years).
Cited by
- supports Estrogen-based menopausal hormone therapy is effective for symptom management, but evidence does not show that it attenuates muscle mass loss or increases muscle mass.