Skin Wrinkles May Provide a Glimpse Into Bone Health

Megan Brooks

June 06, 2011

June 6, 2011 (Boston, Massachusetts) — A close look at the skin of early postmenopausal women might provide a glimpse into their skeletal health, according to a study presented here at ENDO 2011: The Endocrine Society 93rd Annual Meeting.

The study found a significant inverse association between skin wrinkles and bone mineral density (BMD) in a population of women within 3 years of menopause who were not on any hormone therapy and who had not had any cosmetic skin procedures.

"It's a unique population when changes are happening in a dynamic fashion." This is a relation "not previously described," said study presenter Lubna Pal, MBBS, MRCOG, MSc, a reproductive endocrinologist and associate professor at Yale University School of Medicine in New Haven, Connecticut.

Common Building Block

The architecture of the skeleton and the skin share a common building block: collagen, Dr. Pal explained. Age-related changes in collagen contribute to age-related skin changes like wrinkles and sagging, and might also contribute to reduced BMD.

"When I am seeing an older patient, her bigger concern is what is happening to her skin; the clinician's concern is what is happening to her bones," Dr. Pal said. "So part of the question was: Can I fine tune to the patient's concern and get a sense of the bone health?"

Dr. Pal and colleagues performed a cross-sectional analysis of baseline data on 114 early postmenopausal women (70% white) enrolled in the longitudinal Kronos Early Estrogen Prevention Study (KEEPS).

As part of an ancillary study of the skin, the distribution and depth of skin wrinkles were assessed at 11 sites on the face and neck using the Lemperle wrinkle scale. Skin firmness was assessed at the forehead and cheek using a durometer, which has been validated in patients with scleroderma, and bone density was assessed with dual x-ray absorptiometry at the lumbar spine, hip, and total body.

The researchers observed a clear inverse correlation between skin wrinkling and BMD at the spine (r, –0.27; P < .01), femoral neck (r, –0.29; < .01), and total body (r, –0.26; P =.01), independent of age, body composition, or other factors known to influence BMD.

"Basically, what we found was that the higher the wrinkle score, the worse the bone mineral density," Dr. Pal said, "so our hypothesis was substantiated by these associations."

Firmer skin of the face and forehead was associated with higher BMD.

"Powerful Potential Relevance"

Madhusmita Misra, MD, MPH, from Massachusetts General Hospital and Harvard Medical School, in Boston, who was not involved in this study, said: "This is a meaningful association if, indeed, it is real; we need future data to confirm that."

"We have multiple clinical risk factors that are already available that identify an individual's fracture risk; this may be yet another piece that would enhance the overall predictability. I think it is of powerful potential relevance, but it needs to be substantiated," Dr. Misra added.

"Ultimately," Dr. Pal said, "we want to know if the intensity of skin wrinkles can allow the identification of women who are more likely to fracture a bone, especially the femoral neck or hip." If this is the case, then looking at skin wrinkles plus other clinical risk factors "may allow the identification of fracture risk in populations that do not have access to more costly technology."

But Dr. Pal agrees with Dr. Misra that much more study is needed.

"This is just the tip of the iceberg," Dr. Pal said. "It's a tantalizing association" that needs to be followed-up in long-term studies to substantiate a relation between wrinkles and the risk for bone fracture.

Dr. Pal noted that the women in the study are being followed longitudinally, and that it will be "interesting to see in the coming years whether women with deeper wrinkles are losing bone at a faster rate than other women."

The study was funded by Aurora Foundation to the Kronos Longevity Research Institute in Phoenix, Arizona. Dr. Pal and Dr. Misra have disclosed no relevant financial relationships.

ENDO 2011: The Endocrine Society 93rd Annual Meeting: Abstract P3-126. Presented June 4, 2011.

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