The Association Between Hormone Therapy and Sarcopenia in Postmenopausal Women

The Korea National Health and Nutrition Examination Survey, 2008-2011

Sung-Woo Kim, MD; Rebecca Kim, MD


Menopause. 2020;27(5):506-511. 

In This Article

Abstract and Introduction


Objective: Menopausal transition contributes to sarcopenia, but the effects of hormone therapy (HT) on sarcopenia in postmenopausal women have not been determined. This study assessed the effect of HT on sarcopenia in postmenopausal women.

Methods: The present study included 4,254 postmenopausal women who participated in the Korea National Health and Nutritional Examination Surveys from 2008 to 2011. Appendicular skeletal muscle mass divided by weight (ASM/Wt) and the prevalence of sarcopenia were analyzed in groups of women stratified by duration of HT use.

Results: ASM/Wt was higher and the prevalence of sarcopenia was lower in participants with a history of prolonged (≥13 mo) HT use than in participants with a shorter duration of HT use or no HT use. After adjusting for multiple confounding factors, prolonged use of HT remained significantly associated with estimated mean ASM/Wt and the prevalence of sarcopenia (odds ratio: 0.60; 95% confidence interval: 0.41–0.88; P = 0.01). In addition, the prevalence of sarcopenia was linearly associated with history of hypertension, duration of hypertension, physical activity, and duration of HT use. Subgroup analysis showed that the association between duration of HT use and the prevalence of sarcopenia was maintained in younger (<65 y old) and leaner (body mass index <25 kg/m2) postmenopausal women.

Conclusions: The present study showed that the prolonged use of HT was associated with high muscle mass and a low prevalence of sarcopenia in postmenopausal women.


Sarcopenia is defined as a loss of skeletal muscle mass and strength, and is believed to mostly affect older individuals.[1] Muscle mass decreases with age, with a 0.5% to 1.0% reduction in muscle mass per year after 70 years of age.[2] Sarcopenia is present in about one quarter to one half of men and women older than 65 years,[3] but may occur earlier in life.[4] Sarcopenia is now considered a muscle disease causing adverse health outcomes due to low muscle mass and strength.[5] Sarcopenia increases the risks of falls, fractures, disability, and functional impairments, as well as mortality.[6–9] In addition, individuals with sarcopenia have higher insulin resistance and are at increased risk of diabetes and cardiovascular disease than nonsarcopenic individuals.[10–12] Because women have a longer lifespan than men, women are more likely to experience the negative muscular changes associated with aging.

The aging process is often accompanied by comorbid conditions that contribute to the development of sarcopenia.[13,14] Age-related reductions in anabolic hormones such as testosterone, growth hormone, and insulin-like growth factor-1 have been shown to be associated with muscle loss.[15,16] Although sarcopenia is highly prevalent in postmenopausal women,[17,18] whether decline of estrogen contributes to development of sarcopenia in postmenopausal women is not determined. Accelerated muscle loss is associated with the menopausal transition,[19,20] suggesting that hormone supplementation may prevent or reduce loss in muscle mass.[21] Studies assessing the association between hormone therapy (HT) use and muscle loss have, however, yielded inconsistent results.[20,22,23] To our knowledge, few large-scale studies have assessed the ability of HT use to attenuate muscle loss in postmenopausal women. The present study therefore evaluated whether the duration of HT use was associated with muscle mass and the prevalence of sarcopenia in postmenopausal women.