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Menopausal HT may prevent age-associated fat mass increase

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March 28, 2018

Georgios Papadakis
Georgios E. Papadakis

Postmenopausal women currently using hormone therapy had less visceral adipose tissue compared with those who never used HT, and this use prevented 10-year gains of visceral adipose tissue and android fat mass, study data show.

“This is the first large study on postmenopausal women specifically assessing intravisceral fat according to menopausal HT using high-accuracy measurement by DXA,” Georgios E. Papadakis, MD, chief resident in the service of endocrinology, diabetes and metabolism, CHUV, Lausanne University Hospital in Lausanne, Switzerland, told Endocrine Today. “Thus, the age-associated increase in fat mass is prevented in women on menopausal HT. However, this effect rapidly disappears after treatment withdrawal. In addition, this study showed no advantage of menopausal HT for enhancement of lean mass.”

Papadakis and colleagues evaluated data from the OsteoLaus cohort on 1,053 postmenopausal women who were current (n = 216; mean age, 62.6 years; mean HT duration, 12.2 years), past (n = 288; mean age, 66.8 years; mean HT duration, 7.9 years) and never (n = 549; mean age, 61.3 years) users of menopausal HT to determine the effect of HT on fat mass, visceral adipose tissue and nonbone lean mass.

Current HT users had lower visceral adipose tissue compared with never users (P = .03). Current use lowered the risk for 10-year gain of visceral adipose tissue (P < .01) and subtotal and android fat mass (P < .05) compared with past and never use.

Researchers did not observe any benefit of menopausal HT on nonbone lean mass, sarcopenia indices or handgrip strength. However, a trend for lower nonbone lean mass was observed among current users compared with never users (P = .05).

No significant differences were observed between the groups for glucose, insulin and adipokine levels.

“The decrease of intravisceral fat seen in menopausal HT users may have important cardiovascular and bone implications,” Papadakis said. “This favorable effect of menopausal HT on adiposity should be taken into account when assessing the benefit-risk ratio before prescribing menopausal HT. Nevertheless, as discussed in the article, the effect size is relative small. In addition, the absence of residual effect on past users indicates that physicians should be cautious when stopping menopausal HT and strongly encourage women to optimize nutrition and increase physical activity in order to counteract this eventual rebound effect.”

Future studies should examine the effects on body composition of different types and routes of administration for menopausal HT, as well as consequences of withdrawal, Papadakis said. – by Amber Cox

For more information:

Georgios E. Papadakis, MD, FMH, can be reached at georgios.papdakis@chuv.ch.

Disclosures: The authors report no relevant financial disclosures.

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Nanette Santoro
Perspective

This study has several strengths (large numbers, reasonable accounting for hormone use) but some key weaknesses that make it difficult to interpret. First and foremost, it is an observational study, and therefore it is very difficult to attribute cause to the associations that the authors observed. Women who are prescribed estrogen may be healthier in many ways, only some of which can be measured by the methods used in this study. Overall, they tend to be higher socioeconomic status, more likely to exercise (which was true, but not statistically significant in this study), and to have fewer cardiovascular risk factors. On the other hand, women who are not prescribed estrogen can be a mixed bag of healthy and also far less healthy women for whom estrogen use is not indicated. These are the things that the authors can measure.

There are many unmeasurable factors, such as the greater health “locus of control” that estrogen users tend to have. This refers to the belief that healthy behaviors will keep one healthy. Not everyone feels this way. Women who feel this way tend to be estrogen users and tend to be healthier. Given the “healthy user bias” that usually accrues to estrogen users, the small differences between the users and nonusers seen in this study could well be due to these sorts of biases that cannot be readily assessed and controlled for in a cross-sectional study of association. There is also something called “publication bias” — the process by which studies like the one above in which the results turned out exactly the other way — no association of estrogen use with body composition — tend to receive poor reviews and tend to never get published or to get published in very obscure journals, because the results are not “sexy.”

More powerful than a study like this is the one the authors quote by Shea and colleagues (Shea KL, et al. Menopause. 2015;doi:10.1097/GME.0000000000000430). These authors performed an experimental study in which each woman had an equal chance of getting assigned to estrogen. We need more studies like these to understand the relationships. The interesting thing about the study by Shea is that it implies that estrogen preserves muscle mass. Yet, the study by Papadakis and colleagues did not find this; they found only decreased fat mass. While it is nice to have less fat mass, it is a more important issue in older women to preserve lean body (ie, muscle mass).

Nanette Santoro, MD

Professor and E. Stewart Taylor Chair of Obstetrics and Gynecology
University of Colorado School of Medicine

Disclosure: Santoro reports no relevant financial disclosures.