Association of Sarcopenic Obesity and Osteoporosis in Postmenopausal Women: Risk Factors and Protective Effects of Hormonal Therapy and Nutritional Status.

Abstract

The cross-sectional study of postmenopausal Thai women discovered a strong association between both sarcopenia and sarcopenic obesity and osteoporosis. The risk of sarcopenic obesity was found to increase with poor nutritional status, while a history of menopausal hormone therapy was shown to offer protection.

Purpose: The study aims to investigate the association between sarcopenic obesity and osteoporosis in postmenopausal women and to identify risk factors for sarcopenic obesity.

Methods: Our comprehensive cross-sectional study involved 248 Thai postmenopausal women aged 45-80. Osteoporosis was defined as a bone mineral density (BMD) T-score of less than -2.5 at the lumbar spine, total hip, or femoral neck, as measured by dual-energy X-ray absorptiometry (DXA). Sarcopenic obesity is defined as the co-existence of obesity and sarcopenia according to the criteria established by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). Sarcopenia was defined as skeletal muscle mass adjusted by weight (SMM/W) <35.6%, assessed via Bioelectrical Impedance Analysis (BIA), and compromised muscle function, which includes low hand grip strength (<18 kg) or poor physical performance (chair-stand test time ≥17 seconds). Obesity was defined as a fat mass percentage >41%, a body mass index (BMI) ≥25 kg/m², or a waist circumference ≥80 cm. Moreover, a questionnaire of baseline characteristics and the factor associated with sarcopenic obesity was collected, including age, years since menopause, history of menopausal hormone therapy, underlying diseases, medications, nutritional status assessed by the Mini Nutritional Assessment (MNA), and physical activity assessed by The Global Physical Activity Questionnaire (GPAQ). Univariate and multiple logistic regression analyses were used to examine the associated factors with sarcopenic obesity.

Results: The prevalence of sarcopenic obesity was 13.3%, and sarcopenia was present in 28.63%, while osteoporosis affected 39.91% of the participants. Sarcopenia and sarcopenic obesity were significantly associated with osteoporosis (odds ratio (OR) 3.05; 95% CI, 1.69-5.49; p < 0.05 and OR 2.65; 95% CI, 1.23-5.68; p < 0.05, respectively). In univariate and stepwise logistic regression analyses, a lower MNA score was significantly associated with an increased risk of sarcopenic obesity. Specifically, participants with an MNA score of 8-11 had an OR of 2.26; 95% CI,1.04-4.92; p < 0.04, while those with a score <8 exhibited a markedly elevated risk (OR 25.6; 95% CI, 1.04-4.92; p < 0.05). Conversely, the use of menopausal hormone therapy (MHT) was identified as a significant protective factor against sarcopenic obesity (OR 0.29; 95% CI, 0.10-0.79; p < 0.05).

Conclusion: Both sarcopenia and sarcopenic obesity are linked to osteoporosis. Menopausal hormone therapy and nutritional status are significantly associated with sarcopenic obesity in postmenopausal women.