The association between abdominal muscle mass quantified by computed tomography and osteoporosis in postmenopausal women.

Abstract

Introduction: Osteoporosis is a significant health concern among postmenopausal women owing to its association with increased fracturerisk and morbidity. Although traditional risk factors such as hormonal changes, dietary intake, and physical activity have been extensivelyinvestigated, the role of muscle mass, particularly abdominal muscle mass, in bone health remains incompletely understood. This studyaimed to investigate the association between abdominal muscle mass, as measured by computed tomography (CT), and osteoporosis inpostmenopausal Korean women.

Material and methods: This retrospective cross-sectional study included 1,723 postmenopausal women who underwent both abdominal CT and dual-energy X-ray absorptiometry (DXA) for bone mineral density (BMD) assessment. Abdominal muscle mass was quantifiedusing total abdominal muscle area (TAMA) at the L3 vertebral level on CT. Osteoporosis was defined as a T-score ≤ -2.5 at the lumbar spine or hip. Multivariable logistic regression analyses were conducted to examine the association between TAMA and osteoporosis, adjustingfor age, body mass index, lifestyle factors, and biochemical markers.

Results: Participants in the highest TAMA quartile exhibited significantly higher BMD in both the lumbar spine and hip than those in the lowest quartile (p < 0.05). Higher TAMA was independently associated with a lower risk of osteoporosis (adjusted OR, 0.365up of autosomal recessive disorders characterized by enzyme deficiencies thatimpair adrenal steroidogenesis, most commonly due to 21-hydroxylase deficiency. The biochemical defects in CAH translate to a spectrumof clinical consequences, which include adrenal insufficiency, genital ambiguity or disordered sex development, infertility, short stature,and an increased risk of metabolic syndrome during adolescence and adulthood. The severity and clinical features of CAH vary dependingon the enzymatic defect, residual enzymatic activity, the age of presentation, and genotype. This review comprehensively covers the genetic background, classification, and clinical spectrum of CAH, including classical and non-classical forms. We discuss the importance and implementation of neonatal screening programs for early diagnosis and intervention. Specialattention is given to differences in treatment approaches between children and adolescents, highlighting the challenges of optimizingglucocorticoid and mineralocorticoid therapy across developmental stages. Furthermore, we present emerging novel pharmacologicalagents currently in clinical trials aimed at improving disease management. The review also addresses potential complications associatedwith CAH, such as metabolic syndrome, cardiovascular risks, and bone health issues. Emphasizing a patient-centered approach, wehighlight the critical role of experienced endocrinologists in delinering individualized care to improve long-term outcomes. Our review summarizes the current knowledge, aims to guide clinicians in evidence-based management and highlights ongoing research into innovativetherapies for CAH.