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Is Postmenopausal Estrogen Therapy Associated With Neuromuscular Function or Falling in Elderly Women?

Is Postmenopausal Estrogen Therapy Associated With Neuromuscular Function or Falling in Elderly... Abstract Background: Muscle strength declines with advancing age; the causes of this are uncertain. In women, strength begins to decline around the time of menopause, suggesting that hormonal changes might influence strength. To determine the effect of postmenopausal estrogen use on muscle strength, neuromuscular function, and the risk of falling, we examined 9704 participants aged 65 years or more enrolled in the Study of Osteoporotic Fractures. Methods: We measured hip abductor, triceps extensor, and hand-grip muscle strength, balance, gait speed, and self-reported functional disability. Falls during the first year of follow-up were determined from postcards that participants mailed every 4 months indicating whether they had fallen in the previous 4 months (>99% complete follow-up). Results: After adjusting for age, medications, medical history, and personal habits, current estrogen users did not differ in a clinically meaningful way from those who had never used estrogen on tests of hip abductor strength (mean difference, 0.15 kg; 95% confidence interval, —0.05 to 0.34 kg), triceps extensor strength (0.005 kg; —0.17 to 0.18 kg), or grip strength (0.30 kg; 0.00 to 0.59 kg). Gait speed, time to stand five times from a chair, balance, self-reported disability, and incidence of falls (odds ratio, 1.12; 95% confidence interval, 0.87 to 1.44) also did not differ between current users and never users. In addition, current users were similar to past users on all measures. Conclusion: We found no evidence that postmenopausal estrogen use has beneficial effects on muscle strength or neuromuscular function or that it reduces the risk of falling.(Arch Intern Med. 1995;155:293-299) References 1. Evans W. Exercise and muscle function in frail older persons. In: Weindruch R, Hadley E, Ory M, eds. Reducing Frailty and Falls in Older Persons . Springfield, III: Charles C Thomas Publisher; 1991:431-439. 2. Buchner D. Strategies to improve functional status in older adults by increasing skeletal muscle strength: rationale and design. In: Weindruch R, Hadley E, Ory M, ed. Reducing Frailty and Falls in Older Persons . Springfield, III: Charles C Thomas Publisher; 1991:177-186. 3. Nevitt M. Falls in older persons: risk factors and prevention. In: Berg RL, ed. The Second Fifty Years: Promoting Health and Preventing Disability . Washington, DC: National Academy Press, National Academy of Sciences; 1990: 263-290. 4. Evans J. After the fall: consequences and implications of falls by old people. In: Vellas B, Toupet M, Rubenstein L, Albarede J, Christen Y, eds. Falls, Balance and Gait Disorders in the Elderly . Paris, France: Elsevier; 1992:39-53. 5. Timiras P, ed. Physiological Basis of Geriatrics . New York, NY: Macmillan Publishing Co Inc; 1988. 6. Larsson L, Grimby G, Karlsson J. Muscle strength and speed of movement in relation to age and muscle morphology. J Appl Physiol . 1979;46:451-456. 7. Montoye H, Lamphiear D. Grip and arm strength in males and females, age 10 to 69. Res Q . 1977;48:109-120. 8. Thorngren K, Werner C. Normal grip strength. Acta Orthop Scand . 1979;50: 225-259.Crossref 9. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil . 1985;66: 69-74. 10. Vandervoort AA, McComas AJ. Contractile changes in opposing muscles of the human ankle joint with aging. J Appl Physiol . 1986;61:361-367. 11. MacLennan WJ, Hall MRP, Timothy JI, Robinson M. Is weakness in old age due to muscle wasting? Age Ageing . 1980:9:188-192.Crossref 12. Grady D, Halloran B, Cummings S, et al. 1,25-Dihydroxyvitamin D3 and muscle strength in the elderly: a randomized controlled trial. J Clin Endocrinol Metab . 1991;73:1111-1117.Crossref 13. Clement F. Longitudinal and cross-sectional assessments of age changes in physical strength as related to sex, social class, and mental ability. J Gerontol . 1974;29:423-429.Crossref 14. Gross M, McGrain P, Demilio N, Plyler L. Relationship between multiple predictor variables and normal knee torque production. Phys Ther . 1989:69:54-62. 15. Suzuki S, Yamamuro T. Long-term effects of estrogen on rat skeletal muscle. Exp Neurol . 1985;87:291-299.Crossref 16. Swerdloff R, Wang C. Androgen deficiency and aging in men. West J Med . 1993;159:579-585. 17. Cauley J, Petrini A, LaPorte R, et al. The decline of grip strength in the menopause: relationship to physical activity, estrogen use and anthropometric factors. J Chronic Dis . 1987;40:115-120.Crossref 18. Phillips S, Rook K, Siddle N, Bruce S, Woledge R. Muscle weakness in women occurs at an earlier age than in men, but strength is preserved by hormone replacement therapy. Clin Sci . 1993;84:95-98. 19. Cauley J, Gutal J, Kuller L, LeDonne D, Powell J. The epidemiology of serum sex hormones in postmenopausal women. Am J Epidemiol . 1989;129:1120-1131. 20. Winner S, Morgan C, Evans J. Perimenopausal risk of falling and incidence of distal forearm fracture. BMJ . 1989;298:1486-1488.Crossref 21. Cummings S, Black D, Nevitt M, et al. Appendlcular bone density and age predict hip fracture In women: the Study of Osteoporotic Fractures Research Group. JAMA . 1990;263:665-668.Crossref 22. Bohannon R. Test-retest reliability of hand-held dynamometry during a single session of strength assessment. Phys Ther . 1986;66:206-209. 23. Fitti J, Kovar M. The Supplement on Aging to the 1984 National Health Interview Survey. Vital Health Stat 1 . 1987;21:1-115. 24. Cauley J, Cummings S, Black D, Mascioli S, Seeley D. Prevalence and determinants of estrogen replacement therapy In elderly women. Am J Obstet Gynecol . 1990;163:1438-1444.Crossref 25. Paffenbarger RS, Wing AL, Hyde RT. Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol . 1978;108:161-175. 26. Larsson L. Aging in mammalian skeletal muscle. In: Mortimer J, Pirozzolo F, Maletta G, eds. The Aging Motor System . New York, NY: Praeger Scientific; 1982:60-97. 27. Puah J, Bailey C. Effect of ovarian hormones on glucose metabolism in mouse soleus muscle. Endocrinology 1985:117:1136.Crossref 28. Ihemelandu E. Comparison of effect of oestrogen on muscle development of male and female mice. Acta Anat . 1981;110:311-317.Crossref 29. Korobi M, Yamamuro T. Effects of gonadectomy and estrogen administration on rat skeletal muscle. Clin Orthop . 1989;243:306-311. 30. Ihemelandu E. Effect of oestrogen on muscle development of female rabbits. Acta Anat . 1980:108:310-315.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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References (33)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430030087010
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Muscle strength declines with advancing age; the causes of this are uncertain. In women, strength begins to decline around the time of menopause, suggesting that hormonal changes might influence strength. To determine the effect of postmenopausal estrogen use on muscle strength, neuromuscular function, and the risk of falling, we examined 9704 participants aged 65 years or more enrolled in the Study of Osteoporotic Fractures. Methods: We measured hip abductor, triceps extensor, and hand-grip muscle strength, balance, gait speed, and self-reported functional disability. Falls during the first year of follow-up were determined from postcards that participants mailed every 4 months indicating whether they had fallen in the previous 4 months (>99% complete follow-up). Results: After adjusting for age, medications, medical history, and personal habits, current estrogen users did not differ in a clinically meaningful way from those who had never used estrogen on tests of hip abductor strength (mean difference, 0.15 kg; 95% confidence interval, —0.05 to 0.34 kg), triceps extensor strength (0.005 kg; —0.17 to 0.18 kg), or grip strength (0.30 kg; 0.00 to 0.59 kg). Gait speed, time to stand five times from a chair, balance, self-reported disability, and incidence of falls (odds ratio, 1.12; 95% confidence interval, 0.87 to 1.44) also did not differ between current users and never users. In addition, current users were similar to past users on all measures. Conclusion: We found no evidence that postmenopausal estrogen use has beneficial effects on muscle strength or neuromuscular function or that it reduces the risk of falling.(Arch Intern Med. 1995;155:293-299) References 1. Evans W. Exercise and muscle function in frail older persons. In: Weindruch R, Hadley E, Ory M, eds. Reducing Frailty and Falls in Older Persons . Springfield, III: Charles C Thomas Publisher; 1991:431-439. 2. Buchner D. Strategies to improve functional status in older adults by increasing skeletal muscle strength: rationale and design. In: Weindruch R, Hadley E, Ory M, ed. Reducing Frailty and Falls in Older Persons . Springfield, III: Charles C Thomas Publisher; 1991:177-186. 3. Nevitt M. Falls in older persons: risk factors and prevention. In: Berg RL, ed. The Second Fifty Years: Promoting Health and Preventing Disability . Washington, DC: National Academy Press, National Academy of Sciences; 1990: 263-290. 4. Evans J. After the fall: consequences and implications of falls by old people. In: Vellas B, Toupet M, Rubenstein L, Albarede J, Christen Y, eds. Falls, Balance and Gait Disorders in the Elderly . Paris, France: Elsevier; 1992:39-53. 5. Timiras P, ed. Physiological Basis of Geriatrics . New York, NY: Macmillan Publishing Co Inc; 1988. 6. Larsson L, Grimby G, Karlsson J. Muscle strength and speed of movement in relation to age and muscle morphology. J Appl Physiol . 1979;46:451-456. 7. Montoye H, Lamphiear D. Grip and arm strength in males and females, age 10 to 69. Res Q . 1977;48:109-120. 8. Thorngren K, Werner C. Normal grip strength. Acta Orthop Scand . 1979;50: 225-259.Crossref 9. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil . 1985;66: 69-74. 10. Vandervoort AA, McComas AJ. Contractile changes in opposing muscles of the human ankle joint with aging. J Appl Physiol . 1986;61:361-367. 11. MacLennan WJ, Hall MRP, Timothy JI, Robinson M. Is weakness in old age due to muscle wasting? Age Ageing . 1980:9:188-192.Crossref 12. Grady D, Halloran B, Cummings S, et al. 1,25-Dihydroxyvitamin D3 and muscle strength in the elderly: a randomized controlled trial. J Clin Endocrinol Metab . 1991;73:1111-1117.Crossref 13. Clement F. Longitudinal and cross-sectional assessments of age changes in physical strength as related to sex, social class, and mental ability. J Gerontol . 1974;29:423-429.Crossref 14. Gross M, McGrain P, Demilio N, Plyler L. Relationship between multiple predictor variables and normal knee torque production. Phys Ther . 1989:69:54-62. 15. Suzuki S, Yamamuro T. Long-term effects of estrogen on rat skeletal muscle. Exp Neurol . 1985;87:291-299.Crossref 16. Swerdloff R, Wang C. Androgen deficiency and aging in men. West J Med . 1993;159:579-585. 17. Cauley J, Petrini A, LaPorte R, et al. The decline of grip strength in the menopause: relationship to physical activity, estrogen use and anthropometric factors. J Chronic Dis . 1987;40:115-120.Crossref 18. Phillips S, Rook K, Siddle N, Bruce S, Woledge R. Muscle weakness in women occurs at an earlier age than in men, but strength is preserved by hormone replacement therapy. Clin Sci . 1993;84:95-98. 19. Cauley J, Gutal J, Kuller L, LeDonne D, Powell J. The epidemiology of serum sex hormones in postmenopausal women. Am J Epidemiol . 1989;129:1120-1131. 20. Winner S, Morgan C, Evans J. Perimenopausal risk of falling and incidence of distal forearm fracture. BMJ . 1989;298:1486-1488.Crossref 21. Cummings S, Black D, Nevitt M, et al. Appendlcular bone density and age predict hip fracture In women: the Study of Osteoporotic Fractures Research Group. JAMA . 1990;263:665-668.Crossref 22. Bohannon R. Test-retest reliability of hand-held dynamometry during a single session of strength assessment. Phys Ther . 1986;66:206-209. 23. Fitti J, Kovar M. The Supplement on Aging to the 1984 National Health Interview Survey. Vital Health Stat 1 . 1987;21:1-115. 24. Cauley J, Cummings S, Black D, Mascioli S, Seeley D. Prevalence and determinants of estrogen replacement therapy In elderly women. Am J Obstet Gynecol . 1990;163:1438-1444.Crossref 25. Paffenbarger RS, Wing AL, Hyde RT. Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol . 1978;108:161-175. 26. Larsson L. Aging in mammalian skeletal muscle. In: Mortimer J, Pirozzolo F, Maletta G, eds. The Aging Motor System . New York, NY: Praeger Scientific; 1982:60-97. 27. Puah J, Bailey C. Effect of ovarian hormones on glucose metabolism in mouse soleus muscle. Endocrinology 1985:117:1136.Crossref 28. Ihemelandu E. Comparison of effect of oestrogen on muscle development of male and female mice. Acta Anat . 1981;110:311-317.Crossref 29. Korobi M, Yamamuro T. Effects of gonadectomy and estrogen administration on rat skeletal muscle. Clin Orthop . 1989;243:306-311. 30. Ihemelandu E. Effect of oestrogen on muscle development of female rabbits. Acta Anat . 1980:108:310-315.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 13, 1995

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