title: Ultra-low-dose estradiol and norethisterone acetate: effective menopausal symptom relief Postmenopausal hormone therapy and body composition--a substudy of the estrogen plus progestin trial of the Women's Health Initiative. Effects of exercise training and hormone replacement therapy on lean and fat mass in postmenopausal women. Hormone replacement therapy dissociates fat mass and bone mass, and tends to reduce weight gain in early postmenopausal women: a randomized controlled 5-year clinical trial of the Danish Osteoporosis Prevention Study. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Effects of HRT and exercise training on insulin action, glucose tolerance, and body composition in older women. The influence of menopause and hormonal replacement therapy on body cell mass and body fat mass. Operational definitions of sarcopenia and their associations with 5-year changes in falls risk in community-dwelling middle-aged and older adults Effects of ultra-low-dose estrogen therapy on muscle and physical function in older women. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial Postmenopausal hormone replacement therapy prevents central distribution of body fat after menopause. The Physical Activity Scale for the Elderly (PASE): development and evaluation. Muscular transcriptome in postmenopausal women with or without hormone replacement. Sarcopenia: prevalence and prognostic significance in hospitalized patients. Supplementation with DHEA: effect on muscle size, strength, quality of life, and lipids. Obesity and sarcopenia after menopause are reversed by sex hormone replacement therapy. The effect of hormone replacement therapy on appendicular lean tissue mass in early postmenopausal women Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Estrogen/gestagen therapy changes soft tissue body composition in postmenopausal women. Growth hormone and sex steroid administration in healthy aged women and men: a randomized controlled trial. Measurement of body composition in burned children: is there a gold standard? The Minimum Effective Dose of Estrogen for Prevention of Postmenopausal Bone Loss Body composition during treatment with conjugated estrogens with and without medroxyprogesterone acetate: analysis of the women's Health, Osteoporosis, Progestin, Estrogen (HOPE) trial.
abstract: Objective To evaluate the efficacy of two ultra-low-dose 17β-estradiol plus norethisterone acetate ( NETA ) treatment regimens for relieving  menopausal symptoms . Design A total of 577 postmenopausal women were enrolled , in three treatment groups in a double-blind , r and omized , placebo-controlled study of 0.5 mg 17β-estradiol + 0.1 mg NETA or 0.5 mg 17β-estradiol + 0.25 mg NETA or placebo . Participants returned at weeks 4 , 8 , 12 and 24 for climacteric complaint evaluation based on a daily diary vasomotor symptom record . Patients were assessed by the Greene Climacteric Scale and urogenital symptoms were also evaluated . Results Treatment with ultra-low-dose 0.5 mg 17β-estradiol + 0.1 mg NETA ( 0.1 Group ) or 0.5 mg 17β-estradiol + 0.25 mg NETA ( 0.25 Group ) effectively reduced the severity and number of hot flushes within the initial weeks of therapy . Compared to placebo , a rapid , statistically significant decrease in the frequency and severity of hot flushes was achieved by week 3 , followed by further improvement which continued throughout the study . There were no statistically significant differences between the active treatment arms . Conclusions The data show that both ultra-low-dose regimens are effective in reducing the severity and number of hot flushes compared to placebo , with good safety profiles BACKGROUND It has been suggested that hormone therapy may help counter undesirable changes in body composition in older women . OBJECTIVE This study was design ed to test whether estrogen plus progestin ( E+P ) therapy favorably affects age-related changes in body composition in postmenopausal women . DESIGN The sub study was composed of 835 women from the estrogen plus progestin trial of the Women 's Health Initiative who were r and omly assigned to receive either  E+P therapy ( n = 437 ) or placebo ( n = 398 ) . The women had a mean age of 63.1 y and , on average , were 13.8 y past menopause . More than 17 % of the participants were from an ethnic minority . No significant differences in baseline body composition ( measured with dual-energy X-ray absorptiometry ) by intervention assignment were observed . RESULTS After 3 y of intervention , the women who received active E+P therapy lost less lean soft tissue mass ( -0.04 kg ) than did the women who received placebo ( -0.44 kg ; P = 0.001 ) . Additionally , the women in the E+P group had less upper-body fat distribution than did the women in the placebo group ( change in ratio of trunk to leg fat mass : -0.025 for the E+P group and 0.004 for the placebo group ; P = 0.003 ) . A sensitivity analysis , which was conducted on the women who took > or = 80 % of the study medication during the intervention period , corroborated the findings from the intent-to-treat analysis . CONCLUSIONS A 3-y E+P intervention significantly reduced both the loss of lean soft tissue mass and the ratio of trunk to leg fat mass  in postmenopausal women . However , the effect sizes were small , and whether these changes in body composition lead to significant health benefits remains to be confirmed BACKGROUND Menopause is associated with decreases in lean mass and increases in fat mass . Serum hormone levels and hormone replacement therapy ( HRT ) may modify the effects of exercise training on body composition in postmenopausal women . METHODS We assessed the changes in total body and regional lean soft tissue and fat mass ( using dual-energy x-ray absorptiometry ) in 94 sedentary postmenopausal women , aged 40 - 65 years , after 12 months of resistance and weight-bearing aerobic exercise training . Women currently on oral HRT ( n = 39 ) and not on HRT ( n = 55 ) were r and omized within groups to exercise and no exercise , result ing in four groups : exercise + HRT ( n = 20 ) , HRT ( n = 22 ) , exercise ( n = 24 ) , and control ( n = 28 ) . Fasting blood sample s were measured for resting serum total levels of estrone , estradiol , cortisol , and rostenedione , growth hormone , and insulin-like growth factor 1 at baseline and 12 months . RESULTS We found significant effects of exercise on increases in total body , arm , and leg lean soft tissue mass , and decreases in leg fat mass and percentage of body fat . There were no interaction effects of exercise and HRT on the changes in muscle strength and body composition . No significant changes in total hormone levels were found after 12 months . CONCLUSIONS Exercise training result ed in significant beneficial changes in lean soft tissue and fat mass in early postmenopausal women . These changes in body composition were neither influenced by prolonged HRT use nor accompanied by changes in total levels of the hormones determined in this study The aim of this study was to study the influence of hormone replacement therapy ( HRT ) on weight changes , body composition , and bone mass in early postmenopausal women in a partly r and omized comprehensive cohort study design . A total of 2016 women ages 45 - 58 years from 3 months to 2 years past last menstrual bleeding were included . One thous and were r and omly assigned to HRT or no HRT in an open trial , whereas the others were allocated according to their preferences . All were followed for 5 years for body weight , bone mass , and body composition measurements . Body weight increased less over the 5 years in women r and omized to HRT ( 1.94 + /- 4.86 kg ) than in women r and omized to no HRT ( 2.57 + /- 4.63 , p = 0.046 ) . A similar pattern was seen in the group receiving HRT or not by their own choice . The smaller weight gain in women on HRT was almost entirely caused by a lesser gain in fat . The main determinant of the weight gain was a decline in physical fitness . Women opting for HRT had a significantly lower body weight at inclusion than the other participants , but the results in the self-selected part of the study followed the pattern found in the r and omized part . The change in fat mass was the strongest predictor of bone changes in untreated women , whereas the change in lean body mass was the strongest predictor when HRT was given . Body weight increases after the menopause . The gain in weight is related to a decrease in working capacity . HRT is associated with a smaller increase in fat mass after menopause . Fat gain protects against bone loss in untreated women but not in HRT-treated women . The data suggest that women 's attitudes to HRT are more positive if they have low body weight , but there is no evidence that the conclusions in this study are skewed by selection bias Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The independent and combined effects of exercise training and hormone replacement therapy ( HRT ) on body composition , fat distribution , glucose tolerance , and insulin action were studied in postmenopausal women , aged 68 + /- 5 yr , assigned to control ( n = 19 ) , exercise ( n = 18 ) , HRT ( n = 15 ) , and exercise + HRT ( n = 16 ) groups . The exercise consisted of 2 mo of flexibility exercises followed by 9 mo of endurance exercise . HRT was conjugated estrogens 0.625 mg/day and trimonthly medroxyprogesterone acetate 5 mg/day for 13 days . Total and regional body composition were measured by dual-energy X-ray absorptiometry . Serum glucose and insulin responses were measured during a 2-h oral glucose tolerance test . There were significant main effects of exercise on reductions in total and regional ( trunk , arms , legs ) fat mass , increase in leg fat-free mass , and improvements in glucose tolerance and insulin action . There were significant main effects of HRT on the reduction of total fat mass ( HRT , -3.0 + /- 4.0 kg ; no HRT , -1.3 + /- 2.6 kg ) , with a strong trend for reductions in trunk and leg fat mass ( both P = 0.07 ) . There was also a significant improvement in insulin action in response to HRT . These results suggest that there are independent and additive effects of exercise training and HRT on the reduction in fat mass and improvement in insulin action in postmenopausal women ; the effect of HRT on insulin action may be mediated , in part , through changes in central adiposity OBJECTIVE Our purpose was to determine the efficacy of dietary calcium augmentation in the prevention of early postmenopausal bone density loss in comparison with hormonal replacement therapy and placebo . STUDY DESIGN A three-arm parallel r and omized trial comparing the influence of placebo , dietary calcium augmentation , and estrogen-progesterone-calcium in 118 women who were within 6 years of menopause was conducted .  Dual photon absorptiometry was performed annually to measure lean and fat mass . In addition , the ratio of fat in the trunk/extremities was measured . RESULTS Body weight increased in each group . The increase was statistically significant in the hormone replacement group ( 0.8 kg/year ) . The percent of body fat increased in each group from baseline measurements , with the greatest increase in the hormonal replacement group . There was a decline in the extremity/trunk ratio in the hormonal replacement group as a result of a relatively greater increase in the trunk fat mass . There was a rapid rate of loss in lean body mass that was equal among groups . CONCLUSIONS Menopause is associated with a gain in fat mass and a loss of lean body mass , but these changes in body composition are not prevented by hormone replacement therapy Summary Sarcopenia may be diagnosed in the clinic using operational definitions based on low muscle mass or function . This prospect i ve , population -based study revealed that sex-specific associations may exist between operational definitions of sarcopenia and falls in community-dwelling middle-aged and older adults . Introduction The objective of this study is to verify associations between sarcopenia and falls risk and to determine changes in sarcopenia prevalence over 5 years in middle-aged and older men and women according to different anthropometric and performance-based operational definitions . Methods N = 681 volunteers ( 48 % female ; mean ± SD age 61.4 ± 7.0 years ) participated in baseline and follow-up assessment s ( mean 5.1 ± 0.5 years later ) . Appendicular lean mass ( ALM ) was assessed by dual-energy X-ray absorptiometry , h and grip ( HGS ) and lower-limb ( LLS ) strength were assessed by dynamometry , and falls risk was determined using the physiological profile assessment . Anthropometric definitions ( ALM/height squared [ ALM – H ] , ALM/weight × 100 and a residuals method [ ALM – R ] ) and performance-based definitions ( HGS , LLS and upper- and lower-limb muscle quality [ LMQ ] ) of sarcopenia were examined . The lowest 20 % of the sex-specific distribution for each definition at baseline was classified as sarcopenia . Results Sarcopenia prevalence increased after 5 years for all operational definitions except ALM – H ( men : −4.0 % ; women : −5.5 % ) . Men classified with sarcopenia according to anthropometric definitions , and women classified with sarcopenia according to performance-based definitions , had significant increases in falls risk over 5 years ( all P < 0.05 ) compared to individuals without sarcopenia . Significant sex interactions were observed for ALM-R , LLS and LMQ ( all P < 0.05 ) definitions . Conclusions Sarcopenia prevalence generally increases at a higher rate when assessed using performance-based definitions . Sarcopenia is associated with increases in falls risk over 5 years in community-dwelling middle-aged and older adults , but sex-specific differences may exist according to different anthropometric or performance-based definitions OBJECTIVES To determine the effects of ultra-low-dose hormone therapy on muscle mass and physical function in community-dwelling women . DESIGN Double-blind , placebo-controlled trial . SETTING Clinical research center in Connecticut . PARTICIPANTS Healthy , community-dwelling women aged 65 and older ( n=167 ) . INTERVENTION Eligible women were r and omly assigned to treatment with 0.25 mg 17-beta estradiol or placebo for 36 months . All women ( estradiol or placebo ) with an intact uterus received micronized progesterone 100 mg/d for 2 weeks every 6 months . All participants received 1,300 mg elemental calcium with 1,000 IU vitamin D per day . MEASUREMENTS Appendicular skeletal muscle mass ( ASM ) , lean body mass ( LBM ) , and percentage body fat were measured using dual x-ray absorptiometry . Sarcopenia was defined as skeletal muscle mass ( ASM/height2 ) 2 st and ard deviations or less than young , healthy reference population mean . Physical activity ( Physical Activity Scale in the Elderly ( PASE ) ) and performance were measured . Serum estrone , estradiol , and sex hormone-binding globulin were measured . RESULTS The prevalence of sarcopenia at baseline was 13 % . There were no baseline differences between groups except for PASE score and chair rise time , in which the estrogen group had better performance . No changes in ASM , LBM , percentage of body fat , or physical performance were found after 3 years of estrogen therapy . CONCLUSION Sarcopenia was present in 13 % of this group of community-dwelling , postmenopausal older women . Ultra-low-dose estrogen therapy neither improves nor harms ASM . Similarly , no changes in body fat or physical performance were detected CONTEXT Despite decades of accumulated observational evidence , the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain . OBJECTIVE To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States . DESIGN Estrogen plus progestin component of the Women 's Health Initiative , a r and omized controlled primary prevention trial ( planned duration , 8.5 years ) in which 16608 postmenopausal women aged 50 - 79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993 - 1998 . INTERVENTIONS Participants received conjugated equine estrogens , 0.625 mg/d , plus medroxyprogesterone acetate , 2.5 mg/d , in 1 tablet ( n = 8506 ) or placebo ( n = 8102 ) . MAIN OUTCOMES MEASURES The primary outcome was coronary heart disease ( CHD ) ( nonfatal myocardial infa rct ion and CHD death ) , with invasive breast cancer as the primary adverse outcome . A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke , pulmonary embolism ( PE ) , endometrial cancer , colorectal cancer , hip fracture , and death due to other causes . RESULTS On May 31 , 2002 , after a mean of 5.2 years of follow-up , the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits . This report includes data on the major clinical outcomes through April 30 , 2002 . Estimated hazard ratios ( HRs ) ( nominal 95 % confidence intervals [ CIs ] ) were as follows : CHD , 1.29 ( 1.02 - 1.63 ) with 286 cases ; breast cancer , 1.26 ( 1.00 - 1.59 ) with 290 cases ; stroke , 1.41 ( 1.07 - 1.85 ) with 212 cases ; PE , 2.13 ( 1.39 - 3.25 ) with 101 cases ; colorectal cancer , 0.63 ( 0.43 - 0.92 ) with 112 cases ; endometrial cancer , 0.83 ( 0.47 - 1.47 ) with 47 cases ; hip fracture , 0.66 ( 0.45 - 0.98 ) with 106 cases ; and death due to other causes , 0.92 ( 0.74 - 1.14 ) with 331 cases . Corresponding HRs ( nominal 95 % CIs ) for composite outcomes were 1.22 ( 1.09 - 1.36 ) for total cardiovascular disease ( arterial and venous disease ) , 1.03 ( 0.90 - 1.17 ) for total cancer , 0.76 ( 0.69 - 0.85 ) for combined fractures , 0.98 ( 0.82 - 1.18 ) for total mortality , and 1.15 ( 1.03 - 1.28 ) for the global index . Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events , 8 more strokes , 8 more PEs , and 8 more invasive breast cancers , while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures . The absolute excess risk of events included in the global index was 19 per 10 000 person-years . CONCLUSIONS Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women .  All-cause mortality was not affected during the trial . The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases , and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD The reduction in cardiovascular risk induced by hormone replacement therapy is only partly explained by changes in serum lipids and lipoproteins . As body composition and body fat distribution in particular are independent predictors of cardiovascular disease , we investigated the effect of postmenopausal hormone therapy on body composition parameters directly measured . Sixty-two early postmenopausal women were followed up for 2 years in a prospect i ve , r and omized , placebo-controlled study . We found that combined estrogen-progestogen therapy prevented the increase in abdominal fat after menopause ( P less than .05 ) , and that this effect was independent of the effect on serum lipids and lipoproteins . The therapy reduced postmenopausal bone loss significantly ( P less than .001 ) , whereas it did not have a statistically significant influence on total body fat mass or total lean body mass . The findings of the present study suggest that some of the protective impact of postmenopausal hormone therapy on cardiovascular disease may be explained by the effect on body composition , in particular abdominal fat A Physical Activity Scale for the Elderly ( PASE ) was evaluated in a sample of community-dwelling , older adults . Respondents were r and omly assigned to complete the PASE by mail or telephone before or after a home visit assessment . Item weights for the PASE were derived by regressing a physical activity principal component score on responses to the PASE . The component score was based on 3-day motion sensor counts , a 3-day physical activity dairy and a global activity self- assessment . Test-retest reliability , assessed over a 3 - 7 week interval , was 0.75 ( 95 % CI = 0.69 - 0.80 ) . Reliability for mail administration ( r = 0.84 ) was higher than for telephone administration ( r = 0.68 ) . Construct validity was established by correlating PASE scores with health status and physiologic measures . As hypothesized , PASE scores were positively associated with grip strength ( r = 0.37 ) , static balance ( r = + 0.33 ) , leg strength ( r = 0.25 ) and negatively correlated with resting heart rate ( r = -0.13 ) , age ( r = -0.34 ) and perceived health status ( r = -0.34 ) ; and overall Sickness Impact Profile score ( r = -0.42 ) . The PASE is a brief , easily scored , reliable and valid instrument for the assessment of physical activity in epidemiologic studies of older people The loss of muscle mass and strength with aging is well characterized , but our knowledge of the molecular mechanisms underlying the development of sarcopenia remains incomplete . Although menopause is often accompanied with first signs of age-associated changes in muscle structure and function , the effects of hormone replacement therapy ( HRT ) or menopause-related decline in estrogen production in the muscles of postmenopausal women is not well understood . Furthermore the knowledge of the global transcriptional changes that take place in skeletal muscle in relation to estrogen status has thus far been completely lacking . We used a r and omized double-blinded study design together with an explorative microarray experiment to characterize possible effects of continuous , combined HRT and estrogen deprivation on the skeletal muscle of fifteen women . Here , we report the differential response of both Gene Ontology-annotated biological processes and some individual genes responding differentially to the use or non-use of HRT . Our results revealed transcription level changes in , for example , muscle protein and energy metabolism . In particular , the ubiquitine-proteosome system was found to be effected at several levels . HRT seemed to partially counteract the postmenopause-related transcriptional changes . Our results suggest that during the early postmenopausal years , when there is no counteracting medication available , muscle transcriptome changes notably , whereas HRT appears to slow down this phenomenon and could therefore aid in maintaining proper muscle mass and function after menopause BACKGROUND Sarcopenia is prevalent in older population s with many causes and varying outcomes however information for use in clinical practice is still lacking . AIMS The aim of this report is to identify the clinical determinants and prognostic significance of sarcopenia in a cohort of hospitalized acutely ill older patients . METHODS Four hundred and thirty two r and omly selected patients had their baseline clinical characteristic data assessed within 72 h of admission , at 6 weeks and at 6 months .  Nutritional status was assessed from anthropometric and biochemical data . Sarcopenia was diagnosed from low muscle mass and low muscle strength-h and grip using anthropometric measures based on the European Working Group criteria . RESULTS Compared with patients without sarcopenia , those diagnosed with sarcopenia 44 ( 10 % ) were more likely to be older , have more depression symptoms and lower serum albumin concentration . The length of hospital stay ( LOS ) was significantly longer in patients diagnosed with sarcopenia compared with patients without sarcopenia [ mean ( SD ) LOS 13.4 ( 8.8 ) versus 9.4 ( 7 ) days respectively , p = 0.003 ] . The risk of non-elective readmission in the 6 months follow up period was significantly lower in patients without sarcopenia compared with those diagnosed with sarcopenia ( adjusted hazard ratio .53 ( 95 % CI : .32 to .87 , p = 0.013 ) . The death rate was also lower in patients without sarcopenia 38/388 ( 10 % ) , compared with those with sarcopenia 12/44 ( 27 % ) , p-value = .001 . CONCLUSION Older people with sarcopenia have poor clinical outcome following acute illness compared with those without sarcopenia OBJECTIVE To evaluate the effects of combination estrogen/ and rogen therapy on muscle mass , strength and endurance , serum hormone and lipid profiles , and quality of life measures in postmenopausal women . METHODS Prospect i ve , r and omized , placebo-controlled pilot study at a tertiary care medical center . Fifty postmenopausal women were r and omized to a 12-week course of ( 1 ) dehydroepi and rostenedione ( DHEA ) 50 mg daily , ( 2 ) conjugated equine estrogen ( CEE ) 0.625 mg daily , ( 3 ) DHEA 50 mg+CEE 0.625 mg daily , or ( 4 ) placebo . Main outcome measures of lower extremity muscle ( calf ) mass , functional muscle parameters , serum hormone and lipid levels , and quality of life ( QOL ) were obtained at baseline and after treatment . Statistical analysis compared percent change from baseline values and treatment differences among outcomes . RESULTS Significant increases in mean DHEA , DHEA sulfate ( DHEA-S ) , testosterone , and and rostenedione levels were noted with DHEA alone or combined DHEA/CEE treatments when compared with placebo . Compared with no hormone therapy , none of the supplemental hormone groups caused significant changes in muscle mass , muscle strength , muscle endurance , feelings of well-being , sleep , or sexual function . CONCLUSIONS And rogen replacement therapy , with DHEA , to menopausal women increases serum and rogen levels without any appreciable effect on muscle cross-sectional area , muscle strength , muscle function , or improvement in health-related QOL OBJECTIVE Menopause is linked to an increase in fat mass and a decrease in lean mass exceeding age-related changes , possibly related to reduced output of ovarian steroids . In this study we examined the effect of combined postmenopausal hormone replacement therapy ( HRT ) on the total and regional distribution of fat and lean body mass . RESEARCH METHODS AND PROCEDURES Sixteen healthy postmenopausal women ( age : 55 + /- 3 years ) were studied in a placebo-controlled , crossover study and were r and omized to 17beta estradiol plus cyclic norethisterone acetate ( HRT ) or placebo in two 12-week periods separated by a 3-month washout . Total and regional body composition was measured by DXA at baseline and in the 10th treatment week in both periods . Changes were compared by a paired Student 's t test . RESULTS The change in body weight during HRT was equal to the change during placebo ( -24.6 g vs. -164 g , p = 0.42 ) , but relative fat mass was significantly reduced ( -0.5 % vs. + 1.24 % , p < 0.01 ) . During HRT , compared with during placebo , lean body mass increased ( + 347 g vs. -996 g , p < 0.01 ) and total fat mass decreased ( -400 g vs. + 836 g , p = 0.06 ) . Total bone mineral content increased ( + 28.9 g vs. -4.4 g , p = 0.04 ) and abdominal fat decreased ( -185 g vs. + 253 g , p = 0.04 ) during HRT compared with placebo . DISCUSSION HRT is linked to the reversal of both menopause-related obesity and loss of lean mass , without overall change in body weight . The increase in lean body mass during HRT is likely explained by muscle anabolism , which in turn , prevents disease in the elderly Objective The impact of hormone replacement therapy ( HRT ) on skeletal muscle mass is still a controversial issue in women 's health . Some authors hypothesize anabolic effects , others catabolic . These hypotheses , however , await confirmation by longitudinal observations based on more direct measurements of muscle mass . The aim of the present preliminary study was to evaluate the effect of a 3-year HRT program on appendicular lean tissue mass ( LTMA ) in early postmenopausal women aged 45–54 years . Design This was a r and omized , double-blind and placebo-controlled trial . Women received HRT with 2 mg estradiol valerate combined either continuously with 1 mg cyproterone acetate ( days 1–28;n = 15 ) or sequentially with 75 & mgr;g levonorgestrel ( days 17–28;n = 15 ) , or placebo ( n = 18 ) . Serum estradiol was measured by radioimmunoassay . LTMA was measured by dual photon absorptiometry ( baseline ) and dual energy X-ray absorptiometry ( years 2 and 3 ) . Results Baseline serum estradiol did not show significant correlation with the respective LTMA ( r = 0.018 , p = 0.88 , n = 75 ) . Cross-sectional analysis found no significant differences between the intervention groups at any time points . The longitudinal changes between years 2 and 3 showed a trend toward decreasing LTMA in those receiving HRT ( −0.08 ± 0.12 kg , n = 30 ) compared to those receiving placebo ( 0.12 ± 0.25 kg , n = 18 , p = 0.44 ) . Conclusions The present preliminary study did not find significant effects on LTMA caused by HRT . The trends toward decreasing LTMA in the HRT groups might suggest catabolic rather than anabolic effects . These trends , however , await confirmation by larger clinical trials BACKGROUND AND AIMS sarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals . We evaluated the impact of sarcopenia on the risk of all-cause death in a population of frail older persons living in community . METHODS we analysed data from the Aging and Longevity Study , a prospect i ve cohort study that collected data on all subjects aged 80 years and older residing in the Sirente geographic area ( n = 364 ) . The present analysis was conducted among those subjects who were between 80 and 85 years of age at the time of the baseline assessment ( n = 197 ) . The main outcome measure was all-cause mortality over 7-year follow-up . According to the European Working Group on Sarcopenia in Older People ( EWGSOP ) criteria , the diagnosis of sarcopenia required the documentation of low muscle mass and the documentation of either low muscle strength or low physical performance . Cox proportional regression models were used to estimate crude and adjusted hazard ratios and 95 % confidence intervals of death by the presence of sarcopenia . RESULTS using the EWGSOP-suggested criteria , 43 subjects with sarcopenia ( 21.8 % ) were identified . During the 7-year follow-up , 29 ( 67.4 % ) participants died among subjects with sarcopenia compared with 63 subjects ( 41.2 % ) without sarcopenia ( P < 0.001 ) . After adjusting for potential confounders including age , gender , education , activities of daily living ( ADL ) impairment , body mass index , hypertension , congestive heart failure , chronic obstructive pulmonary disease , number of diseases , TNF-α , participants with sarcopenia had a higher risk of death for all causes compared with non-sarcopenic subjects ( HR : 2.32 , 95 % CI : 1.01 - 5.43 ) . CONCLUSIONS our results obtained from a representative sample of very old and frail subjects show that sarcopenia is associated with mortality , independently of age and other clinical and functional variables The long-term effect of percutaneous and oral estrogen replacement therapy on soft tissue body composition was examined in a two-year , placebo-controlled study with 110 early postmenopausal women . The women were allocated to four treatment groups : ( 1 ) oral cyclical combination of estradiol valerate and cyproterone acetate , ( 2 ) oral placebo , ( 3 ) percutaneous 17 beta-estradiol , supplemented by oral progesterone during the second year , or ( 4 ) percutaneous placebo cream .  Total-body lean body mass ( LBM ) and fat mass ( FM ) were measured by dual photon ( 153Gd ) absorptiometry once a year , and the fat layer in the distal forearm ( FATarm ) was measured every 3 months by single photon ( 125I ) absorptiometry . Both hormone therapies prevented an increase in FATarm , as observed in the placebo groups . A similar pattern was seen for FM , body weight , and skin-fold thickness ( measured once a year by mechanical calipers ) , whereas LBM was unaffected by the therapy . Hormonal replacement therapy prevents the age-related increase in body fat observed after the menopause CONTEXT Hormone administration to elderly individuals can increase lean body mass ( LBM ) and decrease fat , but interactive effects of growth hormone ( GH ) and sex steroids and their influence on strength and endurance are unknown . OBJECTIVE To evaluate the effects of recombinant human GH and /or sex steroids on body composition , strength , endurance , and adverse outcomes in aged persons . DESIGN , SETTING , AND PARTICIPANTS A 26-week r and omized , double-blind , placebo-controlled parallel-group trial in healthy , ambulatory , community-dwelling US women ( n = 57 ) and men ( n = 74 ) aged 65 to 88 years recruited between June 1992 and July 1998 . INTERVENTIONS Participants were r and omized to receive GH ( starting dose , 30 micro g/kg , reduced to 20 micro g/kg , subcutaneously 3 times/wk ) + sex steroids ( women : transdermal estradiol , 100 micro g/d , plus oral medroxyprogesterone acetate , 10 mg/d , during the last 10 days of each 28-day cycle [ HRT ] ; men : testosterone enanthate , biweekly intramuscular injections of 100 mg ) ( n = 35 ) ; GH + placebo sex steroid ( n = 30 ) ; sex steroid + placebo GH ( n = 35 ) ; or placebo GH + placebo sex steroid ( n = 31 ) in a 2 x 2 factorial design . MAIN OUTCOME MEASURES Lean body mass , fat mass , muscle strength , maximum oxygen uptake ( VO(2)max ) during treadmill test , and adverse effects . RESULTS In women , LBM increased by 0.4 kg with placebo , 1.2 kg with HRT ( P = .09 ) , 1.0 kg with GH ( P = .001 ) , and 2.1 kg with GH + HRT ( P<.001 ) . Fat mass decreased significantly in the GH and GH + HRT groups . In men , LBM increased by 0.1 kg with placebo , 1.4 kg with testosterone ( P = .06 ) , 3.1 kg with GH ( P<.001 ) , and 4.3 kg with GH + testosterone ( P<.001 ) . Fat mass decreased significantly with GH and GH + testosterone . Women 's strength decreased in the placebo group and increased nonsignificantly with HRT ( P = .09 ) , GH ( P = .29 ) , and GH + HRT ( P = .14 ) . Men 's strength also did not increase significantly except for a marginally significant increase of 13.5 kg with GH + testosterone ( P = .05 ) . Women 's VO(2)max declined by 0.4 mL/min/kg in the placebo and HRT groups but increased with GH ( P = .07 ) and GH + HRT ( P = .06 ) . Men 's VO(2)max declined by 1.2 mL/min/kg with placebo and by 0.4 mL/min/kg with testosterone ( P = .49 ) but increased with GH ( P = .11 ) and with GH + testosterone ( P<.001 ) . Changes in strength ( r = 0.355 ; P<.001 ) and in VO(2)max ( r = 0.320 ; P = .002 ) were directly related to changes in LBM . Edema was significantly more common in women taking GH ( 39 % vs 0 % ) and GH + HRT ( 38 % vs 0 % ) . Carpal tunnel symptoms were more common in men taking GH + testosterone ( 32 % vs 0 % ) and arthralgias were more common in men taking GH ( 41 % vs 0 % ) . Diabetes or glucose intolerance occurred in 18 GH-treated men vs 7 not receiving GH ( P = .006 ) . CONCLUSIONS In this study , GH with or without sex steroids in healthy , aged women and men increased LBM and decreased fat mass .  Sex steroid + GH increased muscle strength marginally and VO ( 2)max in men , but women had no significant change in strength or cardiovascular endurance . Because adverse effects were frequent ( importantly , diabetes and glucose intolerance ) , GH interventions in the elderly should be confined to controlled studies BACKGROUND Maintaining lean body mass ( LBM ) after a severe burn is an essential goal of modern burn treatment . An accurate determination of LBM is necessary for short- and long-term therapeutic decisions . The aim of this study was to compare 2 measurement methods for body composition , whole-body potassium counting ( K count ) and dual x-ray absorptiometry ( DEXA ) , in a large prospect i ve clinical trial in severely burned pediatric patients . METHODS Two-hundred seventy-nine patients admitted with burns covering 40 % of total body surface area ( TBSA ) were enrolled in the study . Patients enrolled were  controls  or received  long-term treatment with recombinant human growth hormone ( rhGH ) . Near-simultaneous measurements of LBM with DEXA and fat-free mass ( FFM ) with K count were performed at hospital discharge and at 6 , 9 , 12 , 18 , and 24 months post injury . Results were correlated using Pearson 's regression analysis . Agreement between the 2 methods was analyzed with the Bl and -Altman method . RESULTS Age , gender distribution , weight , burn size , and admission time from injury were not significantly different between control and treatment groups . rhGH and control patients at all time points postburn showed a good correlation between LBM and FFM measurements ( R(2 ) between 0.9 and 0.95 ) . Bl and -Altman revealed that the mean bias and 95 % limits of agreement depended only on patient weight and not on treatment or time postburn . The 95 % limits ranged from 0.1 + /- 2.9 kg for LBM or FFM in 7- to 18-kg patients to 16.3 + /- 17.8 kg for LBM or FFM in patients > 60 kg . CONCLUSIONS DEXA can provide a sufficiently accurate determination of LBM and changes in body composition , but a correction factor must be included for older children and adolescents with more LBM . DEXA scans are easier , cheaper , and less stressful for the patient , and this method should be used rather than the K count In a controlled single blind study to determine the minimal effective dose of estrogen for protection against bone loss , conjugated equine estrogens in doses of 0.625 and 1.25 mg per day were equally effective in reducing  bone loss in postmenopausal and oophorectomized women when bone mass was estimated by single-photon absorptiometry or radiogrammetry . Daily dose levels of less than 0.625 mg were essentially ineffective . Fifty percent response level was calculated to be 0.45 mg per day . Concomitant biochemical effects , reduction in urine calcium and hydroxyproline , were compatible with the observed effects on bone mineral OBJECTIVE The objective of the study was to determine the effects of several doses of conjugated estrogens ( CE ) and CE plus medroxyprogesterone acetate ( MPA ) on body composition ( BC ) . STUDY DESIGN This was a r and omized , double-blind , placebo-controlled sub study of the Women 's Health , Osteoporosis , Progestin , Estrogen ( HOPE ) trial . Healthy women ( n = 822 , 1 - 4 years after menopause ) were r and omly assigned to receive the following treatments daily for 2 years : CE , 0.625 mg ; CE , 0.625 mg , and MPA , 2.5 mg ; CE , 0.45 mg ; CE , 0.45 mg , and MPA , 2.5 mg ; CE , 0.45 mg , and MPA , 1.5 mg ; CE , 0.3 mg ; CE , 0.3 mg , and MPA , 1.5 mg ; or placebo .  Body weight ( BW ) was assessed every 3 - 4 cycles and fat body mass ( FBM ) , lean body mass ( LBM ) , and percent body fat ( PBF ) at cycles 6 , 13 , 19 , and 26 . RESULTS In the placebo group , BW , FBM , and PBF increased at each visit during the study . Changes in these parameters were smaller in the active groups . These effects were independent of CE dose and the presence of MPA . Changes in LBM were small and comparable across groups . CONCLUSION Treatment with CE or CE and MPA for up to 2 years does not affect BC
target: Conclusions and Relevance This systematic review and meta- analysis did not show a significant beneficial or detrimental association of HT with muscle mass .
background: Importance Hormone therapy ( HT ) has been suggested for protection against age-related muscle weakness in women .
  However , the potential for HT-associated health risks necessitates a better underst and ing of the direction and magnitude of the association between HT and health outcomes , such as lean body mass ( LBM ) .
  Objective To determine whether HT was associated with reduced LBM loss compared with not receiving HT  among postmenopausal women aged 50 years and older .