The role of estrogens in osteosarcopenia: from biology to potential dual therapeutic effects

Abstract

Osteoporosis and sarcopenia are two conditions associated with aging and characterized by a simultaneous decline in bone and muscle mass, respectively. These conditions share common risk factors (genetic, endocrine, nutritional and lifestyle factors) and biological pathways that often co-exist in a syndrome known as osteosarcopenia. Among the endocrine causes, estrogens play a critical role, especially in women. Estrogens have been demonstrated to exert a positive effect on bone and muscle development and maintenance. For this reason, menopause is characterized by a loss in bone mineral density and skeletal muscle quality and quantity. To date, studies indicate a positive effect of hormonal therapy on the prevention and management of osteoporosis, to the point that estrogen is prescribed as a first-line treatment for osteoporosis by the major international authorities. While results on sarcopenia are still disputable, such that estrogens are not recommended to prevent muscle loss in postmenopausal women, increased response to anabolic stimuli with estrogen therapy suggests similar beneficial effects on muscle as seen with bone, particularly when combined with resistance exercise.

雌激素在骨肌减少症中的作用：从生物学到潜在的双重治疗效应 摘要

骨质疏松症和肌肉减少症是两种与衰老相关的疾病, 其特征是骨骼和肉量同时下降。这些疾病具有共同的风险因素（遗传、内分泌、营养和生活方式因素）和生物学因素, 这些因素通常在称为骨肌减少症中共存。在内分泌因素中, 雌激素起着至关重要的作用, 尤其是对女性。雌激素已被证明对骨骼和肌肉的发育和维持有积极作用。因此, 绝经特征是骨密度和骨骼肌质量和数量的降低。迄今为止, 研究表明激素治疗对骨质疏松症的预防和管理具有积极作用, 主要国际权威机构将雌激素作为骨质疏松症的一线治疗药物。虽然针对肌肉减少症的治疗仍有争议, 例如不建议应用雌激素来预防绝经后女性肌肉减少, 但雌激素治疗对骨骼合成代谢刺激的反应增强一样, 对肌肉有类似的有益作用, 尤其是与抗阻运动相结合时。

Keywords:

• Osteosarcopenia
• estrogens
• menopause
• muscle
• bone
• osteoporosis
• sarcopenia

Potential conflict of interest

The authors have no conflict of interest to declare.

Additional information

Funding

This work was supported by the Australian Institute for Musculoskeletal Science (AIMSS) (Seed Grant).