Systematic review on the relationship between menopausal hormone replacement therapy, sarcopenia, and...

Whilst the beneficial effect of menopausal hormone replacement therapy (HRT) on osteoporosis is well established, its effect on sarcopenia is less clear. We conducted a systematic review of evidence exploring the relationship between HRT and sarcopenia.

We searched OVID Medline, Embase, CINAHL and Web of Science to 8 August 2024, identifying both in randomised controlled trials (RCTs) and observational studies of community-dwelling women. We excluded articles focussed on androgen therapy, or hormone therapy for indications other than menopause. Our primary outcome was the effect of HRT upon sarcopenia defined by a consensus set of criteria (e.g. the definition proposed by the European Working Group on Sarcopenia in Older People 2). Grip strength, measures of physical performance, and radiological measures of muscle quantity were included as secondary outcomes. Reporting follows PRISMA guidelines.

Searches identified 6090 articles, of which 43 were included in our final analysis. No studies used a consensus definition of sarcopenia. Most used data over 20 years old, with older formulations of HRT, though formulations were inconsistently reported. Of the 15 RCTs included, two of six suggested a beneficial effect on grip strength, one of six on physical performance, and seven of 12 on radiologically assessed muscle quantity. Of the 28 observational studies included, three of 11 suggested a beneficial effect on grip strength, two of seven on physical performance and three of 18 on radiologically assessed muscle quantity. No studies reported detrimental effects on muscle. Risk of bias was high/severe. Observational models seldom adjusted for confounders.

No studies used modern consensus definitions of sarcopenia. For secondary outcomes, there was no consistent evidence of benefit, with methodological flaws, and outmoded HRT formulations.