Leisure time physical activity and bone mineral density preservation during the menopause transition and postmenopause: a longitudinal cohort analysis from the Study of Women's Health Across the Nation (SWAN)

Gail A Greendale; Nicholas J Jackson; Albert Shieh; Jane A Cauley; Carrie Karvonen-Gutierrez; Kelly R Ylitalo; Kelley Pettee Gabriel; Barbara Sternfeld; Arun S Karlamangla

doi:10.1016/j.lana.2023.100481

Leisure time physical activity and bone mineral density preservation during the menopause transition and postmenopause: a longitudinal cohort analysis from the Study of Women's Health Across the Nation (SWAN)

Lancet Reg Health Am. 2023 Mar 26:21:100481. doi: 10.1016/j.lana.2023.100481. eCollection 2023 May.

Authors

Gail A Greendale¹, Nicholas J Jackson², Albert Shieh¹, Jane A Cauley³, Carrie Karvonen-Gutierrez⁴, Kelly R Ylitalo⁵, Kelley Pettee Gabriel⁶, Barbara Sternfeld⁷, Arun S Karlamangla¹

Affiliations

¹ Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, USA.
² Department of Medicine, Division of General Internal Medicine, UCLA, Los Angeles, CA, USA.
³ Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
⁵ Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA.
⁶ Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
⁷ Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.

Abstract

Background: Whether greater leisure time physical activity (LTPA) is associated with less bone mineral density (BMD) loss during the menopause transition (MT) remains an open question. We hypothesized that: 1) larger increases in LTPA from pre-/early perimenopause (period 1) to late perimenopause/postmenopause (period 2) would be associated with a slower period 2 BMD loss rate; and 2) greater entire-study LTPA levels would be associated with better final absolute BMD (g/cm²).

Methods: Data were from of the Study of Women's Health Across the Nation (1996-2017). Exclusions were: bone beneficial medications, inability to identify start of the MT, and extreme BMD change rates. LTPA measures were a validated ordinal scale and number of metabolic equivalents per hour per week (MET hr wk^-1) from sport/exercise. Multiply adjusted, linear regression models estimated: 1) BMD decline rate (annualized %) as a function of LTPA change; and 2) final BMD as a function of entire-study LTPA.

Findings: Median [p25, p75] MET hr wk^-1 were 4.2 [0.9, 10.1] and 4.9 [1.4, 11.2] in periods 1 and 2, respectively; walking was the commonest activity. In adjusted models (N = 875), greater increases in LTPA ordinal score and MET hr wk^-1 were statistically significantly associated with a slower decline in femoral neck (FN) BMD. Larger entire-study averages of each LTPA measure were statistically significantly related to better final FN and lumbar spine BMD levels.

Interpretation: Findings suggest that LTPA, at modest levels, mitigate MT-related BMD decline and even small increases in intensity, duration or frequency of common activities may lessen bone loss at the population level.

Funding: US-NIH.

Keywords: Bone mineral density; Menopause; Physical activity; Women.

Abstract

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