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) - PubMed (original) (raw)

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 et al. Lancet Reg Health Am. 2023.

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.

© 2023 The Authors.

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Conflict of interest statement

All authors declare that they have no financial relationships with any organisation that might have an interest in the submitted work and have no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1

Fig. 1

Derivation of analytic sample for the change-in-BMD outcome.

Fig. 2

Fig. 2

Derivation of analytic sample for the final BMD outcome.

Fig. 3

Fig. 3

a. Model-predicted relation between change in leisure-time phyisical activity (LTPA) ordinal score from period 1 (premenopause & early perimenopause) to period 2 (late perimenopause & postmenopause) and rate of decline in femoral neck (FN) bone mineral density (BMD) during period 2. Mean and SD of change in LPTA score were 0.05 (0.58) units. Values shown on the X-axis are those in the observed range, excluding extreme values (top and bottom 5%). Error bars depict the 95% confidence intervals. b. Model-predicted relation between change in MET hr wk−1 based on top 2 sports/exercises between period 1 and period 2 and rate of decline in FN BMD during period 2. Median and p25, p75 of change in MET hr wk−1 were 0.25 [−1.94, 2.95]. Values shown on the X-axis are those in the observed range, excluding extreme values (top and bottom 5%). Error bars depict the 95% confidence intervals.

Fig. 4

Fig. 4

a. Model-predicted relation between entire-study average LTPA ordinal score and final femoral neck (FN) BMD. Values on the X-axis are those in the observed range. Error bars depict the 95% confidence intervals. Dashed lines illustrate the 25th and 75th percentile values of the LTPA ordinal score and corresponding final FN BMD levels. b. Model-predicted relation between entire-study average MET hr wk−1 from top 2 sports/excericses and final FN BMD. Values on the X-axis are those in the observed range. Error bars depict the 95% confidence intervals. Dashed lines illustrate the 25th and 75th percentile values of MET hr wk−1 and corresponding final BMD levels.

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