Effects of 20-mg oestradiol implant therapy on bone mineral density, fat distribution and muscle mass in postmenopausal women

Analysis of Risk Factors for the Association of Sarcopenia in Patients with Type 2 Diabetes Mellitus

Background

Previous studies have shown that the prevalence of sarcopenia in patients with type 2 diabetes mellitus (T2DM) has increased significantly over the years. However, the risk factors for the association of sarcopenia in patients with T2DM are unknown. Therefore, we attempted to investigate the risk factors through measurement and analysis of the patients' data from April 2020 to April 2022.

Methods

A total of 334 hospitalized patients with T2DM were divided into sarcopenia group (n=101) and non-sarcopenia group (n=233). Clinical factors were compared between the two groups and also between the two genders. Receiver operating characteristic curve (ROC) was used to analyze the ROC diagnostic ability of related factors in sarcopenia.

Results

(1) Among the 334 patients, the overall prevalence of sarcopenia was 30.2%; 41.3% in men and 20.1% in women. (2) The multifactorial logistic regression analysis showed that gender (specifically for men; OR=4.997, 95% CI: 2.611-9.564), low body mass index (BMI) (OR=1.525, 95% CI: 1.353-1.718), lower 25(OH)D levels (OR=1.076, 95% CI:1.036-1.117), and lower IGF-1 (OR=1.013, 95% CI:1.006-1.020) were independent risk factors (P < 0.05). (3) ROC curve analysis results showed that BMI, 25 (OH) D, IGF-1, and testosterone (for men) had predictive significance for sarcopenia with T2DM (P < 0.05). However, the AUC of 25 (OH) D, IGF-1 and testosterone (for men) were all <0.7, while the AUC of BMI and the combined factors were all >0.7, has great predictive significance.

Conclusion

The prevalence of sarcopenia in hospitalized patients with T2DM is higher in men than in women. Low BMI and lower serum levels of 25 (OH) D and IGF-1 are risk factors of sarcopenia in patients with T2DM. Low BMI, 25(OH)D, IGF-1, and testosterone (for men) all contributed to the prediction of sarcopenia, among which BMI and combined factors were more significant.

Effects of sarcopenia and sarcopenic obesity on joint pain and degenerative osteoarthritis in postmenopausal women

This study aimed to identify the prevalence of sarcopenia, obesity, and sarcopenic obesity and examine their association with radiographic knee osteoarthritis (OA) and knee pain in Korean postmenopausal women. This cross-sectional study utilized the data from Korean National Health and Nutrition Examination Surveys 2009–2011. The participants were categorized into 4 groups based on body composition: either sarcopenic (appendicular skeletal muscle < 23%) or not, either obese (body mass index ≥ 25.0 kg/m²) or not. The prevalence of radiographic knee OA and knee pain was calculated. The effect of hormone replacement therapy (HRT) was also evaluated. The prevalence of radiographic knee OA, knee pain, and both were all highest in the sarcopenic obese group and lowest in the control group (61.49% vs. 41.54%, 39.11% vs. 27.55%, 32.04% vs. 17.82%, all p < 0.001). Without sarcopenia, obese women showed significantly higher ratio of radiographic knee OA only (57.64% vs. 41.54%, p < 0.001). With sarcopenia, the coexistence of obesity presented higher ratio of radiographic knee OA, knee pain, and both compared to sarcopenia without obesity (61.49% vs. 41.82%, 39.11% vs. 27.61%, 32.04% vs. 17.60%, all p < 0.001). The use of HRT for more than 1 year was not associated with radiographic knee OA, knee pain, or both (p = 0.147, 0.689 and 0.649, respectively). Obesity with sarcopenia had greater effect on knee OA compared to obesity without sarcopenia. Moreover, HRT use for more than 1 year was not associated with the prevalence of knee OA. Therefore, more efforts should focus on reducing body fat and increasing muscle in postmenopausal women with knee OA.

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

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.

Appendicular lean mass is lower in late compared with early perimenopausal women: potential role of FSH

Age-related declines in skeletal muscle mass (i.e., sarcopenia) contribute to physical disability in older women. Although a menopause-related increase in fat mass is well documented, whether menopause influences muscle mass and sarcopenia is unclear. We determined the extent to which skeletal muscle mass differs across the stages of the menopause transition in women and whether these differences are associated with estradiol or other sex hormones. This was a cross-sectional study of 144 healthy women (aged 30-70 yr) classified as premenopausal [n = 30, 38 ± 6 yr (means ± SD)], early (n = 31, 50 ± 3 yr) and late (n = 30, 50 ± 4 yr) perimenopausal, and early (n = 26, 55 ± 3 yr) and late (n = 27, 62 ± 4 yr) postmenopausal. Appendicular lean mass (ALM) adjusted by the square of height in meters (ALM index; ALMi) was assessed by dual-energy X-ray absorptiometry. ALMi was lower (P < 0.05) in late perimenopausal and postmenopausal compared with early perimenopausal, with no significant differences between other groups (premenopausal 6.6 ± 0.6, early perimenopausal 6.8 ± 0.8, late perimenopausal 6.1 ± 0.8, early postmenopausal 6.5 ± 1.1, and late postmenopausal 6.2 ± 0.9 kg/m²). The prevalence of sarcopenia (ALMi ≤ 5.67 kg/m²) was 7%, 3%, 30%, 27%, and 32% in premenopausal, early and late perimenopausal, and early and late postmenopausal groups, respectively. ALMi measured across menopause stages was inversely correlated to follicle-stimulating hormone (FSH; r = -0.28, P = 0.003) but not to estradiol (r = 0.088, P = 0.34). The menopause transition appears to be a vulnerable period for the loss of skeletal muscle mass that may begin during the late perimenopausal transition. Future studies are necessary to investigate the potential effect of FSH on skeletal muscle.NEW & NOTEWORTHY Our data suggest that the late perimenopausal stage may be a vulnerable period for the loss of skeletal muscle, potentially related to elevations in FSH.

Vastus Lateralis Architecture Changes During Pregnancy - A Longitudinal Study

While the incidence of falls has been described to increase with pregnancy, the mechanism behind this is unclear. Pregnancy associated changes in lower extremity muscle strength could be a possible factor influencing injury risk. Thus, the aim of this longitudinal study was to investigate muscle strength and architectural properties of the lower limbs in different stages of pregnancy and postpartum. In nineteen pregnant women (30 ± 4 years) and fifteen non-pregnant controls (28 ± 4 years) muscle strength and architectural properties of the vastus lateralis muscle were assessed combining dynamometry, ultrasound, kinematic, and electromyographic measurements. Body mass and body composition were determined using bioimpedance analysis. In the pregnant women, the measurements were conducted in the 16 ± 4th (EP) and 29 ± 4th week of pregnancy (LP) as well as in the 32 ± 9th week postpartum (PP). Muscle thickness and pennation angle of the fascicles significantly increased at LP, while muscle strength remained constant during and after pregnancy. Body mass, skeletal muscle mass, fat mass, intracellular and extracellular water also peaked at LP. Postpartum values did not differ from the controls. Changes in the muscle properties were not related to changes in body mass and body composition. Conditions during pregnancy promote changes in the vastus lateralis architecture indicating muscle hypertrophy. However, pregnancy did not increase muscle strength while body mass progressively increases. Therefore, in the event of balance perturbations pregnant women may not be able to meet the requirements for the increased physical demand.

Functions of estrogen and estrogen receptor signaling on skeletal muscle

Activity of estrogen, a sex steroid hormone, is not only limited to the reproductive organs but also involves other organs and tissues, including skeletal muscle. In postmenopausal women, estrogen decline causes endocrine and metabolic dysfunction, leading to a predisposition to osteoporosis, metabolic syndrome, and decreased muscle mass and strength. The decline in skeletal muscle mass often associates with sarcopenia, a popular condition observed in fragile elder people. In addition, varying estrogen levels associated with the menstrual phases may modulate exercise performance in women. Estrogen is thus considered to play a crucial role in skeletal muscle homeostasis and exercise capacity, although its precise mechanisms remain to be elucidated. In this article, we review the role of estrogen in the skeletal muscle, outlining the proposed molecular mechanisms. We especially focus on the current understanding of estrogen actions on mitochondria metabolism in skeletal muscle.

Increased body fat mass explains the positive association between circulating estradiol and insulin resistance in postmenopausal women

The relationship between circulating estrogen levels and cardiometabolic risk factors such as insulin resistance is unclear in postmenopausal women. High estradiol (E₂) levels have been reported to predict increased risk of type 2 diabetes in this population. We aimed to examine associations among estrogen levels, adiposity measurements, and cardiometabolic risk variables including insulin resistance in postmenopausal women. One hundred-one healthy participants (mean ± SD: age 57 ± 4 yr, BMI 27.9 ± 4.8 kg/m²) were included in the analysis. Fifteen plasma steroids or metabolites were measured by liquid chromatography-tandem mass spectrometry. Insulin sensitivity was assessed with a hyperinsulinemic-euglycemic clamp. Body composition and fat distribution were determined with hydrostatic weighing and computed tomography, respectively. Blood lipids and circulating cytokines were also measured. Circulating E₂ was positively correlated with all adiposity indexes ( r = 0.62 to 0.42, P < 0.0001) except waist-to-hip ratio. E₂ was positively correlated with VLDL-cholesterol, plasma-, VLDL-, and HDL-triglyceride levels ( r = 0.31 to 0.24, P < 0.02) as well as with hs-CRP and IL-6 ( r = 0.52 and 0.29, P < 0.005) and negatively with HDL-cholesterol, adiponectin, and insulin sensitivity ( r = -0.36 to -0.20, P < 0.02). With adjustments for percent body fat, correlations between E₂ and metabolic risk variables were no longer significant. Similar results were observed for circulating estrone (E₁) and estrone-sulfate (E₁-S) levels. In conclusion, circulating estrogen concentrations are proportional to adipose mass in postmenopausal women, although they remain in the low range. Insulin resistance as well as altered blood lipids and cytokines are observed when circulating estrogen levels are high within that range, but these differences are explained by concomitant variation in total adiposity.

Effects of methionine restriction and endurance exercise on bones of ovariectomized rats: a study of histomorphometry, densitometry, and biomechanical properties

To investigate the effects of dietary methionine restriction (MetR) and endurance exercise on bone quality under a condition of estrogen deficiency, female Sprague-Dawley rats (36-wk-old) were assigned to a sham surgery group or one of five ovariectomized groups subjected to interventions of no treatment (Ovx), endurance exercise (Exe), methionine restriction (MetR), methionine restriction plus endurance exercise (MetR + Exe), and estrogen treatment (Est). Rats in the exercise groups were subjected to a treadmill running regimen. MetR and control diets contained 0.172 and 0.86% methionine, respectively. After the 12-wk intervention, all animals were killed, and serum and bone tissues were collected for analyses. Compared with estrogen treatment, MetR diet and endurance exercise showed better or equivalent efficiency in reducing body weight gain caused by ovariectomy ( P < 0.05). Whereas only the Est group showed evidence for reduced bone turnover compared with the Ovx group, MetR diet and/or endurance exercise demonstrated efficiencies in downregulating serum insulin, leptin, triglyceride, and thiobarbituric acid reactive substances ( P < 0.05). Both the Exe and MetR groups showed higher femoral cortical and total volumetric bone mineral density (vBMD), but only the Exe and Est groups preserved cancellous bone volume and/or vBMD of distal femora ( P < 0.05) compared with the Ovx group. After being normalized to body mass, femora of the MetR and MetR + Exe groups had relatively higher bending strength and dimension values followed by the Sham, Exe, and Est groups ( P < 0.05). In conclusion, both MetR diet and endurance exercise improved cortical bone properties, but only endurance exercise preserved cancellous bone under estrogen deficiency.

Higher levels of endogenous estradiol are associated with frailty in postmenopausal women from the toledo study for healthy aging

BACKGROUND

Adverse effects of higher endogenous estradiol (E2) levels on various clinical outcomes and on determinants of the frailty syndrome have recently been reported. However, there are no data about the potential relationship between E2 and frailty. We aimed to study the association between E2 levels and frailty among older postmenopausal women not taking hormonal therapy.

METHODS

We used data from the Toledo Study for Healthy Aging, a Spanish population-based cohort study. Frailty was defined according to Fried's approach. Multivariate odds ratios (OR) and 95% confidence intervals (CI) associated with E2 levels were estimated using polytomous logistic regression.

RESULTS

E2 levels decreased significantly with age and educational level, whereas they increased with body mass index, high-sensitivity C-reactive protein (hs-CRP), and impairment in Katz activities of daily living. Higher E2 levels were associated with the prevalence of frailty among women younger than 79 yr, but not in the oldest group (p interaction = 0.047). After adjustment, OR of frailty associated with a 1 sd increase of E2 was 1.51 (95% CI, 1.04-2.20; P = 0.03). We identified an interaction between E2 and hs-CRP on the prevalence of frailty (P value = 0.042). Women with both higher E2 and hs-CRP (defined as values into the upper tertile) had an age-adjusted OR of 4.2 (95% CI, 1.7-10.5; P = 0.002), compared with women with low levels of both E2 and hs-CRP.

CONCLUSION

Higher E2 levels were associated with frailty in postmenopausal women. The synergism between higher E2 and hs-CRP levels suggests the existence of physiopathological mechanisms connecting inflammation and estrogen to frailty.

Estimation of lean body weight in older women with hip fracture

OBJECTIVE

Lean body weight (LBW) decreases with age while total body fat increases, resulting in altered drug pharmacokinetics. A semi-mechanistic equation estimating LBW using height, weight and sex has been developed for potential use across a wide range of body compositions. The aim of this study was to determine the ability of the LBW equation to estimate dual energy x-ray absorptiometry-derived fat free mass (FFM(DXA)) in a population of older women with recent hip fracture.

METHODS

Baseline, four and 12 month data obtained from 23 women enrolled in the Sarcopenia and Hip Fracture study were pooled to give 58 measurements. LBW was estimated using the equation: LBW (kg) = (9270 x Wt) / (8780 + (244 x BMI)). Body composition was classified as: 'normal' (BMI <25kg/m(2) and not sarcopenic), 'overweight-obese' (BMI >25kg/m(2) and not sarcopenic), 'sarcopenic' (sarcopenic and BMI <25kg/m(2)), or 'sarcopenic-obese' (sarcopenic and BMI >25kg/m(2)). The ability of the LBW equation to predict FFMDXA was determined graphically using Bland-Altman plots and quantitatively using the method of Sheiner and Beal.

RESULTS

The mean ± SD age of female participants women was 83±7 years (n=23). Sarcopenia was frequently observed (65.2%). Bland-Altman plots demonstrated an underestimation by the LBW equation compared to FFMDXA. The bias (95% CI) and precision (95% CI) calculated using the method of Sheiner and Beal was 0.5kg (-0.7, 1.66kg) and 4.4kg (-3.7, 12.4kg) respectively for pooled data.

CONCLUSION

This equation can be used to easily calculate LBW. When compared to FFMDXA, the LBW equation resulted in a small underestimation on average in this population of women with recent hip fracture. The degree of bias may not be clinically important although further studies of larger heterogeneous cohorts are needed to investigate and potentially improve the accuracy of this predictive equation in larger clinical cohorts.

Similarities in acquired factors related to postmenopausal osteoporosis and sarcopenia

Postmenopausal population is at increased risk of musculoskeletal impairments. Sarcopenia and osteoporosis are associated with significant morbidity and social and health-care costs. These two conditions are uniquely linked with similarities in pathophysiology and diagnostic methods. Uniform diagnostic criteria for sarcopenia are still evolving. Postmenopausal sarcopenia and osteoporosis share many environmental risk- and preventive factors. Moreover, geriatric frailty syndrome may result from interaction of osteoporosis and sarcopenia and may lead to increased mortality. The present paper reviews the factors in evolution of postmenopausal sarcopenia and osteoporosis.

Benefits of estrogen replacement for skeletal muscle mass and function in post-menopausal females: evidence from human and animal studies

Age related loss of skeletal muscle mass and strength accelerates with the onset of menopause in women. Recent evidence from human and animal studies provides compelling evidence for the role of estrogen based hormone replacement therapy (HRT) in maintaining and enhancing muscle mass and strength and protecting against muscle damage. The physiological mechanisms by which estrogen can positively influence skeletal muscle mass and strength and protect against post-damage inflammation and disruption are also beginning to emerge. These less well known benefits of estrogen for skeletal muscle coupled with other benefits of estrogen to bone and metabolic health in older females provide further incentives for HRT use to enhance overall health in post-menopausal women. New research also attests to the safety of shorter term HRT in younger post-menopausal females. Overall the benefits of HRT to muscle health and function could assist in offsetting age related loss of muscle mass and function and delay age related morbidity and their use for overall health benefits in aging females should continue to be evaluated.

Menopause and sarcopenia: A potential role for sex hormones

Menopause is associated with a decline in estrogen levels, which could lead to an increase in visceral adiposity as well as a decrease in bone density, muscle mass and muscle strength. This decline in muscle mass, known as sarcopenia, is frequently observed in postmenopausal women. Potential causes of sarcopenia include age-related changes in the hormonal status, low levels of physical activity, reduced protein intake and increased oxidative stress. However, the role of sex hormones, specifically estrogens, on the onset of sarcopenia is controversial. Preventing sarcopenia and preserving muscle strength are highly relevant in order to prevent functional impairment and physical disability. To date, resistance training has been shown to be effective in attenuating age-related muscle loss and strength. However, results on the effect of hormonal supplementation to treat or prevent sarcopenia are contradictory. Further research is needed to identify other potential mechanisms of sarcopenia as well as effective interventions for the prevention and treatment of sarcopenia. Therefore, the purpose of this review will be to examine the role of sex hormonal status in the development of sarcopenia. We will also overview the physical as well as metabolic consequences of sarcopenia and the efficiency of different interventions for the prevention and treatment of sarcopenia.

Assessment of musculoskeletal system in women with jumping mechanography

The purpose of this study was to investigate and add reference data about the musculoskeletal system in women. The mechanography system of the Leonardo™ platform (Novotec, Germany) was used to measure parameters of movement (velocity, force, power) in 176 healthy Greek women aged 20–79 years, separated according to age decade in six groups: group 1 (n = 12), 20–29 years; group 2 (n = 14), 30–39 years; group 3 (n = 33), 40–49 years; group 4 (n = 59), 50–59 years including 21 postmenopausal; group 5 (n = 31), 60–69 years including 12 postmenopausal; and group 6 (n = 27), 70–79 years all postmenopausal. This system measures forces applied to the plate over time, calculates through acceleration the vertical velocity of center of gravity and using force and velocity it calculates power of vertical movements. All women performed a counter-movement jump (brief squat before the jump) with freely moving arms. Weight was recorded on the platform before the jump and height was measured with a wall-mounted ruler. Body weight and body mass index were gradually increased; on the contrary height and all movement parameters except force (velocity, power) were statistically decreased during aging and after menopause.

Estradiol and genistein antagonize the ovariectomy effects on skeletal muscle myosin heavy chain expression via ER-beta mediated pathways

The age-related decline in ovarian sex hormone production following the onset of menopause alters skeletal muscle metabolic, structural and functional characteristics. The myosin heavy chain (MHC) expression pattern defines skeletal muscle contraction velocity and is therefore an important factor in skeletal muscle function. The present study was designed to examine the effects of 17beta estradiol (E2), estrogen receptor (ER) subtype selective agonists (ERalpha, ERbeta) or genistein (Gen) following ovary removal (OVX) in female Wistar rats in combination with a high intensity treadmill-based exercise protocol (Ex) or normal cage-based activity (NoEx) on MHC protein expression patterns in the slow fiber type m.Soleus (Sol) and the fast fiber type m.Gastrocnemius (Gas). Gen and E2 in the Sol significantly stimulated MHC-I expression relative to OVX only in the absence of exercise (NoEx). MHC-IIb expression in the Gas was significantly increased relative to OVX in Gen Ex and E2 Ex and NoEx groups. The estrogenic effects in the Sol and Gas were both predominantly mediated via ERbeta pathways, since the ERbeta agonist induced greater MHC increases than OVX or ERalpha. We therefore propose that high intensity exercise in combination with exposure to E2, Gen, ERalpha or ERbeta agonists in OVX rats exerts differential effects on MHC expression in skeletal muscles composed of mainly slow type I MHC (Sol) or fast type II MHC (Gas). In summary, the data shows that MHC composition is affected by estrogens and exercise in a fiber type specific manner and that these effects are mainly mediated by ER-beta. This is of great importance with respect to skeletal muscle health and potential treatment with ER selective agonists.

Differential estrogenic 17beta-hydroxysteroid dehydrogenase activity and type 12 17beta-hydroxysteroid dehydrogenase expression levels in preadipocytes and differentiated adipocytes

Estradiol (E2) is produced locally in adipose tissue and could play an important role in fat distribution and accumulation, especially in women. It is well recognized that aromatase is expressed in adipose tissue; however the identity of its estrogenic 17beta-hydroxysteroid dehydrogenase (17beta-HSD) partner is not identified. To gain a better knowledge about the enzyme responsible for the conversion of estrone into estradiol, we determined the activity and expression levels of known estrogenic 17beta-HSDs, namely types 1, 7 and 12 17beta-HSD in preadipocytes before and after differentiation into mature adipocytes using an adipogenic media. Estrogenic 17beta-HSD activity was assessed using [(14)C]-labelled estrone, while mRNA expression levels of types 1, 7 and 12 17beta-HSD were quantified using real-time PCR and protein expression levels of type 12 17beta-HSD was determined using immunoblot analysis. The data indicate that there is a low conversion of E1 into E2 in preadipocytes; however this activity is increased approximately 5-fold (p<0.0001) in differentiated adipocytes. The increased estrogenic 17beta-HSD activity is consistent with the increase in protein expression levels of 17beta-HSD12.

Skeletal muscle and bone: effect of sex steroids and aging

Both estrogen and testosterone are present in males and females. Both hormones contribute to the well being of skeletal muscle and bone in men and women, and there is evidence that the loss of sex hormones is associated with the age-related decline in bone and skeletal muscle mass. Hormonal supplementation of older adults to restore estrogen and testosterone levels to those of young men and women is not without penalty.

Estimation of thigh muscle cross-sectional area by dual-energy X-ray absorptiometry in frail elderly patients

BACKGROUND

Thigh muscle mass and cross-sectional area (CSA) are useful indexes of sarcopenia and the response to treatment in older patients. Current criterion methods are computed tomography (CT) and magnetic resonance imaging.

OBJECTIVE

The objective was to compare thigh muscle mass estimated by dual-energy X-ray absorptiometry (DXA), a less expensive and more accessible method, with thigh muscle CSA determined by CT in a group of elderly patients recovering from hip fracture.

DESIGN

Midthigh muscle CSA (in cm(2)) was assessed from a 1-mm CT slice and midthigh muscle mass (g) from a 1.3-cm DXA slice in 30 patients (24 women) aged 81 +/- 8 y during 12 mo of follow-up. Fat-to-lean soft tissue ratios were calculated with each technique to permit direct comparison of a variable in the same units.

RESULTS

Baseline midthigh muscle CSA was highly correlated with midthigh muscle mass (r = 0.86, P < 0.001) such that DXA predicted CT-determined CSA with an SEE of 10 cm(2) (an error of approximately 12% of the mean CSA value). CT- and DXA-determined ratios of midthigh fat to lean mass were similarly related (intraclass correlation coefficient = 0.87, P < 0.001). When data were expressed as the changes from baseline to follow-up, CT and DXA changes were weakly correlated (intraclass correlation coefficient = 0.51, P = 0.019).

CONCLUSIONS

Assessment of sarcopenia by DXA midthigh slice is a potential low-radiation, accessible alternative to CT scanning of older patients. The errors inherent in this technique indicate, however, that it should be applied to groups of patients rather than to individuals or to evaluate the response to interventions.

Effects of combined female sex hormone replacement therapy on body fat percentage and distribution

The effectiveness of hormone replacement therapy for patients with cardiovascular disease and for postmenopausal women with associated cardiovascular risks is currently under wide investigation. Among the cardiovascular risks are those related to body fat percentage and distribution. The present study undertook to investigate the effects of combined hormone replacement therapy on body fat percentage and distribution in postmenopausal women. Data for the present study were collected via retrospective analyses of 287 healthy postmenopausal women (146 as a study group, 141 as controls). Participants in the study group received 0.625 mg conjugated equine estrogen combined with 2.5 mg medroxyprogesterone acetate per day for 18 months. Body fat percentage and fat distribution were evaluated through the electrical impedance method and measurements of skinfold thickness, respectively. Two indices of centripetal fat distribution were defined: ratio of trunk-to-extremity skinfold thickness (T/E index), and ratio of upper-to-lower body skinfold thickness (U/L index). Investigators found that a daily dose of 0.625 mg of conjugated equine estrogen combined with 2.5 mg of medroxyprogesterone acetate taken for 18 months increased body fat percentage by decreasing lean body mass and by affecting upper-to-lower body fat distribution, without producing significant changes in overall weight. A slight decrease in the trunk-to-extremity body fat ratio was noted at 18 months of treatment, but this decrease did not reach statistical significance. Data related to the effects of hormone replacement therapy on body fat percentage and distribution in postmenopausal women are scarce. Additional research is needed to clarify the possible health benefits of hormone replacement therapy.