A review article proposed a new term "musculoskeletal syndrome of menopause" to describe the collection of musculoskeletal symptoms experienced by women during the menopausal transition. Investigators argued that this terminology was necessary to adequately communicate the role of declining estrogen levels in the development of these symptoms and to guide prevention and treatment strategies.
In the review, published in the journal Climacteric, the investigators noted that more than 70% of women may experience musculoskeletal symptoms during the transition from perimenopause to postmenopause, with 25% of them becoming disabling. These symptoms, which were largely influenced by decreasing estrogen levels, included arthralgia, sarcopenia, reduced bone density, and osteoarthritis progression. The average age of onset for perimenopause was reported as 47.5 years, whereas the average age of menopause was 52.6 ± 2.5 years—with Hispanic women experiencing onset approximately 2 years earlier.
During perimenopause, women experienced an average reduction of 10% in bone mineral density and a reduction of 0.6% in muscle mass per year after menopause. The investigators discussed the important functions of estrogen related to inflammation, muscle mass and strength, satellite-cell proliferation, bone density, and cartilage health. They explained that as estrogen levels declined during menopause, women may experience increased inflammation and pain, loss of muscle mass and strength, reduced muscle regenerative capacity, decreased bone mineral density, and cartilage damage.
Estrogen deficiency was associated with significant bone loss, increasing fragility and risk of fracture. The review noted that between 30% and 50% of women experience a clinical fracture during their lifetime, and 70% of hip fractures occur in women.
To mitigate these effects, the investigators suggested several preventive and treatment strategies, including proper nutrition, vitamin D and magnesium supplementation, and resistance exercise. They also mentioned that vitamin K2 supplementation might decrease the progression and treat osteoporosis, as a meta-analysis found significantly increased changes in lumbar and forearm bone mineral density without evidence of serious adverse effects. Menopausal hormone therapy was discussed as a potential intervention to slow the rate of estrogen loss and alleviate musculoskeletal symptoms.
The investigators emphasized the importance of clinician awareness of the musculoskeletal syndrome of menopause, particularly among orthopedic surgeons who might be the primary point of contact for women presenting with these symptoms. They also highlighted the need for further research to determine optimal management and prevention strategies, including the potential role of early menopausal hormone therapy in preventing rapid progression of musculoskeletal conditions.
No potential conflict of interest was reported by the authors.