Long-term benefits and risks of HRT (Section 11): Loss of muscle mass (Sarcopenia)

Overall this NICE guideline on the menopause provides an enormous resource. Because of the depth of the research undertaken and the extensive literature review, the guideline will provide an invaluable source of information and reference, for many different types of research and review into women's health over the next decades.

This is one of the most important and promising areas of the guideline as there is no evidence of harm, there is only positive evidence (11.8.6).

The guideline makes reference to musculoskeletal system (11.8.7.5), there is a good case for taking this further. There is very extensive research into osteoporosis (11.6), HRT and estrogen generally showing very positive benefits. The measurement involved in osteoporosis studies can often be used to measure muscle, to diagnose sarcopenia; this is however rarely used.

It would be sensible for those involved in arranging osteoporosis studies, (for example, the National Osteoporosis Society) to extend these studies of osteoporosis to look at sarcopenia as well. This might well have major effect in reducing the costs of setting up studies on sarcopenia alone.

Understandably, it was outside of the scope of the guideline to look at the measures, nutrition, exercise and lifestyle, which are involved in protecting muscle mass and the avoidance of sarcopenia (11.8.7.2). Clearly, however, these other issues need to be taken into account by healthcare professionals in this area, and the guideline recognised this.

From the individual patient’s point of view, it might perhaps be more sensible to look at the muscular skeletal system as a whole, rather than bone and muscle as separate entities. This would avoid the need for separate doctors, separate clinic appointments, separate care, separate advice and separate treatments.

Does this point the way to new types of musculoskeletal assessment? With a musculoskeletal score – such as a new body mass index (BMI) like score. This would relate to a combination of bone measurements in some form with muscle measurement, so that a useful scoring system could be developed, of practical clinical predictive use. Such an ‘Osteosarco index’ score would be of value in economic predictions, and of use in predicting disability and enhancing Disability Free Life Expectancy.

The main reason the very elderly walk with a doddery gait is not so much ‘weak bones’ (Osteoporosis) as ‘weak muscles’ (Sarcopenia).