Risedronate or exercise for lean mass preservation during menopause: secondary analysis of a randomized controlled trial

Abstract

Abstract Background The menopause transition is marked by hormonal shifts leading to body composition changes, such as fat mass gain and lean mass loss. Weight‐bearing and resistance exercise can help maintain lean mass during the menopause transition; however, uptake is low. Preclinical research points to bisphosphonates as also being effective in preventing loss of lean mass. Thus, we sought to investigate whether bisphosphonate therapy can mitigate loss of lean mass and outperform weight‐bearing exercise in the years immediately following menopause. Methods Data come from the Heartland Osteoporosis Prevention Study (NCT02186600), where osteopenic, postmenopausal women were randomized to bisphosphonate (n = 91), weight‐bearing/resistance exercise (n = 92), or control (n = 93) conditions over a 1 year period. Dual‐energy X‐ray absorptiometry‐derived body composition measures (including total lean mass, total fat mass, lean mass index, and lean‐to‐fat mass ratio) were ascertained at baseline, 6 months, and 12 months. Adherence to risedronate and weight‐bearing exercise was defined as the percentage of dosages taken and exercise sessions attended. Intent‐to‐treat analysis using linear modelling was used to generate treatment effects on body composition. Secondary analysis utilized per‐protocol analysis and included adjustment for weight change. Results A total of 276 women (age: 54.5 years; 83.3% Caucasian; body mass index: 25.7 kg/m2) were included in the analyses; 12 month adherence to the risedronate and exercise interventions was 89% and 64%, respectively. Group‐by‐time interactions were observed for lean mass, revealing that exercise (0.43 ± 1.49 kg) and risedronate groups (0.31 ± 1.68 kg) gained significantly more lean mass than control group (−0.15 ± 1.27 kg) over 12 months. However, after controlling for weight change in secondary analysis, the difference in lean mass change between control and risedronate became non‐significant (P = 0.059). Conclusions Results suggest that both 12 months of oral risedronate and 12 months of weight‐bearing exercise may diminish lean mass loss experienced during the menopause transition as compared with control. The lean mass‐sparing effect for risedronate may be driven by overall weight change.

Keywords

• Menopause
• Bisphosphonate
• Lean mass
• Ageing
• Exercise