Could a Woman's Wrinkles Predict Risk of Fractures?

Researchers say menopausal skin holds clues to bone density, but experts have their doubts

By Alan Mozes
HealthDay Reporter

SATURDAY, June 4 (HealthDay News) -- As if facial wrinkles didn't have a bad enough rap, a new study suggests that the worse a woman's wrinkles are in early menopause, the lower her bone density.

That is not to say that wrinkled skin is being cited as causing poorer skeletal health, merely that the two factors are associated.

But because poor bone density can lead to broken bones, a link between wrinkles and bone density -- if confirmed -- might prompt development of an inexpensive way to identify postmenopausal women at highest risk for fractures, the researchers say.

"We hypothesized that because skin and bone share common tissue architecture, the physical attributes of skin in menopausal women will relate to bone density and bone quality," said study principal author Dr. Lubna Pal, a reproductive endocrinologist and associate professor at Yale School of Medicine, New Haven, Conn. "And what we found is consistent with that hypothesis."

Pal and her colleagues are slated to present their findings Monday in Boston at the Endocrine Society's annual meeting.

The authors point out that a possible relationship between bone and skin health could be rooted in the fact that the two share the same building blocks -- proteins called collagens.

Age-related collagen changes, they noted, could explain both the wrinkling and sagging of skin and a simultaneous deterioration of bone quality and quantity.

According to the Arthritis Foundation, about half of all bone loss women experience in a lifetime occurs during the first decade following menopause.

For their study, the research team focused on 114 women in their late 40s and early 50s, drawn from the larger Kronos Early Estrogen Prevention Study (KEEPS). The latter study was funded by the Aurora Foundation and the Kronos Longevity Research Institute in Phoenix.

All the participants had entered menopause within the three years leading up to the study. No participants were taking hormone therapy, and none had undergone any cosmetic skin procedures.

Researchers tested skin firmness in the forehead and cheek region with a device called a durometer, and tallied the number and depth of face and neck wrinkles at 11 sites. To test bone density in different parts of the body, researchers used dual X-ray absorptiometry (DEXA) and a portable heel ultrasound device.

The results: The firmer the face and forehead, the greater the bone density; the more wrinkles, the lower the bone density. The latter relationship was consistent across various body areas, including the hip, lumbar spine and heel.

The association held up even after accounting for factors known to affect bone density, including age and body composition.

The authors noted that follow-up work over a longer period of time is needed to confirm the current findings and clarify the underlying factors driving a skin-bone link.

"This is very preliminary data," Pal cautioned. "Right now we're just at the tip of the iceberg, and we have one more year to study these women before the trial is completed. So we're hoping to make sense of these observations in a much more meaningful manner as we move ahead."

In addition, research presented at medical meetings is considered preliminary until published in a peer-reviewed medical journal.

Dr. Elton Strauss, an associate professor and chief of orthopedic trauma and adult reconstruction at the Mount Sinai School of Medicine in New York City, said he was surprised by the finding.

"People who have skin wrinkles usually spend a lot of time in the sun," he noted. "And that promotes the development of a lot of vitamin D, which is good for bone health. So I would have thought we might see just the opposite effect."

Much more information is needed to validate the findings, Strauss said. "This is just the beginning of something -- maybe. But I don't think you can hang your hat on it," he said.

Dr. Melvin Paul Rosenwasser, a professor of orthopedic surgery at Columbia University College of Physicians and Surgeons in New York City, also reacted to the study with a degree of skepticism.

"People study lots of things and look for associations," he noted. "And while it's not too far a stretch to say that wrinkles might be associated with bone loss, there are so many variables at play -- like sun exposure and nutrition and so many other things -- that it would be hard for me to say that this [skin] could be a valuable screening tool, unless the sensitivity and specificity of this specific relationship was high enough."

"You don't want to give people a false sense of security that wrinkles are always an indication of bone loss, or that if you don't have wrinkles you don't have bone loss, unless there is clearly a very high connection between the two," Rosenwasser added. And to determine that, a much larger study is needed, he said.

More information

For more on menopause, visit the U.S. National Library of Medicine.

SOURCES: Lubna Pal, M.D., reproductive endocrinologist and associate professor, Yale School of Medicine, New Haven, Conn.; Elton Strauss, M.D., associate professor and chief, orthopedic trauma and adult reconstruction, Mount Sinai School of Medicine, New York City; Melvin Paul Rosenwasser, M.D., professor, orthopedic surgery, Columbia University College of Physicians and Surgeons, New York City; June 4, 2011, presentation, Endocrine Society meeting, Boston

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