Menopausal Hormone Therapy Is Associated With Reduced Total and Visceral Adiposity: The OsteoLaus Cohort
J Clin Endocrinol Metab, May
Menopausal Hormone Therapy Is Associated With Reduced Total and Visceral Adiposity: The OsteoLaus Cohort
Georgios E. Papadakis 0
Didier Hans 1
Elena Gonzalez Rodriguez 0 1
Peter Vollenweider 2
Gerard Waeber 2
Pedro Marques-Vidal 2
Olivier Lamy 1 2
0 Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital , CH-1011 Lausanne , Switzerland
1 Center of Bone Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital , CH-1011 Lausanne , Switzerland
2 Service of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital , CH-1011 Lausanne , Switzerland
Context: After menopause, fat mass (FM) and visceral adipose tissue (VAT) increase and nonbone lean body mass (LBM) decreases. Whether menopausal hormone therapy (MHT) reverses these changes remains controversial. Objective: To assess the effect of MHT on FM, VAT, and LBM before and after its withdrawal and evaluate potential confounders. Design: Cross-sectional study. Setting: General community. Patients or Other Participants: Women of the OsteoLaus cohort (50 to 80 years old) who underwent dual-energy X-ray absorptiometry (DXA) with body composition assessment. After we excluded women with estrogen-modifying medications, the 1053 participants were categorized into current users (CUs), past users (PUs), and never users (NUs) of MHT. Intervention: None. Main Outcome Measures: VAT measured by DXA was the primary outcome. We assessed subtotal and android FM, LBM, muscle strength (hand grip), and confounding factors (caloric intake, physical activity, biomarkers). Results: The groups significantly differed in age, NU , CU , PU. Age-adjusted VAT was lower in CUs than NUs (P = 0.03). CUs exhibited lower age-adjusted body mass index (BMI) (20.9 kg/m2) and a trend for lower FM (21.3 kg). The 10-year gain of VAT (P , 0.01) and subtotal and android FM (P , 0.05) was prevented in CUs. No difference in LBM or hand grip was detected. No residual effect was detected for PUs, including for early MHT discontinuers. The confounding factors did not significantly differ between groups except for higher caloric intake in PUs compared with NUs. Conclusions: MHT is associated with significantly decreased VAT, BMI, and android FM. No benefit is detected for LBM. The benefits are not preserved in PUs, suggesting caution when MHT is discontinued. (J Clin Endocrinol Metab 103: 1948-1957, 2018)
Mand muscular compartments (
). In particular,
enopause is accompanied by changes in bone, fat,
menopause transition has been linked to increased
propensity for weight gain and fat mass (FM)
). Whether this association is caused by
declining ovarian hormone secretion or aging remains
an open question (
). Data are more robust regarding
the effect of menopause on regional fat. Several
prospective studies have shown a greater increase of
abdominal fat after menopause, leading to a shift from a
gynoid to an android pattern of fat distribution (
The causal association with estrogen deficiency is
supported by preclinical data demonstrating that
disruption of estradiol (E2) signaling by estrogen receptor
(ER) deletion or ovariectomy (OVX) accelerates fat
). It is important to emphasize that
excess of central fat, and specifically of visceral adipose
tissue (VAT) in humans, is associated with insulin
resistance and high prevalence of metabolic syndrome,
which are risk factors for atherosclerotic
cardiovascular disease (
A decline in nonbone lean body mass (LBM), also
called fat-free or skeletal muscle mass, has been described
across menopause (
). It remains unclear whether this
finding is a consequence of estrogen deficiency or of
indirect factors such as a more sedentary lifestyle (10).
Interventional trials assessing the effect of menopausal
hormone therapy (MHT) on body composition have
yielded mixed results regarding total FM and LBM (
Those inconsistent findings can reflect differences in the
population studied, study design (natural vs induced
menopause), type of MHT, and method for assessing
body composition. Conversely, most studies evaluating
the effect of gonadotropin-releasing hormone agonists
(GnRH-Ags), creating an artificial menopause state,
have found increased total adiposity and intra-abdominal
). Interestingly, the most recent one (
that this phenotype could be prevented by estrogen
Another point that remains unclear is whether the
eventual impact of MHT on FM is the result of a direct effect
on adipocytes or indirect mechanisms such as altered energy
intake or energy expenditure (
) or behavioral effects on
mood and anxiety (
), which in turn might affect food
intake and physical activity. In addition, insulin and
adipokines (leptin, adiponectin) have been suggested as potential
modifiers in the crosstalk between the reproductive axis and
energy homeostasis both centrally and peripherally (
In this cross-sectional study, we assessed the effect of
MHT on FM, VAT, and LBM before and after its
withdrawal and attempted to explore potential
confounders as detailed earlier.
Materials and Methods
We analyzed data from the OsteoLaus study (
is a substudy of the CoLaus study, an ongoing prospective
study aiming to assess the determinants of cardiovascular
disease by using a population-based sample drawn from the
city of Lausanne, Switzerland (
). The aims of the OsteoLaus
study are to compare different models of fracture risk
prediction and to assess the relationship between osteoporosis and
cardiovascular diseases. Recruitment of OsteoLaus
participants was detailed previously (
). CoLaus data (second visit)
were collected within 6 months before the OsteoLaus visit. The
study was approved by the Institutional Ethics Committee of
the University of Lausanne. All participants signed an
A total of 1500 postmenopausal women, aged 50 to
80 years, were questioned on current or past MHT use, its type,
and duration, if applicable. All participants underwent a spine
and hip dual-energy X-ray absorptiometry (DXA) scan on a
Discovery DXA System (Hologic, Inc., Marlborough, MA).
We included in this study all the women for whom body
composition assessment was performed during the DXA scan
(n = 1086). Exclusion criteria were intake of medication
with estrogen-mediated effects (aromatase inhibitors,
tamoxifen, antiandrogens), extreme body mass index (BMI) values
(BMI .37 kg/m2), and uninterpretable or incomplete DXA
scans (low-quality images). The remaining participants were
divided into three groups: current users (CUs), past users (PUs),
and never users (NUs) of MHT. CUs were taking MHT at trial
entry or discontinued treatment ,6 months earlier. PUs
discontinued MHT $6 months before trial entry (otherwise
considered as CUs). MHT use for ,6 months, reported in 25
participants (,3 months in 23/25), was considered unlikely to
cause considerable changes in body composition, and these
subjects were classified as NUs.
All body composition measurements were in accordance with
published guidelines by the International Society for Clinical
). The subjects were placed in a supine position
with palms down and arms at sides, slightly separated from the
trunk, and correctly centered on the scanning field. Regions of
interest (ROIs) were defined by the analytical program and
included total body, trunk, head, pelvis, upper limbs, lower limbs,
and android and gynoid regions. The lower boundary of the
android region was defined at the pelvis cut line and the upper
boundary above the pelvis cut line by 20% of the distance between
the pelvis and chin. The upper boundary of the gynoid ROI was
defined below the pelvis cut line by 1.5 times the height of the
android space, and gynoid ROI height was equal to 2 times the
android ROI height. For each region, DXA scanned weight of total
mass, FM, and LBM. VAT was measured as the fat tissue located
deep in the abdomen around the internal organs, as opposed to
subcutaneous adipose tissue. Android LBM and FM, gynoid LBM
and FM, and VAT were analyzed in a second step from the initial
body composition images. For technical reasons, 87 examinations
could not be reanalyzed, rendering analysis of the aforementioned
parameters impossible in these participants.
Body composition outcomes were VAT; subtotal FM (calculated
by extracting head FM from total FM); android and gynoid FM;
fat mass index (FMI), calculated as the ratio of total body FM over
height squared; subtotal, android, and gynoid LBM, by analogy to
FM; lean mass index (LMI), defined as the ratio of total LBM over
height squared; and sarcopenia indices (
): appendicular lean mass
index (ALMI), calculated as the ratio of appendicular lean mass
(ALM) over height squared, and ALM divided by BMI.
Assessment of muscle strength via handgrip was available for
990 participants. Participants of the CoLaus aged .50 were
invited to participate in a substudy on frailty, which included
grip strength, assessed with a Baseline? hydraulic hand
dynamometer (Fabrication Enterprises, Inc., White Plains, NY).
Positioning of the participants was done according to the
American Society of Hand Therapists guidelines (
seated, shoulders adducted and neutrally rotated, elbow flexed
at 90?, forearm in neutral position, and wrist between 0? and
30? of dorsiflexion. Three measurements were performed
consecutively at the dominant hand, and the highest value
(expressed in kilograms) was used for the analysis.
Dietary intake was available for 988 participants. Dietary
intake was assessed with the self-administered, semiquantitative
Food Frequency Questionnaire (FFQ), which has been validated
against 24-hour recalls among 626 volunteers from the Geneva
). Briefly, the FFQ assesses dietary intake for the
previous 4 weeks and consists of 97 different food items that
account for .90% of the intake of calories, proteins, fats,
carbohydrates, alcohol, cholesterol, vitamin D, and retinol and
85% of fiber, carotene, and iron. Conversion of FFQ responses
into nutrients was based on the French CIQUAL food
composition table. Total energy intake was computed, including
Physical activity was estimated in 901 participants by a
selfadministered physical activity frequency questionnaire. The
questionnaire lists 70 activities or groups of activities and was
validated against measurements of energy expenditure by heart
rate monitor with satisfactory correlations (r = 0.76) between
the two methods (
). For this study, only sedentary status (yes/
no) was used. Sedentary status was defined as spending ,10%
of total daily energy expenditure in activities with an
intensity .4 basal metabolic rate equivalents.
Blood sampling was performed at the second CoLaus visit.
Most biological assays were performed by the Lausanne
University Hospital Clinical Laboratory on fresh blood samples
within 2 hours of blood collection. Glucose was assessed by
glucose dehydrogenase, with a maximum interassay and
intraassay coefficient of variation (CV) of 2.1% and 1.0%,
respectively. Insulin was assessed by a solid-phase, two-site
chemiluminescent immunometric assay (Diagnostic Products
Corporation, Los Angeles, CA), with a maximum intra-assay
CV of 13.7%. Homeostatic model assessment of insulin
resistance (HOMA-IR) was calculated according to the formula
(glucose 3 insulin)/22.5. Adiponectin and leptin levels were
measured with a multiplexed particle-based flow cytometric
cytokine assay with maximum intra-assay CVs of 8.4% and
9.5%, respectively (
). The analysis was conducted with a
conventional flow cytometer (Guava EasyCyte Plus; Millipore,
Zug, Switzerland). HOMA-IR and serum adipokine levels were
available for 1046 and 977 participants, respectively.
Screening for current or past depression was performed with
the Diagnostic Interview for Genetic Studies, as described
). Depression was defined as the presence of
depressive personality disorder or major depressive disorder
(single or recurrent episode). Antidepressant treatment was
considered as present for any reported medicine with an
Anatomical Therapeutic Chemical code beginning with ?N06A?
(antidepressants) or ?N06CA? (antidepressants in combination
with psycholeptics) (https://www.whocc.no/atc_ddd_index/).
Statistical analyses were conducted in Stata version 14.1
(StataCorp, College Station, TX) for Windows. Because of their skewed
distributions, leptin and adiponectin concentrations were log
transformed before analysis. Descriptive results were expressed as
the number of participants (percentage) or as average 6 standard
deviation. Bivariate analyses were conducted with x2 for
categorical variables and analysis of variance for continuous variables.
Multivariable analyses for continuous variables were conducted
with analysis of variance or multiple regression; results were
expressed either as adjusted average 6 standard error (SE) or as
slope and 95% confidence interval. Post hoc pairwise comparisons
were performed with the Scheffe method. Statistical significance
was considered for a two-tailed test with a P value ,0.05.
The flowchart of the study is shown in Fig. 1. After
application of exclusion criteria (n = 26), the remaining
1053 women were classified in the three groups: 549 NUs
(52.14%), 216 CUs (20.51%), and 288 PUs (27.35%).
Android composition, gynoid composition, and VAT
were available for 966/1053 participants (91.7%: 510
NUs, 255 PUs, and 201 CUs).
Characteristics of participants
Almost all participants were white (.98% for each
group). The three groups differed significantly in age:
66.8 6 6.3, 62.6 6 6.7, and 61.3 6 7.9 years for PUs,
CUs, and NUs, respectively (CUs vs NUs, P = 0.04; PUs vs
NUs, P , 0.001). Accordingly, all results were adjusted
for age. In the unadjusted analysis, there was a trend for
BMI differences with CUs , NUs , PUs: 24.9 6 4.1,
25.7 6 4.3, and 25.8.0 6 4.3 kg/m2, respectively (CUs vs
NUs, P = 0.052; CUs vs PUs, P = 0.049). Average MHT
duration was 12.2 6 8.8 years in CUs and 7.9 6 6.3 years
in PUs. The latter had an average of 8.5 6 5.8 years since
MHT withdrawal at study entry.
Association between MHT and measures of body fat, muscle mass, and strength
The age-adjusted values of body composition parameters
according to MHT status are presented in Table 1. CUs
exhibited significantly lower VAT values than NUs.
Similarly, a consistently significant advantage of CUs over
NUs was found for BMI, android FM, percentage of
subtotal FM, and FMI (P , 0.05). PUs showed no
advantage in comparison with NUs for all FM outcomes. We
did not detect any statistical benefit for the MHT groups
regarding LBM, sarcopenia indices, and handgrip strength.
On the contrary, there was a trend for lower LMI in the CUs
(CUs vs NUs, P = 0.05). The ratio ALM/BMI was the only
parameter for which CUs clearly exceeded both PUs and
NUs without reaching statistical significance.
We also performed a regression analysis of different
outcomes with age, stratified by MHT group (Table 2).
The slopes for 10-year increments were significantly
positive in NUs for BMI, subtotal FM, android FM, VAT,
and FMI while being flat for both CUs and PUs.
Betweengroup comparison confirmed a significant benefit for
both MHT groups (P for interaction , 0.05) for all the
aforementioned outcomes and percentage FM. The most
prominent difference was seen for VAT (P = 0.01). The
associations between BMI, subtotal FM, android FM,
and VAT with age are represented in Fig. 2. There was no
difference between groups for the slopes of LBM
outcomes, with a tendency for loss of muscle mass in all three
groups. When we selectively analyzed women aged ,60
years, no statistical differences persisted between groups.
Comparison of potential confounders between
In an attempt to explore potential confounders,
ageadjusted results between MHT groups are shown in
Table 3. No significant difference was detected for glucose,
insulin, and adipokine levels. Insulin resistance tended to
decrease in treatment groups: CUs , PUs , NUs.
Adiponectin was higher in PUs and CUs, and leptin levels were
lower in CUs (not significant for both parameters). Caloric
intake differed between groups but in favor of NUs (NUs ,
CUs , PUs; NUs vs PUs, P = 0.039). There was no difference
between groups in sedentary status, prevalence of
depression, or use of antidepressant medications at study entry.
Subgroup analysis according to MHT duration and time since MHT withdrawal
Table 4 shows the main outcomes of CUs according to
MHT duration and of PUs according to MHT duration and
time since MHT withdrawal. Three subgroups were
compared: 0 to 2, 2 to 5, and .5 years. There was no difference
between subgroups for any of the outcomes studied. Similar
results were noted when we repeated the analysis of PUs
between two groups of time since MHT discontinuation: ,5
years and .5 years. The effect of time since MHT
withdrawal was further explored by a hinge analysis, which did
not identify a reliable inflection point (data not shown).
MHT is associated with lower visceral adiposity
This cross-sectional analysis of the OsteoLaus cohort
demonstrated that active MHT use is associated with
significantly lower levels of VAT measured by DXA (Table 1,
Supplemental Fig. 1). The significant increase of VAT with
age in NUs was completely prevented in CUs, suggesting that
MHT slows down the age-associated increase of VAT.
These results are in agreement with a recent randomized
study in premenopausal women who experienced an
increase in VAT under GnRH-Ag (
), a phenotype reversed
by estrogen therapy.
Menopause is accompanied by changes in body
). Although menopause-associated bone
loss is reversed by MHT (16), the evidence for its effect
on FM is less consistent. Randomized controlled trials
have yielded mixed results, with some showing a slight
decrease in BMI and total FM with MHT (
whereas a subgroup analysis of the Women?s Health
Initiative (WHI) trial (26) did not detect a significant
advantage. Despite conflicting results about total FM,
most studies detected a reduction in central fat with
MHT, as indicated by reduced waist circumference (
decrease in DXA-measured trunk to leg fat ratio (
lower waist-to-hip ratio (
), reduced trunk FM
measured by whole-body computed tomography (
reduced DXA-measured android fat (
). Several small
studies have assessed the effect of MHT on VAT, as
reviewed by Santen et al. (
). The majority showed
reduced VAT, except for a randomized placebo-controlled
study in nonobese, early postmenopausal women (
that showed no benefit of MHT for intra-abdominal fat
(assessed by computed tomography at L4 to L5
vertebral disk level). This result was potentially attributed to
the continuous estrogen/progestin regimen used in
this study and an accompanying decrease in insulin
aP for interaction.
sensitivity, even though another prospective
nonrandomized study implementing a continuous MHT
regimen detected a benefit regarding android shift of fat
Current MHT users have lower BMI, FMI, and android fat
Our data also pointed out a slight but significant
superiority of CUs regarding lower BMI, android fat, and
Results are expressed as age-adjusted mean 6 SE or as percentages for sedentarity and depression prevalence. Between-group comparisons performed
with analysis of variance.
aThe exact sample size differs according to the parameter analyzed (glucose, n = 1048; insulin, n = 1046; HOMA-IR, n = 1046; leptin, n = 977; adiponectin,
n = 977; total caloric intake, n = 988; sedentarity index, n = 901; depression scale, n = 678).
bStatistical analysis performed on log-transformed data.
Results are expressed as adjusted mean 6 SE. Statistical analysis was performed with an analysis of variance model including age, BMI, duration of MHT,
and time since discontinuation.
FMI. Interestingly, all studies showing a significant
decrease in total or central adiposity recruited early
postmenopausal women (
25, 26, 28
), whereas differences
were less pronounced in older populations, as in the WHI
trial (average age .63 years). It is possible that the
beneficial effect of MHT on FM is more pronounced in
the early postmenopausal period and that age-mediated
changes overcome the MHT benefits later in life. Of note,
even in the studies showing significant benefits, the effect
size was small. The only published meta-analysis (
showed a significant reduction in waist circumference
and abdominal fat (measured by dual energy photon or
DXA) by 0.8% (5 trials) and 6.8% (4 trials), respectively.
MHT prevents the age-associated gain of body fat
The benefit of MHT was confirmed in the regression
analysis, which highlighted a clear divergence between
CUs and NUs regarding the association between age and
body fat parameters. Indeed, NUs had significantly larger
slopes for increase of BMI, subtotal and android FM, and
FMI. MHT prevented significantly the age-associated
increase of these parameters. This type of analysis
offers the benefit of a projection over time, going beyond
the limits of a simple cross-sectional analysis.
Potential confounders do not seem to explain the
MHT effect on FM
It remains controversial whether the beneficial effect of
MHT on FM is caused by a direct effect on adipocytes,
mediated by other hormones, or by modifying intermediary
factors such as nutrition or physical activity. In the
current study, CUs tended to be less sedentary (61.4%
vs 65.4% and 67.6% for NUs and PUs, respectively)
without reaching statistical significance. Caloric intake was
significantly higher in PUs than in NUs; CUs did not differ
from the other two groups. Despite findings of positive
correlations between E2 and leptin independently of body
fat in one study of premenopausal women (
levels did not differ significantly in our cohort after
adjustment for age and subtotal FM (data not shown). Finally,
no difference was found regarding the prevalence of
depression between groups.
Existing evidence on regulation of energy intake and
expenditure by estrogens has been recently reviewed by
Leeners et al. (
). Strong preclinical data support an
important role for estrogen in bioenergetics. Both OVX mice
and rats exhibited a marked reduction of spontaneous
physical activity and a decrease in resting energy
expenditure, whereas OVX rats developed an additional increase
in energy intake (
). The latter was not seen in OVX mice, in
line with our data in NUs. In menstruating women, resting
energy expenditure is higher in the midluteal phase, when
E2 is elevated; low in the early follicular phase, when E2 is
lower; and further reduced by GnRH-Ag (
). An indirect
effect via an increase in sedentarity was postulated by
Lovejoy et al. (
), who prospectively followed physical
activity annually by accelerometry in women going through
menopause and detected a decrease of 50% over 4 years.
The benefit of MHT on FM does not seem to persist after its withdrawal
Another interesting point of our study is the clear
absence of residual effect of MHT in PUs. PUs were
classified according to MHT duration and time since
MHT discontinuation; this analysis surprisingly showed
no residual effect in early discontinuers, unlike our results
regarding bone mineral density (
), suggesting a very
rapid rebound effect after MHT withdrawal. However,
the regression analysis detected significantly less steep
slopes in PUs than in NUs for multiple FM outcomes, a
result that deserves further exploration by a longitudinal
study. To the best of our knowledge, no other study has
specifically assessed body composition in PUs. Studies
with GnRH-Ag (
) have shown significant increases
in total and central adiposity as soon as 4 months after
estrogen withdrawal, consistent with our hypothesis of a
rapid rebound effect. The rapid response of FM to
external stimuli is also illustrated by the early increase in FM
(+21.3%) only 8 weeks after training cessation in elite
taekwondo athletes (37). The observed increase in caloric
intake of PUs in our study provides another possible
explanation for the rapid loss of FM benefits after MHT
withdrawal. It would be reasonable to suggest
confirmation of these results in the setting of a randomized trial
to eliminate contribution of a selection bias.
MHT does not have any detectable benefit on lean mass
We hypothesized that MHT leads to increased LBM,
which in turn would contribute to its favorable bone
effects via increased mechanical load. Strongly positive
correlations between LBM and bone mineral density,
previously demonstrated (
), support a potential
link. Surprisingly, we did not detect any benefit among
MHT users for LBM or muscle strength. These results
were confirmed even after we excluded women using
osteoporotic drugs other than MHT (n = 82, data not
shown), thus arguing against an intermediate role of
LBM in the MHT-mediated bone benefits.
Our results add to the conflicting evidence of available
studies with the only available meta-analysis (
showing a slight but significant increase (+3.3%) of LBM
in MHT users. One possible explanation might be the
type of MHT. Certain progestogens, such as the
norethisterone acetate used by Arabi et al. (
androgenic properties that could have an anabolic effect on
LBM. More importantly, the effect of MHT on LBM can
be selective for early postmenopausal women, weaning
off rapidly under the stronger effect of age. In favor of this
hypothesis, the WHI trial revealed that MHT
significantly delayed loss of LBM after 3 years (
Nevertheless, this relation was completely reversed between
year 3 and 6 of the study, with a slight decrease in LBM in
all groups at the end of year 6 (
), a finding also
confirmed in the subset of women with high compliance.
In our analysis, no LBM benefit was revealed when
we analyzed only data from younger postmenopausal
women (,60 years old). It is possible that this
timedependent effect is limited to a much shorter period
after menopause (e.g., up to 5 years), as suggested by the
studies discussed earlier (
Strengths and limitations
This study has several limitations. The cross-sectional
design is inevitably accompanied by a selection bias.
Information on the beginning and the end of MHT was
self-reported. This was also the case for the route of
administration (oral, transdermal, vaginal), the type of MHT
(estrogen-alone or estrogen/progestin), and the history of
hysterectomy, preventing us from reliably assessing these
factors. Furthermore, we were unable to verify
participants? adherence to MHT. Most participants were white,
limiting the generalizability of study?s conclusions to other
ethnicities. Our evaluation of confounding factors is
partial. The physical activity assessment was only rough.
We did not measure resting energy expenditure, which is a
potential target of estrogen treatment.
On the other hand, our study has considerable strengths
to be taken into account. The large sample of the OsteoLaus
cohort allows adequate statistical power. Body composition
assessment was performed with DXA and last-generation
software, which allowed reliable measurement of VAT,
differentiating it from subcutaneous adipose tissue (
This large, prospective study of postmenopausal women
has explored the effect of MHT on VAT by reliably
distinguishing it from other components of fat tissue.
In conclusion, current MHT use prevents the increase in
visceral adiposity. This finding may have important
cardiovascular, metabolic, and bone implications that should
be taken into account when assessing the benefit/risk ratio
for MHT prescription. Nevertheless, the effect size on BMI
and total FM is small, and MHT prescription cannot
substitute for other interventions such as physical activity.
Physicians should be aware that the benefit of MHT on body
composition might rapidly disappear after its withdrawal
and strongly encourage women to optimize nutrition and
increase physical activity when stopping MHT. Future
research via prospective and ideally randomized studies should
assess differences depending on type of MHT and route of
administration and on the evolution of body composition
after MHT withdrawal. It would also be interesting to
specifically investigate the effects of MHT on body
composition in populations with an ethnically diverse
composition and in early postmenopausal women.
The authors thank Marie Almudena Metzger, principal research
nurse of the OsteoLaus cohort, who contributed to the data
collection for this study.
Financial Support: The OsteoLaus study is supported by
research grants from Lausanne University Hospital (Centre
Hospitalier Universitaire Vaudois strategic plan funds) and the Swiss
National Science Foundation (grants 32473B_156978). The CoLaus
study is supported by research grants from GlaxoSmithKline, the
Faculty of Biology and Medicine of Lausanne, and the Swiss
National Science Foundation (Schweizerischer Nationalfonds
zur F o?rderung der Wissenschaftlichen Forschung, grants
33CSCO-122661, 33CS30-139468, and 33CS30-148401).
These funding sources had no involvement in the study design,
data collection, analysis and interpretation, writing of the
report, or decision to submit the article for publication.
Correspondence and Reprint Requests: Georgios
Papadakis, MD, Service of Endocrinology, Diabetes and
Metabolism, CHUV, Lausanne University Hospital, Avenue de
la Sallaz 8-10, CH-1011 Lausanne, Switzerland. E-mail:
Disclosure Summary: The authors have nothing to
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