MedPage Today. January 2013
By Kristina Fiore, Staff Writer, MedPage Today
Explain that for early menopausal women, more wrinkles was associated with lower bone mineral density.
Note that having more glabellar wrinkles on the forehead was related to lower bone density at the femoral neck, while increasing skin rigidity at the face and the forehead was tied to stronger bones at the hip and spine.
BOSTON -- A woman's worry lines could make her clinician fret about her bone health, researchers said here.
In a cross-sectional analysis, having more wrinkles was associated with having lower bone mineral density (BMD; P<0.01), Lubna Pal, MBBS, of Yale, and colleagues reported during a press briefing at The Endocrine Society meeting.
"For the older patient, her bigger concern is what is happening to her skin. The clinician's concern is what is happening to her bones," Pal said. "Our question was, can we fine-tune the patient concern to get a sense of the bone issues?"
Pal explained that there are many shared mechanisms in skin and bone health. For instance, collagen, which is more closely associated with skin health, is also important for bones.
Currently, dual x-ray absorptiometry (DXA) scanning is the gold standard for monitoring osteoporosis risk, Pal said, adding that researchers are currently looking for cost-effective markers that will enhance risk detection, and reduce poor outcomes such as fractures.
So she and her colleagues looked at data from the Kronos Early Estrogen Prevention Study (KEEPS), which assessed the efficacy of hormone therapy among early menopausal women.
A total of 114 of those patients also participated in a skin ancillary study that assessed skin wrinkling and rigidity as well as BMD. Skin wrinkles were assessed at 11 sites on the face and neck using the Lemperle wrinkle scale, while skin rigidity was evaluated at the forehead and cheek using a durometer.
Each woman had her BMD assessed via DXA scan at the lumbar spine, hip, and total body.
The researchers conducted a cross-sectional analysis of baseline data, and found that more skin wrinkling was associated with having lower bone density at the spine, femoral neck, and total body (P<0.01 for all).
Conversely, greater skin rigidity was tied to greater BMD at those locations (P<0.001).
Pal and colleagues also found that having more glabellar wrinkles on the forehead was related to lower bone density at the femoral neck (P=0.033), while increasing skin rigidity at the face and the forehead was tied to stronger bones at the hip and spine (P<0.001).
She called it a "tantalizing association," but said the question remains as to whether the association has relevance over time. For instance, are women with deeper wrinkles losing BMD at a faster rate than those with smooth skin?, she said.
Similarly, it would be worth investigating if estrogen therapy can retard the progression of wrinkles, and decrease the pace of bone loss, she said.
Pal noted the study's results could not be generalized because only 13% of the study population was classified as being in a minority group.
Press briefing moderator Judith Turgeon, PhD, of the University of California Davis, said that having such a simple screening tool would be a helpful option, especially as debate rages in Washington D.C., over reimbursement rates for preventive DXA scans.
She said if this screening tool proves viable, its cost effectiveness is especially appealing. "The cost of a fracture would far outweigh the cost of a screen like this," she told MedPage Today.