Hormonal Shifts and Structural Strain: A Literature Review of Menopause and Perimenopause in Relation to Overuse Injuries and Stress Fractures
Abstract
Musculoskeletal injury risk in midlife women has traditionally been attributed to estrogen decline, but this narrow focus overlooks the broader biomechanical, neuromuscular, and structural changes associated with menopause. Estrogen plays a multisystem role in maintaining trabecular bone integrity, collagen turnover, and neuromuscular coordination. Its abrupt loss causes bone demineralization (2%-5% annually in early menopause), impairs tendon repair, and contributes to sarcopenia. Fluctuating estradiol levels during perimenopause may transiently increase ligament laxity, further destabilizing joints. Common injuries such as Achilles and rotator cuff tendinopathies, plantar fasciitis, and stress fractures are amplified by low bone mineral density, prior fracture history, aromatase inhibitor use, and rapid increases in physical activity. Although early initiation of hormone replacement therapy reduces fracture risk by 20%-40%, it is not appropriate for all patients due to contraindications and individualized risk-benefit profiles. Non-hormonal strategies-including resistance training, nutritional optimization, and early screening with dual-energy X-ray absorptiometry and peripheral quantitative computed tomography-remain underutilized, particularly among marginalized populations. This structured narrative review synthesizes evidence from endocrinology, biomechanics, and musculoskeletal epidemiology to evaluate limitations in current research, including reliance on…
Read the paper
Related studies
- Effectiveness of Bisphosphonates and Denosumab on Risk of Vertebral Fractures in Prostate Cancer Patients Under Androgen Deprivation Therapies: A Real-World Prospective Study
- Osteoporosis-related fractures after spinal cord injury: a retrospective study from Brazil
- Serum 25-hydroxyvitamin D, parathyroid hormone, and mortality in older men
- Lack of Association between Vitamin D Insufficiency and Cardiovascular or Fracture Risk: A UK Biobank Study
- Muscle strength and body composition are clinical indicators of osteoporosis
- Incidence of bone protection and associated fragility injuries in patients with proximal femur fractures
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.