Preprint · May 21, 2026
Crude Cross-sectional Associations of Muscle Mass and Muscle Strength with Areal and Volumetric Bone Mineral Density and Bone Mineral Content in Older Adults and Postmenopausal Women: A Multilevel Systematic Review and Meta-analysis
By zuo R, Wang D, Tian H et al.
This project is a systematic review and meta-analysis examining the relationship between muscle mass, muscle strength, and bone density in older adults and postmenopausal women. Aging and menopause are both associated with progressive declines in skeletal muscle and bone health, which may increase the risk of sarcopenia, osteoporosis, falls, fractures, and functional impairment. Because muscle and bone are functionally connected through mechanical loading, endocrine regulation, and shared aging-related pathways, understanding the association between muscle-related indicators and bone density is important for identifying populations at risk and informing prevention strategies. The purpose of this review is to systematically identify, appraise, and synthesize observational evidence on whether muscle mass and muscle strength are associated with bone mineral density and other bone health outcomes in older adults and postmenopausal women. Muscle-related exposures will include indicators such as appendicular skeletal muscle mass, appendicular lean mass, skeletal muscle index, handgrip strength, knee extension strength, and other objective measures of muscle strength or muscle mass. Bone-related outcomes will include bone mineral density, bone mineral content, bone mass, osteoporosis, osteopenia, T-score, Z-score, trabecular bone score, and other relevant skeletal health indicators. Eligible studies will primarily include cross-sectional and cohort studies involving older adults and/or postmenopausal women. Data will be extracted on study characteristics, participant characteristics, muscle and bone measurement methods, skeletal sites, association estimates, adjustment variables, and methodological quality. Where sufficient comparable data is available, random-effects meta-analyses will be conducted. Associations will be synthesized separately according to exposure type, bone outcome, skeletal site, population group, and effect measure. Subgroup and sensitivity analyses may be conducted to explore heterogeneity by study design, sex, menopausal status, ethnicity, bone site, muscle indicator, measurement method, and adjustment level. The expected outcome of this project is a comprehensive synthesis of the current evidence on the muscle–bone relationship in aging and postmenopausal populations. The review is expected to clarify whether muscle mass and muscle strength are positively associated with bone density, whether one muscle-related indicator shows a stronger or more consistent relationship with bone outcomes, and whether these associations differ across skeletal sites or population subgroups. The findings may help inform future research, clinical screening, and prevention strategies targeting osteoporosis, sarcopenia, and musculoskeletal decline in older adults and postmenopausal women.