As women age, changes in hormones affect muscle strength, joint laxity and bone density making them more susceptible to conditions such as osteoporosis, tendon and ligament injuries (Cauley, 2015 ; Chidi-Ogbolu and Baar, 2019) and hip and vertebral fractures (Cauley, 2015). It has been reported women lose more of their strength in their 5th decade as a result of menopause (Cauley, 2015; Leblanc et al., 2017).

Power has been reported to be significantly more valuable than loss of muscle strength (Maltais, Desroches and Dionne, 2009). Power enables us in old age to continue with normal daily living activities and supports the loss of balance and reduces risk and occurrences of falls (Maltais, Desroches and Dionne, 2009). This report will investigate the factors influencing loss of strength and power on the musculoskeletal system from the effects of menopause.

This review paper will focus on age related changes to musculoskeletal health of females from a clinical biomechanical perspective, with a specific focus on the impact of hormonal changes due to menopause. The review paper will discuss the effects of estrogen and other steroid hormones on bone mineral density (BMD) and the mechanism of muscle tendon unit (MTU) stiffness and their influence on increase risk to injury.

Changes in BMD and MTU composition during and after menopause

Estrogen regulates bone metabolism and turnover, during menopause the loss of ovarian estrogen is strongly connected to the decline in BMD (Cauley, 2015). The loss of estrogen increases the risk of hip and vertebral fractures in older women (Cauley, 2015). With the decline in BMD occurrences of falls, joint pain, stiffness and reduced power negatively influence daily living activities (Faria et al., 2010).