Unprecedented clinical tests showed that the severity of a woman's face/neck wrinkles during early menopause reflects her bone density.
“In postmenopausal women the appearance of the skin may offer a glimpse of the skeletal well-being, a relationship not previously described,” said lead author Lubna Pal, M.D., an associate professor at Yale University School of Medicine.
The study demonstrates only an association between bone density and skin wrinkling, stressed Dr. Pal.
But as described in our sidebar see “Skin, bones, and omega-3s”, below these two kinds of connective tissue share key characteristics that support the plausibility of wrinkle-bone links.
And as Dr. Pal said, “This information may allow for the possibility of identifying postmenopausal women at fracture risk at a glance, without dependence on costly tests.”
Dr. Pal's findings apply only to wrinkle severity during early menopause, and the power of wrinkles to predict bone density would be weakened by skin-aging factors like smoking and sun exposure.
Also, since facial wrinkles increase naturally over time, the usefulness of using them to predict bone density at a glance probably lessens as menopause recedes further into a woman's past.
Let's take a closer look at these remarkable, promising results, presented earlier this month at The Endocrine Society's 93rd Annual Meeting in Boston.
Study ties bone strength to skin smoothness
The study was part of an ongoing trial called the Kronos Early Estrogen Prevention Study, or KEEPS.
Skin, bones, and omega-3s
A growing body of evidence indicates that omega-3s are essential to bone health.
For more on this subject, see the “Omega-3s & Bone Health” section of our news archive.
At the same time, bestselling dermatologist Nicholas Perricone, M.D., has long championed omega-3s (and wild salmon) as anti-inflammatory allies to reduction of wrinkles … an approach embodied in his “Nutritional Facelift”.
While the study we report today does not involve omega-3s, the authors propose that collagen may be part of the link they found between bones and wrinkles.
And inflammation causes collagen “cross-linking”, which is a clear cause of both wrinkles and inflexible, inflammation-prone connective tissue.
In 2005, we reported an animal study that pointed to inflammation as a bone risk factor. (See “Omega-3s Seen as Stellar Bone-Builders”)
At the time, lead author Dr. Mark Seifert noted that the anti-inflammatory effects of omega-3s could explain their bone benefits.
Commenting on Seifert's study, Dr. Bruce Watkins of Purdue University made a key observation:
“Our lab and others have shown that omega-3 fatty acids help promote bone formation. We also have shown that higher intakes of omega-6 fatty acids lead to an increased production of compounds associated with bone loss.”
As we wrote then, “The obvious conclusion is that you can help protect against fractures in later life by favoring foods high in omega-3s, and cutting back on processed foods and standard vegetable oils that are high in omega-6s [corn, soy, cottonseed, and regular safflower or sunflower oil]”.
Better choices include olive, walnut, hemp, canola, and macadamia nut oils, as well as the “hi-oleic” versions of safflower and sunflower oils.
The new research doesn't address possible nutritional connections between deeper skin wrinkles and lower bone density.
But it seems that low omega-3 intake and high omega-6 intake is a risk factor for both conditions … a research avenue worth pursuing.
It included 114 women in their late 40s and early 50s who'd had their last menstrual period within the past three years and who were not taking hormone therapy. (Women were excluded from participating if they had undergone any cosmetic skin procedures.)
The women's wrinkles were measured at 11 sites on their face and neck, and each participant received a score based on the number of sites with wrinkles and the depth of the wrinkles.
The skin firmness or rigidity was measured at the forehead and the cheek with a device called a durometer. Study participants also underwent measurement of bone density by dual X-ray absorptiometry (DEXA) and by a portable heel ultrasound device.
The investigators found a significant inverse correlation between the wrinkle score and the bone density, meaning the higher the score (and the worse the wrinkles), the lower the bone density.
This relationship was evident in all skeletal areas – hip, lumbar spine and heel – and was independent of age, body composition, or other factors known to influence bone density.
As one might expect from the link between severe wrinkling and low bone density, having firmer skin of the face and forehead was associated with greater bone density.
As the authors concluded, “In a population of early postmenopausal women, study of the skin is observed to provide a glimpse into the status of the skeleton, a relationship not previously described.”
Wrinkle-bone connection could be collagen-related
Although the connection between bones and skin may seem unclear, Pal explained that they share common building blocks … the group of connective-tissue proteins known as collagens.
As we age, changes in collagen occur that account for age-related skin changes including worsening skin wrinkles and sagging skin … and also contribute to declines in bone quality and quantity.
The authors say that long-term studies are needed to substantiate a relationship between wrinkles and the risk of bone fracture.
“Ultimately, we want to know if intensity of skin wrinkles can allow identification of women who are more likely to fracture a bone, especially the femoral neck or the hip, an often fatal injury in older people,” said Dr. Pal.
And as she said, her team's findings hold serious implications for revealing women's bone health while curbing the rise in health care costs tied to pricey bone-scan technology:

“If this is the case, then including the study of skin wrinkles to other clinical risk factors may allow identification of fracture risk in populations that do not have access to more costly technology” (ES 2011).
  • Pal L et al. [P3-126] Skin Wrinkling and Rigidity Are Predictive of Bone Mineral Density in Early Postmenopausal Women. Monday, June 6, 2011, 1:30 pm. ENDO 2011 - Endocrine Society 93rd Annual Meeting in Boston. Accessed at http://www.abstracts2view.com/endo/view.php?nu=ENDO11L_P3-126
  • The Endocrine Society. Severity of facial wrinkles may predict bone density in early menopause. June 4, 2011. Accessed at http://www.eurekalert.org/pub_releases/2011-06/tes-sof060311.php