Exercise Intervention: Multiple guidelines recommend resistance training as the core strategy for treating SO. Studies in postmenopausal women confirm that regular resistance training can significantly improve muscle strength and body composition, including increasing lean body mass and reducing fat percentage, in a safe and feasible manner.
Nutritional Intervention: According to the ESPEN (European Society for Clinical Nutrition and Metabolism) guidelines on geriatric nutrition, postmenopausal women should have a daily protein intake of ≥ 1.2 g/kg body weight. Protein should be distributed across three meals, with each meal preferably containing ≥ 25–30 g of high-quality protein rich in leucine. Creatine supplementation combined with resistance training can significantly increase muscle strength (+10%–15%) and lean body mass, with more pronounced effects under low estrogen conditions.
Hormone Therapy: Systematic reviews show that low-dose hormone replacement therapy (HRT) slightly improves muscle metabolism, but no significant benefits in muscle strength have been observed in long-term follow-up. Therefore, HRT is not recommended for the primary indication of “increasing muscle mass” and should still follow evidence-based indications for menopausal symptoms and bone health.
Emerging Drugs: In drug development, losartan, an angiotensin II receptor blocker, has shown potential in reducing muscle fibrosis and improving muscle remodeling in animal models, although large-scale clinical studies are lacking. On the other hand, selective androgen receptor modulators (SARMs, such as MK-0773) have been found to increase lean body mass in older women with sarcopenia in research, without significantly improving muscle strength or physical function, indicating therapeutic promise.
Resistance training and high-quality protein intake represent the most evidence-based interventions for postmenopausal SO. Currently, no drugs are approved for the treatment of postmenopausal sarcopenic obesity, but several promising emerging therapies are under investigation. With further research, more precise diagnostic systems and more effective intervention regimens are expected to be established, providing comprehensive support for the prevention and treatment of SO in postmenopausal women.