In the Journals

Bone changes during menopause transition may signal future fracture risk

Albert Shieh

Faster increases in bone turnover during the menopause transition and greater bone turnover during early postmenopause are risk factors for fracture, even among women with relatively preserved bone mineral density, according to findings published in The Journal of Clinical Endocrinology & Metabolism.

“The rapid increase in bone turnover during the menopause transition when women are still in their late 40s and early 50s can have a lasting, detrimental effect on bone strength,” Albert Shieh, MD, MS, assistant professor in the department of medicine at the David Geffen School of Medicine at University of California, Los Angeles, told Healio. “We usually do not think about screening for osteoporosis until women are aged 65 years and older. This study suggests that, in a subset of women, the menopause transition may represent an early window of opportunity to intervene to prevent the rapid increase in bone turnover and its associated loss of bone mineral density and bone strength.”

Shieh and colleagues analyzed data from 484 women who were premenopausal or early perimenopausal at baseline and participating in the Study of Women’s Health Across the Nation, a longitudinal cohort study of the menopause transition (42.2% white; 16.9% black; 17.6% Asian). Researchers assessed bone turnover via urinary N-telopeptide of type I collagen (U-NTX), BMD at the lumbar spine and femoral neck measured via DXA, and self-reported fracture data.

Using Cox proportional hazard models, researchers examined whether a faster increase in bone turnover during the menopause transition, defined as the 4-year period starting 2 years before the final menstrual period and ending 2 years after the final menstrual period, was associated with greater risk for incident fracture after menopause. The rate of increase in bone turnover during the menopause transition was calculated as the total increase in U-NTX from the last visit before the menopause transition to the first visit after the menopause transition, divided by the number of years spanning the menopause transition.

Osteoporosis consult 2019.  
Faster increases in bone turnover during the menopause transition and greater bone turnover during early postmenopause are risk factors for fracture, even among women with relatively preserved bone mineral density.
Source: Adobe Stock

Within the cohort, 5.6% of women reported sustaining a fracture before menopause, all occurring at least 1 year before the start of the menopause transition. Researchers recorded 65 incident fractures after the early postmenopausal visit (58.5% minimum trauma).

Researchers found that each standard deviation increment in the rate of increase in bone turnover during the menopause transition was associated with a 24% greater risk for incident fracture after menopause (P = .008), with results persisting after adjustment for age, race, prior fracture, smoking status, BMI and study site.

Additionally, each standard deviation increment in bone turnover early after menopause was associated with a 27% greater risk for fracture (P = .01). Results persisted in analyses adjusting for menopause transition rate of change and early postmenopausal BMD.

The researchers wrote that the findings extend prior work to link the rate of increase in bone turnover during the menopause transition and bone turnover early after menopause to subsequent fracture.

“We still need to determine how to predict who will have the fastest increases in bone turnover during the menopause transition, and how to best prevent those increases,” Shieh said. – by Regina Schaffer

For more information:

Albert Shieh, MD, MS, can be reached at UCLA Division of Geriatrics, 10945 Le Conte Ave., Suites 2339-2345, Los Angeles, CA 90095; email: asheih@mednet.ucla.edu.

Disclosures: The authors report no relevant financial disclosures.

Albert Shieh

Faster increases in bone turnover during the menopause transition and greater bone turnover during early postmenopause are risk factors for fracture, even among women with relatively preserved bone mineral density, according to findings published in The Journal of Clinical Endocrinology & Metabolism.

“The rapid increase in bone turnover during the menopause transition when women are still in their late 40s and early 50s can have a lasting, detrimental effect on bone strength,” Albert Shieh, MD, MS, assistant professor in the department of medicine at the David Geffen School of Medicine at University of California, Los Angeles, told Healio. “We usually do not think about screening for osteoporosis until women are aged 65 years and older. This study suggests that, in a subset of women, the menopause transition may represent an early window of opportunity to intervene to prevent the rapid increase in bone turnover and its associated loss of bone mineral density and bone strength.”

Shieh and colleagues analyzed data from 484 women who were premenopausal or early perimenopausal at baseline and participating in the Study of Women’s Health Across the Nation, a longitudinal cohort study of the menopause transition (42.2% white; 16.9% black; 17.6% Asian). Researchers assessed bone turnover via urinary N-telopeptide of type I collagen (U-NTX), BMD at the lumbar spine and femoral neck measured via DXA, and self-reported fracture data.

Using Cox proportional hazard models, researchers examined whether a faster increase in bone turnover during the menopause transition, defined as the 4-year period starting 2 years before the final menstrual period and ending 2 years after the final menstrual period, was associated with greater risk for incident fracture after menopause. The rate of increase in bone turnover during the menopause transition was calculated as the total increase in U-NTX from the last visit before the menopause transition to the first visit after the menopause transition, divided by the number of years spanning the menopause transition.

Osteoporosis consult 2019.  
Faster increases in bone turnover during the menopause transition and greater bone turnover during early postmenopause are risk factors for fracture, even among women with relatively preserved bone mineral density.
Source: Adobe Stock

Within the cohort, 5.6% of women reported sustaining a fracture before menopause, all occurring at least 1 year before the start of the menopause transition. Researchers recorded 65 incident fractures after the early postmenopausal visit (58.5% minimum trauma).

Researchers found that each standard deviation increment in the rate of increase in bone turnover during the menopause transition was associated with a 24% greater risk for incident fracture after menopause (P = .008), with results persisting after adjustment for age, race, prior fracture, smoking status, BMI and study site.

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Additionally, each standard deviation increment in bone turnover early after menopause was associated with a 27% greater risk for fracture (P = .01). Results persisted in analyses adjusting for menopause transition rate of change and early postmenopausal BMD.

The researchers wrote that the findings extend prior work to link the rate of increase in bone turnover during the menopause transition and bone turnover early after menopause to subsequent fracture.

“We still need to determine how to predict who will have the fastest increases in bone turnover during the menopause transition, and how to best prevent those increases,” Shieh said. – by Regina Schaffer

For more information:

Albert Shieh, MD, MS, can be reached at UCLA Division of Geriatrics, 10945 Le Conte Ave., Suites 2339-2345, Los Angeles, CA 90095; email: asheih@mednet.ucla.edu.

Disclosures: The authors report no relevant financial disclosures.