Perimenopausal women with higher baseline levels of serum bone turnover markers and a lower trabecular bone score are at increased risk for presenting with osteopenia or osteoporosis at 5-year follow-up, according to findings published in Clinical Endocrinology.
“Our data suggest that increased bone turnover at the beginning of transmenopause induces a higher rate of bone loss and therefore an increased risk of osteoporosis in the coming years,” Gala Gutierrez-Buey, MD, of the department of endocrinology at Clínica Universidad de Navarra in Pamplona, Spain, and colleagues wrote. “This may be of use in identifying women who are likely to lose more bone mass over the transmenopause.”
Gutierrez-Buey and colleagues analyzed data from 64 healthy, premenopausal white women enrolled in a prospective, longitudinal study (mean age, 49 years) who were not prescribed hormone therapy. At baseline and 5-year follow-up, researchers assessed bone mineral density measurements of the lumbar spine, total hip and femoral neck via DXA and trabecular bone score, as well as levels of the bone turnover markers serum osteocalcin, C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP). Researchers used receiver operating curve analysis to determine the diagnostic performance of bone remodeling markers for predicting osteoporosis and multivariable logistic regression analysis to assess the relationship between bone metabolism markers and osteoporosis.
At 5 years, five women remained premenopausal, 15 were perimenopausal and 44 were menopausal (mean age at menopause, 52 years).
At baseline, all women presented with BMD levels within the expected range for age. At follow-up, 23 women had normal BMD, 37 had low bone mass and four had osteoporosis.
Women with osteopenia or osteoporosis at follow-up had higher CTX and P1NP levels at baseline vs. women with normal BMD at follow-up, according to the researchers.
Perimenopausal women with higher baseline levels of serum bone turnover markers and a lower trabecular bone score are at increased risk for presenting with osteopenia or osteoporosis at 5-year follow-up.
The areas under the curve for the prediction of low bone mass or osteoporosis were 0.69 (P = .011) for P1NP, 0.69 for CTX (P = .013) and 0.77 (P = .001) for osteocalcin.
“Importantly, a significant reverse correlation was found between P1NP increase after 5 years and the decrease in lumbar bone density (P = .002),” the researchers wrote.
At baseline, seven women (10.9%) had deteriorated microarchitecture reflected in a trabecular bone score of less than 1.3, according to researchers.
Four women reported low-trauma fractures at follow-up; two of the women had osteopenia and two had osteoporosis, according to researchers. These women had higher levels of P1NP, CTX and sclerostin at baseline vs. women who did not sustain fractures.
“Interestingly, two of the four participants who had low-trauma fractures at follow-up had normal bone densitometry but pathological [trabecular bone score] (< 1.3) at the time of enrollment,” the researchers wrote.
The researchers noted that due to the short follow-up time, there was a low incidence of osteoporosis and fractures reported, and larger, longer studies will be needed to determine the optimal bone turnover marker combination and thresholds to identify women at risk for rapid bone loss. – by Regina Schaffer
Disclosures: Roche Diagnostics provided a grant for this study. The authors report no relevant financial disclosures.