Follicle-stimulating hormone may predict bone loss in premenopausal women
A one-time measurement of follicle-stimulating hormone during pre- or perimenopause may serve as an independent predictor of imminent bone loss, particularly at the lumbar spine, during the menopause transition, according to findings published in the Journal of Bone and Mineral Research.
“Measuring serum follicle-stimulating hormone (FSH) in women in their late 40s may help us forecast who will lose significant bone by the next year — before that bone loss occurs,” 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 Endocrine Today. “Our overarching goal is to determine if preventing menopause transition-related bone loss can help prevent osteoporosis and fractures in later life. The menopause transition may be an opportune time for early prevention because some women lose more than 10% of their total bone mass during a very short period of time.”
Shieh and colleagues analyzed data from 1,559 women participating in the Study of Women’s Health Across the Nation (SWAN), initiated in 1996 when participants were aged 42 to 52 years and premenopausal or perimenopausal (50% white; 58% premenopausal at baseline). Researchers measured estradiol, FSH and bone mineral density via DXA (lumbar spine and femoral neck) at baseline and at each follow-up visit (total 3,618 follow-up visits after baseline and before first postmenopausal visit). Modified Poisson regression was used to assess whether a one-time measurement of estradiol or FSH could predict imminent bone loss by the next year.
Researchers observed that median estradiol levels were similar during premenopause and early perimenopause (median, 40.1 pg/mL and 44.9 pg/mL, respectively) but fell during late perimenopause (median, 21.7 pg/mL). Median FSH levels were also similar during premenopause and early perimenopause (median, 15.5 mIU/mL and 18.9 mIU/mL, respectively) but rose during late perimenopause (median, 83.6 mIU/mL).
After adjustments for menopause stage, age, race and BMI, women with lower estradiol and higher FSH were more likely to lose BMD. At the lumbar spine, each halving of estradiol and each doubling of FSH were associated with 10% and 39% greater risk, respectively, for significant bone loss (P < .0001 for both). At the femoral neck, each halving of estradiol and each doubling of FSH were associated with 12% (P = .01) and 27% (P < .001) greater risk for significant bone loss.
The researchers also found that greater within-individual declines in estradiol and greater increases in FSH were associated with a greater risk for imminent bone loss at the lumber spine, but not at the femoral neck, with results persisting after adjustment for menopausal stage. FSH was more informative than estradiol (assessed by the area under the receiver-operator curve) at identifying women who were more vs. less likely to begin losing bone, especially at the lumbar spine, according to the researchers.
In analyses stratified by menopausal stage, researchers found that predictions were better earlier in the menopausal transition.
The researchers noted that FSH may offer superior prediction of bone loss because it is a better marker of average estrogen-mediated bioactivity vs. estradiol.
“To answer this question, we have two principal research steps,” Shieh said. “The first is to forecast who will lose the most bone during the menopause transition before that bone loss occurs. This study suggests that measuring FSH could be helpful for this purpose. Once we can predict who will lose the most bone, step two is to test whether it is possible to prevent this bone loss from occurring, and whether doing so prevents osteoporosis and fractures in the future.” – 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: firstname.lastname@example.org.
Disclosures: The authors report no relevant financial disclosures.