Abstract
Introduction
Bone density is lower in postmenopausal than in premenopausal women. Recent findings
have suggested that accelerated bone loss already begins before menopause. Despite
numerous cross-sectional studies on menopause-related bone density, longitudinal data
on perimenopausal bone density changes are scarce. This study sought to characterize
the dynamics of changes leading to postmenopausal osteopenia and to possibly find
the time point at which accelarated bone loss begins.
Methods
We prospectively followed 34 pre-, peri- and early postmenopausal women without prior
external hormone use, measuring their lumbar spine trabecular bone density with quantitative
computer tomography at 0, 2 and 6 years. The analysis of the changes over time was
done in a tri-parted fashion, since menopausal status changed variably for individual
subjects: we grouped the participants according to their currently valid menopausal
classification for prospective (baseline classification), interim (2 years) and retrospective
(6-year classification) analysis.
Results
Six different patterns of menopausal transition were identified in our sample. Bone
loss in the groups not reaching postmenopause during 6 years of observation was >50%
of the maximum bone loss observed during the study period.
Invariably for all analyses, the perimenopausal phase with estrogen levels still adequate
was associated with the greatest reduction of trabecular bone mineral density, reaching
6.3% loss annually in the lumbar spine. By comparison, the average rate of loss was
slower in the early postmenopause; total bone loss differed by pattern of menopausal
transition (one-way ANOVA p < 0.05).
Conclusion
The presented data for the first time show the perimenopausal course of trabecular
bone loss (as measured by QCT of the lumbar spine). Acceleration of bone loss during
perimenopause reached half-maximal values of the total bone loss measured around menopause,
despite adequate serum estradiol levels.
Keywords
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Article info
Publication history
Accepted:
April 26,
2006
Received in revised form:
April 22,
2006
Received:
November 11,
2005
Identification
Copyright
© 2006 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
