Estradiol and Follicle-Stimulating Hormone as Predictors of Onset of Menopause Transition-Related Bone Loss in Pre- and Perimenopausal Women - PubMed (original) (raw)

Multicenter Study

. 2019 Dec;34(12):2246-2253.

doi: 10.1002/jbmr.3856. Epub 2019 Oct 24.

Affiliations

Multicenter Study

Estradiol and Follicle-Stimulating Hormone as Predictors of Onset of Menopause Transition-Related Bone Loss in Pre- and Perimenopausal Women

Albert Shieh et al. J Bone Miner Res. 2019 Dec.

Abstract

The menopause transition (MT) may be an opportunity for early intervention to prevent rapid bone loss. To intervene early, we need to be able to prospectively identify pre- and perimenopausal women who are beginning to lose bone. This study examined whether estradiol (E2), or follicle-stimulating hormone (FSH), measured in pre- and perimenopausal women, can predict significant bone loss by the next year. Bone loss was considered significant if bone mineral density (BMD) decline at the lumbar spine (LS) or femoral neck (FN) from a pre- or early perimenopausal baseline to 1 year after the E2 or FSH measurement was greater than the least detectable change. We used data from 1559 participants in the Study of Women's Health Across the Nation and tested E2 and FSH as separate predictors using repeated measures modified Poisson regression. Adjusted for MT stage, age, race/ethnicity, and body mass index, women with lower E2 (and higher FSH) were more likely to lose BMD: At the LS, each halving of E2 and each doubling of FSH were associated with 10% and 39% greater risk of significant bone loss, respectively (p < 0.0001 for each). At the FN, each halving of E2 and each doubling of FSH were associated with 12% (p = 0.01) and 27% (p < 0.001) greater risk of significant bone loss. FSH was more informative than E2 (assessed by the area under the receiver-operator curve) at identifying women who were more versus less likely to begin losing bone, especially at the LS. Prediction was better when hormones were measured in pre- or early perimenopause than in late perimenopause. Tracking within-individual change in either hormone did not predict onset of bone loss better than a single measure. We conclude that measuring FSH in the MT can help prospectively identify women with imminent or ongoing bone loss at the LS. © 2019 American Society for Bone and Mineral Research.

Keywords: DXA; ESTRADIOL; FOLLICLE-STIMULATING HORMONE; GENERAL POPULATION STUDIES; MENOPAUSE.

© 2019 American Society for Bone and Mineral Research.

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Conflict of interest statement

DISCLOSURE STATEMENT

AS, GAG, JAC, CKG, CC and ASK have nothing to disclose.

Figures

Figure 1.

Figure 1.. Analysis sample derivation.

This flow chart shows the derivation of the analysis sample. In order to be included in the study, participants needed to meet the following criteria: 1) be from a SWAN Bone site; 2) have at least 2 E2 or FSH measurements, the first of which was obtained during the early follicular phase (EFP) of the menstrual cycle; and 3) have at least 1 follow-up visit before postmenopause, around which significant bone loss could be assessed.

Figure 2.

Figure 2.. Visual representation of analyses.

Analyses included 1,559 women from whom there were a total of 3,618 follow-up visits (starting from the first follow-up visit to the last follow-up before the clinical diagnosis of postmenopause could be made). (A) The first set of analyses examined whether

single

measures of E2 or FSH could predict imminent MT-related bone loss. The primary predictors were E2 or FSH (tested in separate models) measured at each follow-up visit N. The dependent variable was significant bone loss (categorical outcome, yes vs. no) from SWAN baseline to follow-up visit N+1. Significant bone loss was defined as an annualized rate of decrease in BMD that was greater than the site-specific (LS vs. FN) least specific change. (B) The second set of analyses examined whether

within-individual change

in E2 or FSH could predict imminent MT-related bone loss. The primary predictors were within individual change in E2 or FSH (tested in separate models) from SWAN baseline to each follow-up visit N. The dependent variable was significant bone loss (categorical outcome, yes vs. no) from SWAN baseline to follow-up visit N+1.

References

    1. Greendale G, Sowers M, Han W, Huang M, Finkelstein J, Crandall C, et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: Results from the Study of Women’s Health Across the Nation (SWAN). J Bone Miner Res. 2012;27(1):111–8. -PMC -PubMed
    1. Recker R, Lappe J, Davies K, Heaney R. Bone remodeling increases substantially in the years after menopause and remains increased in older osteoporosis patients J Bone Miner Res. 2004;19(10):1628–33. -PubMed
    1. Akhter M, Lappe J, Davies K, Recker R. Transmenopausal changes in the trabecular bone structure. Bone. 2007;41(1):111–6. -PubMed
    1. Cooper D, Thomas C, Clement J, Turinsky A, Sensen C, Hallgrímsson B. Age-dependent change in the 3D structure of cortical porosity at the human femoral midshaft. Bone. 2007;40(4):957–65. -PubMed
    1. Berger C, Langsetmo L, Joseph L, Hanley D, Davison K, Josse R, et al. Association between change in BMD and fragility fracture in women and men. J Bone Miner Res. 2009;24(2):361–70. -PMC -PubMed

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