Bone Health During the Menopause Transition and Beyond

Abstract

The menopause transition is a critical period for bone health, with rapid losses in bone mass and strength occurring in a 3-year window bracketing the date of the final menstrual period. Declines in bone mass are accompanied by deleterious changes in bone macrostructure and microarchitecture, which may be captured by changes in composite strength indices and indices of trabecular thickness and connectivity. The onset of the rapid bone loss phase is preceded by changes in sex steroid hormones and increases in markers of bone resorption, measurements of which may be clinically useful in predicting the onset of the rapid loss phase and in identifying the women who will lose the most bone strength over the menopause transition.

Keywords: Bone loss trajectories; Bone strength; Bone turnover markers; Fracture; Osteoporosis; Perimenopause; Race/ethnicity differences; Transmenopausal bone loss.

Copyright © 2018 Elsevier Inc. All rights reserved.

Figures

Figure 1:

Schematic depiction of the trajectories of sex steroid hormones (estradiol (blue) and follicular stimulating hormone (green)), bone resorption marker urinary N-telopeptide (U-NTX) (red), and bone mineral density (black) over the menopause transition. Rapid bone loss occurs during transmenopause, a period that lasts from 1 year before to 2 years after the final menstrual period (FMP). Changes in hormone levels and in U-NTX start about 1 year before the transmenopause. Courtesy of A. Shieh, MD, Los Angeles, CA.